Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery

The benefits and drawbacks of music in the operating room

INTRODUCTION

A significant proportion of surgeons listen to music in the operating room (MOR) during a surgical procedure. Over the last twenty years, this practice has been widely studied. The aim of this article is to analyze the effects of MOR on surgical performance, postoperative history and, more generally, on communication in the operating theater.

METHOD

A comprehensive review of the factual literature (randomized trials and systematic reviews) was carried out.

RESULTS

Given the heterogeneity of the published studies, it was not possible to achieve results with a high level of evidence. Above and beyond a probably lightened mental load ascribable to MOR, our review did not demonstrate significant benefits of music (a "Mozart effect") regarding enhanced surgical performance in a clinical setting or a reduced number of perioperative or postoperative adverse events. The major drawbacks of MOR include team communication impediments, surgeon distraction, and frustration felt by team members.

CONCLUSION

MOR implementation should presuppose dialogue and agreement among all members of a caregiving team. Do the advantageous aspects of MOR indeed (finally) consist in lessened mental load and heightened surgeon well-being?

Perioperative Music Implementation in Bariatric Patient Care: An Interventional Study

BACKGROUND

 Perioperative music can positively affect postoperative pain, opioid requirement, and anxiety. These effects are even present when music is played solely during general anesthesia. This study assesses the effect of implementing perioperative music as standard patient care in elective bariatric metabolic surgery (BMS).

METHODS

This prospective study compared the preimplementation (control) and postimplementation (intervention) groups between March and October 2023. The control group did not receive music, while the intervention group received patient-selected music using headphones and a tablet. Music was provided as standard during anesthesia. Only patients undergoing elective BMS (primary ring augmented Roux-en-Y gastric bypass) were included. The primary outcome was postoperative pain on a 10-point scale (numeric rating scale, NRS) on the first postoperative day. The secondary outcomes included postoperative nausea, patient satisfaction, and opioid and antiemetic requirements. Results: In the control group, 66 patients were included, while 65 were included in the intervention group. Median NRS scores were 5 in both groups, showing no significant difference (p = 0.325). Medication use (analgesics and antiemetics) was similar in both groups. Patient satisfaction scores were high at 8 (8-9) and 9 (8-10), respectively, with no significant difference (p = 0.137). In the intervention group, most patients (86%) want to listen to music during subsequent surgical procedures.

CONCLUSION

Implementing perioperative music in BMS did not significantly reduce postoperative pain or postoperative medication use. As the bariatric perioperative tract is already well-received without music, it poses a challenge for detecting notable improvements. However, the strong patient preference for music during future surgeries emphasizes the positive perception of music in perioperative care.

Implementing Music Medicine to Improve Pain Outcomes After Abdominal or Pelvic Surgery: A Quality Improvement Project

PURPOSE

Define the impact of the implementation of evidence-based music medicine (MM) on pain management outcomes after abdominal and pelvic surgery when combined with usual care.

DESIGN

This quality improvement project implemented MM in a hospital postanesthesia care unit using a pretest-posttest design. The Roy Adaptation Model and Kotter's Change theory guided all project phases.

METHODS

Nursing staff were educated in-person, via electronic formats and paper handouts. A convenience sample of adults who underwent abdominal or pelvic surgery was offered a preselected MM playlist (via earphones and MP3 players) in addition to usual care during the Phase I recovery period. The outcomes included administered opioids (oral morphine milligram equivalents), pain levels (numerical rating scale), heart rate, respiratory rate, and systolic blood pressure. The outcomes for those who accepted MM (music group) were compared to those for patients admitted to the postanesthesia care unit 1 month before project implementation (baseline group).

FINDINGS

The music group data revealed highly significant reductions in heart rate (P = .008, Cohen's d = 0.57) and systolic blood pressure (P < .001, Cohen's d = 0.78) at 30 minutes compared with pretest data. In contrast, the baseline group data showed no effect on systolic blood pressure levels (P = .274). The music group showed higher clinical significance (1.8 to >2-fold higher effect size) on reducing numerical rating scale scores at 30 minutes (music group: P < .001, Cohen's d = 1.19; baseline group: P = .008, Cohen's d = 0.55) and the final period in phase I (music group: P < .001, Cohen's d = 1.71; baseline group: P < .001, Cohen's d = 0.93). The mean morphine milligram equivalents dose for the music group (29.5 ± SD 19.8) compared with the baseline group (33.0 ± SD 26.6) was not significantly different (P = .376, Cohen's d = 0.18).

CONCLUSIONS

Adding MM with usual care leads to statistically and clinically significant reductions in pain indicators in adults who had abdominal or pelvic surgeries versus usual care alone.

The effect of listening to music and drawing on coping with dysmenorrhea complaints in nursing students: randomized controlled trial

AIM

To examine the effect of listening to music and drawing on coping with dysmenorrhea complaints of nursing students.

METHODS

The study was a double-blind, three parallel-group randomized controlled trial conducted between August 2023 and May 2024 at Bartın University, Faculty of Health Sciences, Department of Nursing. Ninety-six dysmenorrheic nursing students with regular menstrual cycles were included in the study and randomly assigned to three groups as drawing, music and control groups. Visual Analog Scale (100mmVAS of pain), Perceived Stress Scale (PSS) and Menstrual Symptoms Scale (MSS) were applied to the students at baseline, 1st and 2nd months. The interventions were as follows: the music group listened to a 29-minute and 32-second song three days before menstruation and on the first day of menstruation in the third month composed by Juan Sebastian Martin-Saavedra, while the drawing group created art for the same duration. The pain scores, perceived stress, and menstrual symptoms were measured in all groups after the interventions.

RESULTS

Pretest, 1st and 2nd months 100mmVAS of pain score averages were 7.16 ± 1.99, 7.16 ± 1.99 and 7.50 ± 1.98 for the control group, 7.22 ± 1.64, 4.84 ± 1.80 and 2.13 ± 1.45 for the music group and 6.69 ± 1.80, 5.09 ± 1.55 and 2.91 ± 1.33 for the drawing group, respectively. Pretest, 1st and 2nd months PSS score averages were 28.75 ± 3.71, 29.09 ± 3.87 and 30.03 ± 4.16 for the control group, 29.91 ± 3.98, 14.06 ± 4.06 and 3.59 ± 3.82 for the music group and 27.38 ± 3.63, 18.13 ± 5.60 and 8.34 ± 5.46 for the drawing group, respectively. Pretest, 1st and 2nd months MSS score averages were 79.25 ± 15.41, 88.00 ± 20.08 and 90.66 ± 19.13 for the control group, 85.41 ± 10.77, 62.41 ± 15.23 and 34.00 ± 12.62 for the music group and 80.69 ± 11.07, 65.53 ± 15.37 and 47.31 ± 15.11 for the drawing group, respectively. Mean menstrual pain intensity, mean perceived stress level, and mean menstrual symptoms level in the art and music group decreased significantly at 1st and 2nd months post-intervention (p < .001). A significant increase in score levels was observed in the control group.

CONCLUSIONS

Both art and music practices are effective in significantly reducing menstrual pain, perceived stress, and menstrual symptoms in nursing students with dysmenorrhea. It is important to include listening to music and drawing on women's health and disease nursing practices to control menstrual pain, perceived stress, and menstrual symptoms in dysmenorrhea.

CLINICAL TRIALS REGISTRATION NUMBER

https://clinicaltrials.gov identifier NCT06027489; registered August 30, 2023.

Personal versus therapist perioperative music intervention: a randomized controlled trial

INTRODUCTION

Music interventions can alleviate patient anxiety and improve post-surgical satisfaction. However, it remains uncertain whether personal music preferences affect efficacy. The authors tested whether personal music intervention with patient-selected songs played ad libitum is more effective than standard therapist-designed treatment with classical music.

METHODS

A prospective, parallel-group, single-blinded, randomized controlled trial with 229 participants (aged 18-60 years) previously scheduled for elective surgery. Data analyses followed a modified intention-to-treat principle. The patients were randomized into three groups: Standard care without music (Control), therapist-designed classic music treatment (TT), or personal music intervention with patient-selected songs played ad libitum by the patient (PI). All patients received standard post-anaesthesia care, and music intervention was started upon arrival at the post-anaesthesia care unit. Primary outcomes were anxiety and overall satisfaction at discharge. In contrast, secondary outcomes were systolic blood pressure during music intervention, the sleep quality of the night after surgery, and the occurrence of postoperative nausea and vomiting within the first 24 h after surgery.

RESULTS

Compared with therapist-designed music treatment, personal intervention decreased systolic blood pressure (T 0 : 124.3±13.7, 95% CI:121-127.7; T 20min : 117.6±10.4, 95% CI:115-120.1; T 30min : 116.9±10.6, 95% CI:114.3-119.4), prevented postoperative nausea and vomiting (Control: 55.9%, TT: 64.6%, PI: 77.6%), including severe postoperative nausea (VAS score>4; Control: 44.1%; TT: 33.8%; PI: 20.9%) and severe emesis (Frequency≥3, Control: 13.2%; TT: 7.7%; PI: 4.5%). None of the treatments affected sleep quality at night after surgery (Median, Q1-Q3, Control: 3, 1-3; TT: 3, 1-4; PI: 3, 1-3.5). Personal, but not therapist, music intervention significantly prevented anxiety (Control: 36.4±5.9, 95% CI:35.0-37.9; TT: 36.2±7.1, 95% CI: 34.4-37.9; PI: 33.8±5.6, 95% CI: 32.4-35.2) and emesis (Control: 23.9%; TT: 23.4%; PI: 13.2%) and improved patient satisfaction (Median, Q1-Q3, C: 8, 6-8; TT: 8, 7-9; PI: 8, 7-9).

CONCLUSIONS

Personal music intervention improved postoperative systolic blood pressure, anxiety, nausea, emesis, and overall satisfaction, but not sleep quality, as compared to therapist-designed classic intervention.

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.

Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review

This narrative review aims to summarize non-pharmacological interventions for pain management in hemodialysis patients, assessing their potential benefits and limitations in enhancing patient well-being and quality of life. We reviewed the current literature on five primary non-pharmacological interventions: acupuncture, cognitive behavioral therapy, relaxation techniques, virtual reality, and alternative methods such as transcutaneous electrical nerve stimulation, music therapy, and aromatherapy. We analyzed the evidence regarding their effectiveness, feasibility, and optimal implementation strategies. The existing evidence supports the potential benefits of these interventions in managing pain and improving the well-being of hemodialysis patients. However, further high-quality research is needed to confirm their effectiveness, establish implementation best practices, and assess their long-term impact on patient outcomes. Non-pharmacological interventions hold promise for pain management in hemodialysis patients. Additional research is required to optimize these interventions and validate their effectiveness, contributing to comprehensive pain management strategies for this vulnerable patient population.

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.

Effect of Classical Music on Depth of Sedation and Induction Propofol Requirements in Dogs

The main objective of this prospective, randomized, blind, cross-over experimental study was to evaluate the effect of classical music on the depth of sedation and propofol requirements for the induction of anaesthesia in dogs. Twenty dogs were involved, and each was subjected to three different treatments with a 3-month gap: Chopin music, Mozart music, and no music, via loudspeakers. The dogs were premedicated with acepromazine and butorphanol by intramuscular injection, and anaesthesia was induced using propofol intravenously. To compare the depth of sedation and propofol requirements for the induction of anaesthesia among the different treatments, we utilized non-parametric tests (Kruskal-Wallis test) for the depth of sedation due to a slight deviation from the normal distribution and parametric (ANOVA) for propofol requirements. When exposed to music (Chopin or Mozart), dogs exhibited deeper sedation and required less propofol for their intubation compared to the no-music treatment (p < 0.05). Exposure to classical music had a positive impact on the level of sedation, and more profound central nervous system depression seemed to contribute to approximately 20% lower propofol dose requirements for tracheal intubation. Therefore, classical music during the preoperative period appeared to exert a beneficial effect, at least when applying the specific pre-anaesthetic medications used in the present study.

The Impact of Varied Music Applications on Pain Perception and Situational Pain Catastrophizing

We evaluated how pain processing and situational pain catastrophizing differed between 2 music interventions (Unwind and favorite music) and a control condition (white noise). Healthy adults (n = 70) completed quantitative sensory testing (QST) measuring pressure pain threshold (PPTh) and tolerance (PPTol), heat pain threshold (HPTh), offset analgesia (OA), temporal summation of pain (TSP), and conditioned pain modulation (CPM). Participants completed 3 QST rounds with the presence of white noise (control condition), a relaxing music app (Unwind), and their favorite music, which were presented in a randomized order. The Situational Pain Catastrophizing Scale was completed after each round. Friedman tests and post hoc Wilcoxon signed-rank tests were used to compare pain processing and catastrophizing across the 3 conditions. Participants' PPTh, PPTol, and HPTh were significantly higher during the favorite music condition compared to the other 2 conditions, indicating lower pain sensitivity when listening to favorite music. In contrast, OA was lower in the favorite music condition. Although TSP and CPM were induced by the QST paradigm, these did not differ across the 3 conditions. Situational pain catastrophizing was also significantly lower during the favorite music condition. Several measures of pain sensitivity and situational pain catastrophizing were lower when listening to favorite music compared to relaxing music or white noise. More research is necessary to determine the mechanism(s) by which music modulates pain processing. PERSPECTIVE: This article presents evidence that participant-chosen favorite music can alter several aspects of nociceptive processing, including catastrophic thinking about pain, compared to white noise or relaxing music. Employing an individual's favorite music during episodic or procedural pain might represent a cost effective adjunctive analgesic strategy.

Music Therapy as a Form of Nonpharmacologic Pain Modulation in Patients with Cancer: A Systematic Review of the Current Literature

Simple Summary

Cancer is a condition that affects millions of people worldwide each year. Treatments include pharmacologic and surgical interventions that can pose great risks to the physical and mental health of patients. The objective of this systematic review is to consolidate the literature surrounding the use of music therapy as a low-risk and effective pain management adjunct to traditional cancer therapy. This analysis reveals that the use of music therapy thus far has provided a nearly unanimous positive effect on cancer patients, with the potential to provide both physical and psychosocial benefits. The apparent adverse effects appear to be negligible, and music therapy should be considered when creating a cancer care plan.

Abstract

Aims and Objectives: To consolidate and summarize the current literature surrounding the use of music therapy as an effective noninvasive adjunct to conventional cancer therapy, especially as a low-risk alternative for pain management and anesthetic use in cancer patients. Background: Current studies have proposed that music therapy may be effective as a noninvasive adjunct to conventional cancer therapy in managing numerous outcomes in cancer patients. However, the findings of these investigations have not been consolidated and analyzed on a large scale. Therefore, focusing a systematic review on the effects of music therapy as an adjunct to conventional cancer therapy would give a better understanding of which intervention approaches are associated with better clinical outcomes for cancer patients. Design: A systematic review. Methods: A review of randomized controlled trials to evaluate the effectiveness of music therapy in physical, cognitive, and psychosocial outcomes for cancer patients alone or in conjunction with standard therapy was implemented. We conducted searches using the PubMed/MEDLINE, CINAHL, and Cochrane Library databases for all articles meeting the search criteria up until the time of article extraction in May, 2022. Only studies published in English were included. Two reviewers independently extracted data on participant and intervention characteristics. The main outcome variables included pain, anxiety, quality of life, mood, sleep disorders, fatigue, heart rate, blood pressure, respiratory rate, and oxygen saturation. Results: Of the 202 initially identified articles, 25 randomized controlled trials met the inclusion criteria for evaluation. Of the 25 studies, 23 (92.0%) reported statistically and clinically significant improvements across the outcome variables. Two of the studies (8.00%) found no significant positive effect from music therapy in any of the aforementioned outcomes variables. Conclusion: Music therapy, both as a standalone treatment and when used in conjunction with other pharmacologic and nonpharmacologic modalities, has a generally beneficial effect across several physiologic and psychosocial aspects of cancer.