- Music therapy was found to reduce pain scores and analgesic requirements.
- Benefits of music were observed even when patients were under general anesthesia.
- Anxiety scores were also lower among patients receiving music therapy.
- Patient satisfaction was higher among patients in the music groups.
- Effects were observed among cancer patients and surgical patients.
Music could be offered as a way to help patients reduce pain and anxiety during the postoperative period (Figure 1). Timing and delivery can be adapted to individual clinical settings and medical teams, according to results of a systematic review published recently in The Lancet.
Music was also found to reduce the pain experience of cancer patients in the results of a randomized trial published in the Journal of Palliative Medicine, and a Cochrane systematic review. Music also improved a variety of clinical characteristics in critically ill patients in a trial published in the Journal of Critical Care.
Cochrane Database Systematic Review
A variety of music interventions have been found to improve psychological and physical outcomes in cancer patients. Music was found to relieve extensive emotional, physical, and social suffering in these patients. (Figure 2.)
“This systematic review indicates that music interventions may have beneficial effects on anxiety, pain, fatigue and QoL in people with cancer. Furthermore, music may have a small effect on heart rate, respiratory rate and blood pressure. Most trials were at high risk of bias and, therefore, these results need to be interpreted with caution,” the authors noted.
The Cochrane reviewers endeavored to assess the effects of music therapy and music medicine interventions on psychological and physical outcomes in people with cancer. They searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 1), MEDLINE, Embase, CINAHL, PsycINFO, LILACS, Science Citation Index, CancerLit, CAIRSS, Proquest Digital Dissertations, ClinicalTrials.gov, Current Controlled Trials, the RILM Abstracts of Music Literature, http://www.wfmt.info/Musictherapyworld/, and the National Research Register databases. For the databases that are no longer functional, the authors searched them until their termination date and performed hand searches of music therapy journals. They also reviewed reference lists and contacted experts in person.
Included were all “randomized and quasi-randomized controlled trials of music interventions for improving psychological and physical outcomes in adult and pediatric patients with cancer. We excluded participants undergoing biopsy and aspiration for diagnostic purposes.”
They were able to identify 22 new trials for inclusion in this update. Overall, the evidence supporting this review includes 52 trials with a total of 3731 participants. “We included music therapy interventions offered by trained music therapists, as well as music medicine interventions, which are defined as listening to pre-recorded music, offered by medical staff. We categorized 23 trials as music therapy trials and 29 as music medicine trials.The results suggest that music interventions may have a beneficial effect on anxiety in people with cancer, with a reported average anxiety reduction of 8.54 units (95% confidence interval [CI] -12.04 to -5.05, P<0.0001) on the Spielberger State Anxiety Inventory - State Anxiety (STAI-S) scale (range 20 to 80) and -0.71 standardized units (13 studies, 1028 participants; 95% CI -0.98 to -0.43, P<0.00001; low quality evidence) on other anxiety scales, a moderate to strong effect. Results also suggested a moderately strong, positive impact on depression (7 studies, 723 participants; standardized mean difference (SMD): -0.40, 95% CI -0.74 to -0.06, P=0.02; very low quality evidence), but because of the very low quality of the evidence for this outcome, this result needs to be interpreted with caution. We found no support for an effect of music interventions on mood or distress.”
The reviewers found that music interventions may lead to small reductions in heart rate, respiratory rate and blood pressure. However, music interventions did not appear to influence oxygen saturation levels. Music therapy did, however, result in a significant reduction in pain scores (7 studies, 528 participants; SMD: -0.91, 95% CI -1.46 to -0.36, P=0.001, low quality evidence).
“In addition, music interventions had a small to moderate treatment effect on fatigue (6 studies, 253 participants; SMD: -0.38, 95% CI -0.72 to -0.04, P = 0.03; low quality evidence), but we did not find strong evidence for improvement in physical functioning,” the reviewers noted..
“The results suggest a large effect of music interventions on patients' quality of life (QoL), but the results were highly inconsistent across studies, and the pooled effect size for the music medicine and music therapy studies was accompanied by a large confidence interval (SMD: 0.98, 95% CI -0.36 to 2.33, P=0.15, low quality evidence).
“A comparison between music therapy and music medicine interventions suggests a moderate effect of music therapy interventions for patients' quality of life (QoL) (3 studies, 132 participants; SMD: 0.42, 95% CI 0.06 to 0.78, P = 0.02; very low quality evidence), but we found no evidence of an effect for music medicine interventions.”
The results of single studies suggest that music listening may reduce the need for anesthetics and analgesics as well as decrease recovery time and duration of hospitalization, but more research is needed for these outcomes,” the authors concluded.
Journal of Critical Care
“Intensive care units are a stressful milieu for patients, particularly when under mechanical ventilation which they refer to as inhumane and anxiety producing. Anxiety can impose harmful effects on the course of recovery and overall well-being of the patient,” according to a review published recently in the Journal of Critical Care.
“Music listening, widely used for stress release in all areas of medicine, tends to be a reliable and efficacious treatment for those critically ill patients. It can abate the stress response, decrease anxiety during mechanical ventilation, and induce an overall relaxation response without the use of medication. This relaxation response can lower cardiac workload and oxygen consumption resulting in more effective ventilation. Music may also improve sleep quality and reduce patient's pain with a subsequent decrease in sedative exposure leading to an accelerated ventilator weaning process and a speedier recovery,” the authors concluded.
Journal of Palliative Medicine
An article in the Journal of Palliative Medicine reports on a “randomized trial, with multiple aspects and an allocation ratio of 1:1:1, in which one group listened to music, one group listened to poetry, and another group received no intervention over a period of 3 days.”
In all, 75 adult patients experiencing pain (Figure 3) and hospitalized in a cancer facility were included. The 3-month study had two main outcomes: The primary pain evaluation using the Visual Analogue Scale (VAS). The secondary outcomes included evaluations of depression (Beck Depression Inventory) and hope (Herth Hope Scale).
The study concluded with a sample of 65 participants; 22 in the music group; 22 in the poetry group; and 21 controls. Music therapy resulted in improved VAS pain scores (P<0.001) and depression scores (P=0.004). Poetry therapy was found to result in improves in pain (P<0.001), depression (P=0.001), and hope (P=0.009). “However, a difference between the music and poetry groups and the control group after the study was only observed for the pain outcome (P<0.001) (CI=95%),” the authors explained.
“Both music and poetry produced a similar improvement in the pain intensity. The two therapies also affected depression scores, and only poetry increased hope scores. Further investigation of the effects and comparisons between the two therapies should be performed,” they concluded.
The authors conducted a systematic review of randomized controlled trials (RCTs) that included adult patients undergoing surgical. Included were RCTs in which any form of music initiated before, during, or after surgery and was compared with standard care or other non-drug interventions.
The authors searched MEDLINE, Embase, CINAHL, and Cochrane Central databases and included 73 RCTs in the systematic review. Music therapy was found to reduce postoperative pain scores (SMD -0·77 [95% CI -0·99 to -0·56]), anxiety scores (-0·68 [-0·95 to -0·41]), and analgesia use (-0·37 [-0·54 to -0·20]). Music therapy was also found to increase patient satisfaction scored (1·09 [0·51 to 1·68]). However, but length of stay did not differ (SMD −0·11 [–0·35 to 0·12]) among groups.
Subgroup analyses showed that choice of music and timing of delivery made little difference to outcomes. Meta-regression identified no causes of heterogeneity in eight variables assessed. Music was effective even when patients were under general anesthesia.
“Music could be offered as a way to help patients reduce pain and anxiety during the postoperative period. Timing and delivery can be adapted to individual clinical settings and medical teams,” the authors concluded.