Effectiveness of music on anxiety and pain among cardiac surgery patients: A quantitative systematic review and meta-analysis of randomized controlled trials

Effect of listening to music on anxiety, pain, and cardiorespiratory parameters in cardiac surgery: A randomized clinical trial

PURPOSE

To evaluate the effect of listening to music on preoperative anxiety, postoperative pain (at rest and during coughing), and cardiorespiratory parameters in patients undergoing cardiac surgery.

DESIGN

Single-centered, randomized, parallel, superiority clinical trial.

METHODS

This study was carried out with 50 adult patients undergoing elective cardiac surgery randomly allocated at a 1:1 ratio to one of the groups, experimental (n = 25) or control (n = 25). The experimental group listened to music during the immediate preoperative period and on the first postoperative day. The control group received standard care. State-Trait Anxiety Inventory and Numeric Pain Rating Scale were used to collect data.

FINDINGS

The classical music significantly reduced preoperative state anxiety scores (p < 0.001; dCohen = 2.1), postoperative pain intensity at rest (p < 0.001; dCohen = 1.4) and during coughing (p < 0.001; dCohen = 1.3). There was also a statistically significant reduction in systolic (p = 0.001; dCohen = 0.9) and diastolic blood pressure (p = 0.01; dCohen = 0.6), heart rate (p < 0.001; dCohen = 2.5), respiratory rate (p < 0.001; dCohen = 1.4), and a significant increase in oxygen saturation (p < 0.001; dCohen = 1.2).

CONCLUSIONS

Listening to music had a significant impact on the evaluated outcomes, demonstrating its potential as a complementary intervention to pharmacological treatment for patients undergoing cardiac surgery.

IMPLICATIONS FOR CLINICAL PRACTICE

The findings reinforce the evidence that listening to music is a promising nursing intervention to be used in the perioperative period of cardiac surgeries, with the potential to promote well-being to patients and improve the quality of care provided.

Complementary Approaches to Postoperative Pain Management: A Review of Non-pharmacological Interventions

Postoperative pain significantly affects many surgical patients. While opioids are crucial for pain management, they come with unwanted side effects. Alternatives like nonsteroidal anti-inflammatory drugs, N-methyl-D-aspartate (NMDA) receptor antagonists, and regional anesthesia techniques such as nerve blocks are utilized, but these also have limitations. This underscores the need for complementary non-pharmacological interventions to enhance postoperative pain control and reduce opioid dependence. This study aimed to synthesize evidence on the efficacy of nondrug approaches for managing postoperative pain. The study examined the effects of non-pharmacological interventions such as preoperative patient education, mind-body modalities, and physical therapies. Findings suggest that these approaches can reduce pain intensity, decrease opioid consumption, and enhance recovery outcomes. The study also highlighted the pivotal role of healthcare professionals in implementing these strategies. However, it identified workload constraints and insufficient training as barriers to effective utilization in clinical practice. Integrating non-pharmacological interventions into multimodal pain management regimens can improve postoperative pain control and reduce reliance on opioids. Further research is crucial to definitively establish the efficacy of individual interventions and optimize their combined use in clinical practice. Additionally, enhanced training programs for nurses and initiatives to facilitate the implementation of these strategies are necessary for their successful adoption.

The Impact of Listening to Quran Recitation during Pain-Inducing Procedure among Patients Receiving Mechanical Ventilation Support: An Interventional Study

Background

Pain experienced by intubated patients is caused by several extrinsic sources, including nursing care procedures such as endotracheal suctioning. Several nonpharmacological therapies, including listening to Quran recitation, have never been tested for their pain relief effects among intubated patients, despite these therapies being cost-effective, easy to implement, and free of adverse effects. This study aimed to examine the pain-relieving effect of listening to Quran recitation during pain-inducing procedures in patients receiving mechanical ventilation support.

Materials and Methods

This pilot study used an experimental design with 32 intubated patients at King Abdullah University Hospital in Irbid, Jordan. The Behavioral Pain Scale and Ramsay Sedation Scale were used to assess pain levels and sedation, and physiologic parameters were monitored before and during endotracheal suctioning.

Results

The findings showed significant differences in Behavioral Pain Scale (BPS) scores and heart rate measures between the intervention and control groups after controlling for the level of sedation. The patients in the intervention group scored lower pain and HR measures than those in the control group (F5,26 = 11.47, p < 0.001).

Conclusions

The findings showed significant improvement in the levels of pain and heart rate measures among intubated patients who are exposed to Quran recitation. Complementary medicine is essential to the healthcare plans of critically ill patients and their families. Holy Quran recitation has been reported to be a useful nonpharmacological intervention for critically ill Muslim patients.

Effect of eHealth Interventions on Symptom Management in CABG Surgical Patients: A Systematic Review

This study aimed to evaluate the effectiveness of eHealth interventions on symptom management outcomes of patients undergoing CABG surgery. A systematic review was performed on CINAHL, PubMed, Web of Science, Ovid MEDLINE, and Scopus from 2006 to June 2022. The Joanna Briggs Institute's evaluation tools for RCT and quasi-experimental studies were used to assess the methodological quality of the publications included in this review and to determine the extent to which each publication addressed the possibility of bias in its design. The raters' agreement was determined by using Cohen's kappa test, which yielded a kappa coefficient of 0.51. (PROSPERO registration number: CRD42023398498). A systematic analysis of 11 publications involving 2.586 patients showed that the eHealth intervention effectively increased activity and self-management. eHealth interventions, which are also effective in the management of psychological problems, had results that were partially effective in pain management and effective in quality of life. Digital healthcare has become an important component of patient care. Nurses providing care should be aware that eHealth interventions are showing promising results in patient care.

A meta-review of systematic reviews on the effectiveness of music therapy on depression, stress, anxiety and cognitive function in adult's with dementia or cognitive impairment

BACKGROUND

Subjective cognitive impairment has been reported to be associated with depressive symptoms, stress and anxiety in older people. This study examines the impact of music interventions on cognitive functioning, depression, anxiety, and stress for adults with dementia or cognitive impairment.

METHOD

We searched Academic Search Complete, CINAHL, Medline, and PsycINFO without restriction to date. Systematic reviews with or without meta-analysis of music interventions were included. Effect sizes were estimated using standardized mean difference (SMD), weighted mean difference (WMD), mean difference (MD), and Hedges g, as reported. Effect sizes were reported as 〈 0.1 = small effect to 〉 0.5 as large effect.

RESULTS

Twenty systematic reviews were included. There is evidence that music interventions can have effects on cognitive abilities compared to standard care, with a small to large decrease in anxiety.

CONCLUSION

Music interventions might have variable effects on improved cognitive functioning, depression, anxiety and stress.

The effectiveness of music in improving the recovery of cardiothoracic surgery: a systematic review with meta-analysis and trial sequential analysis

AIM

This study aimed to compile data on the effectiveness of music therapy for patients undergoing cardiothoracic surgery.

BACKGROUND

After cardiac and thoracic surgery, patients often experience physiological and psychological complications, such as anxiety, pain, stress, depression and changes in vital signs, which have a great impact on prognosis.

METHODS

A systematic search of six databases was performed to identify randomized controlled trials investigating music therapy and cardiothoracic surgery. The data were extracted from the qualified research, the data without heterogeneity were analysed by random-effects model (REM) meta-analysis, and the data with heterogeneity were analysed by fixed-effects model (FEM) meta-analysis. We evaluated anxiety, pain, duration of mechanical ventilation, hospital length of stay, stress hormones, opioid consumption, and vital signs, including heart rate (HR), respiratory rate (RR), oxygen saturation (SpO2), diastolic blood pressure (DBP), and systolic blood pressure (SBP) after cardiothoracic surgery. The meta-analysis and sensitivity analysis were performed with RevMan 5.4 and Stata 14 software, and trial sequential analysis was conducted using TSA 0.9.5.10 Beta software. This study was conducted in accordance with the PRISMA guidelines and was registered with PROSPERO.

RESULTS

The study included 24 randomized controlled trials with a total of 1576 patients. Our analysis showed that music therapy can significantly reduce the anxiety scores (SMD= -0.74, 95% CI [-0.96, -0.53], p < 0.01) and pain scores (SMD= -1.21, 95% CI [-1.78, -0.65], p < 0.01) of patients after cardiothoracic surgery. Compared with the control group, music therapy dramatically raised postoperative SpO2 (SMD = 0.75, 95% CI [0.11, 1.39], p = 0.02). In addition, the experimental group had significant statistical significance in reducing HR, SBP and opioid consumption. However, there was no significant difference in respiratory rate, stress hormones, diastolic blood pressure, length of hospital stay, or the duration of mechanical ventilation between the two groups.

CONCLUSIONS

Music therapy can significantly reduce anxiety, pain, HR, SBP, and postoperative opioid use and even improve SpO2 in patients who undergo cardiothoracic surgery. Music therapy has a positive effect on patients after cardiothoracic surgery with few side effects, so it is promising for use in clinics.

TRIAL REGISTRATION

RROSPERO (registration number: CRD42023424602).

The psychophysiology of music-based interventions and the experience of pain

In modern times there is increasing acceptance that music-based interventions are useful aids in the clinical treatment of a range of neurological and psychiatric conditions, including helping to reduce the perception of pain. Indeed, the belief that music, whether listening or performing, can alter human pain experiences has a long history, dating back to the ancient Greeks, and its potential healing properties have long been appreciated by indigenous cultures around the world. The subjective experience of acute or chronic pain is complex, influenced by many intersecting physiological and psychological factors, and it is therefore to be expected that the impact of music therapy on the pain experience may vary from one situation to another, and from one person to another. Where pain persists and becomes chronic, aberrant central processing is a key feature associated with the ongoing pain experience. Nonetheless, beneficial effects of exposure to music on pain relief have been reported across a wide range of acute and chronic conditions, and it has been shown to be effective in neonates, children and adults. In this comprehensive review we examine the various neurochemical, physiological and psychological factors that underpin the impact of music on the pain experience, factors that potentially operate at many levels - the periphery, spinal cord, brainstem, limbic system and multiple areas of cerebral cortex. We discuss the extent to which these factors, individually or in combination, influence how music affects both the quality and intensity of pain, noting that there remains controversy about the respective roles that diverse central and peripheral processes play in this experience. Better understanding of the mechanisms that underlie music's impact on pain perception together with insights into central processing of pain should aid in developing more effective synergistic approaches when music therapy is combined with clinical treatments. The ubiquitous nature of music also facilitates application from the therapeutic environment into daily life, for ongoing individual and social benefit.

The effect of music on the operating surgeon: a pilot randomized crossover trial (the MOSART study)

OBJECTIVE

The experience of stress is common among surgeons while working in the operating theatre (OT). Understanding and finding ways to mitigate this stress is important for optimizing surgical quality and maintaining clinician wellbeing. In this pilot study, we tested the feasibility and reported the outcomes of measuring the effect of background music on intra-operative surgeon stress in the clinical environment.

METHODS

The effect of Music on the Operating Surgeon: A pilot Randomized crossover Trial (the MOSART study) was conducted over a 9-month period in a single-centre. Vascular and general surgeons acting as primary operators (POs) performing elective, general anaesthetic operations were included. The intervention was surgeon-selected music, and the control was the absence of music. Outcome measures were feasibility (recruitment rate, practicability, and completeness of data), heart rate variability (HRV) indices, the Six-Item State-Trait Anxiety Inventory (STAI-6), and the Surgical Task-load Index (SURG-TLX).

RESULTS

Five POs performed 74 eligible randomized cases. The protocol was well tolerated, and no cases were abandoned. Data was incomplete in 8% of cases. The overall mean (SD) operative SURG-TLX score was 48 (±22). Mean HR increased and RMSSD decreased significantly from baseline, suggesting reduced parasympathetic activity while operating. The presence of intra-operative music was not found to affect the psychological or physiological outcomes.

CONCLUSIONS

A music interventional study of this nature is feasible in the operating theatre environment, though no difference was found between in the music and non-music conditions. Follow-up research in a simulated environment with intensive physiological monitoring could be considered.

Benefits of Music Intervention on Anxiety, Pain, and Physiologic Response in Adults Undergoing Surgery: A Systematic Review and Meta-analysis

PURPOSE

Evidence on factors influencing the variations of music's effect on anxiety and pain in surgical patients is unclear. We aimed to elucidate the effects of music intervention on anxiety and pain throughstudy characteristics.

METHODS

We conducted a search on the PubMed, CINAHL, Embase, Cochrane, and Web of Science databases from March 7 to April 21, 2022, for randomized controlled trials (RCTs) for the effect of music intervention on anxiety, pain, and physiological responses in surgical patients. We included studies published within the last 10 years. We assessed the risk of bias in the study using the Cochrane risk of bias tool for randomized trials and performed meta-analyses using a random-effects model for all outcomes. We used change-from-baseline scores as summary statistics and computed bias-corrected standardized mean differences (Hedges'g) for anxiety and pain outcomes and mean differences (MD) for blood pressure and heart rate.

RESULTS

Of the 454 records retrieved, 30 RCTs involving 2280 participants were found to be eligible. Music intervention was found to be superior to standard care in reducing anxiety (Hedges' g = -1.48, 95% confidence interval: -1.97 to -0.98), pain (Hedges's g = -0.67, -1.11 to -0.23), systolic blood pressure (MD = -4.62, -7.38 to -1.86), and heart rate (MD = -3.37, -6.65 to -0.10) in surgical patients. The impact of music on anxiety and pain relief varied significantly depending on the duration of the intervention. The largest effect was observed in interventions lasting between 30 and 60 minutes, with a decrease in anxiety and pain.

CONCLUSIONS

Music intervention is an effective way to reduce anxiety, pain, and physiological responses in surgical patients. Future reviews examining the influence of different types of surgery on the effects of music would add to the body of knowledge in this field. This study has been registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the number CRD42022340203, with a registration date of July 4, 2022.

Efficacy of non-pharmacological interventions in pain relief and opioid consumption after cardiac surgery: A systematic review and Bayesian network meta-analysis

OBJECTIVE

To investigate and rank the evidence for the efficacy of non-pharmacological interventions in relieving pain after cardiac surgery using comprehensive comparisons.

BACKGROUND

Although several previous systematic reviews and meta-analyses showed that non-pharmacological interventions effectively control and reduce pain after cardiac surgery, none quantitatively compared the effect of these different types of interventions.

DESIGN

Systematic review and Bayesian network meta-analysis based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Network Meta-Analysis guidelines.

METHODS

Six databases were searched from inception to April 2021 to collect all published evidence from randomised clinical trials. One author extracted the relevant information from the eligible trials; a second author independently reviewed the data. Before analysing the extracted data, two investigators independently assessed the quality of the included studies. Conventional meta-analysis was conducted using either fixed- or random-effects models according to statistical heterogeneity. The Bayesian network meta-analysis was conducted using the consistency model.

RESULTS

We identified 42 randomised clinical trials comparing 14 groups with 4253 patients. Transcutaneous electrical nerve stimulation, acupressure, music and massage were effective for pain relief, with transcutaneous electrical nerve stimulation being associated with the best probability of successful pain relief after cardiac surgery (cumulative ranking curve surface, 0.97; probability, 77.03%). Acupressure (cumulative ranking curve surface, 0.79; probability, 30.69%) was the second-best option. However, there was no evidence that any pair-up intervention significantly reduced opioid use or anxiety.

CONCLUSIONS

These findings suggest that transcutaneous electrical nerve stimulation, acupressure, music and massage may effectively alleviate postoperative cardiac pain, with transcutaneous electrical nerve stimulation representing the best choice for pain relief.

RELEVANCE TO CLINICAL PRACTICE

The results of this network meta-analysis can guide patients after cardiac surgery and healthcare providers to make optimal decisions in managing postoperative cardiac pain.

TRIAL REGISTRATION

PROSPERO CRD42021246183.