CONTROLLING PAIN Source. Nursing 2010 pages 53, 54 Article by . Mauree H. Whitaker BSN RN Title..

Sounds Soothing; Music Therapy for Postoperative Pain. More than 80% of patients undergoing surgical procedures experience moderate to severe pain post operatively. Uncontrolled pain can delay wound healing and lead to anxiety and depression. Relaxation and music have been recommended in acute pain management guidelines as interventions to be used with analgesics for moderate postoperative pain. Compelling evidence exist that music therapy is a simple cost-effective and benign intervention to reduce the intensity and duration of post operative pain. WHAT THE RESEARCH SHOWS. In one of the first studies of the effects of music therapy, patient scheduled for gynecologic surgery received music therapy for 30 minutes preoperatively and 2 hours after skin closure, then for 15minutes every 2 hrs for the first 48 hrs postoperatively. Compared to the patients controlled group, patients provided with music therapy (using music of their choice) needed less analgesics and had smaller increases in BP and pulse. A meta-analysis (In statistics, a meta-analysis combines the results of several studies that address a set of related research hypotheses) found that postoperative patients who received music therapy had a 50% reduction in pain intensity and needed less analgesics than patients who did not receive music therapy. Other studies have found that patients exposed to music reported 57% to 72% less pain intensity, distress and anxiety than the control patients.

In a study of patients undergoing open coronary artery bypass grafting or aortic valve replacement surgery, patients who listened to soothing music had higher oxytocin and Pao2 levels and higher subjective relaxation scores during bed rest compared to the controlled group (whose oxyticin levels actually decreased). The music therapy patients also experienced reduction over time in respiratory rate and mean arterial pressure. Oxytocin, which is synthesized in the hypothalamus, is released is response to stress and creates a sense of calmness, diminishes the sensation of pain, and promotes wound healing. Low levels of oxytocin have been associated with pain and anxiousness. PRACTICE RECOMMENDATIONS More research is needed to determine the optimum timing of music therapy (whether preoperatively, intra-operatively, postoperatively or a combination) and the duration and frequency of effective music therapy. Most of the studies used 30 min sessions of music therapy, but the question is, is this the optimal therapy length? More research is also needed on the effect of repeated sessions and the influence of different music styles on the stress response. The delivery mode and type of music is also an issue. One study used mp3 players with headphones and gave patients a selection of soft, slow music without lyrics. Another option is also deliver music therapy via a music pillow connected to an mp3 player, so patient can fully relax in bed and listen without headphones. Patients musical preference should be considered in music selection, as different types of music can evoke different response in people. Patients can bring can bring in their own music and music player or choose from a selection provided to them. Many facilities have music TV channels and radio stations that patients can tune in. Tell patients about these options if they are available. Infection control is another concern because of the risk posed by shared equipment. Music pillows can be covered with a clean pillowcase that can easily be changed. Disposable headphone or earbuds can be used, or the

unit could be sanitized with germicidal wipes or sprays between patient uses. IN CONCLUSION Music therapy should be offered as an integral part of multimodal pain management for experiencing pain, including surgical patients. Music is a low risk supportive intervention that most patients find appealing, and that increases relaxation and decreases pain. The therapy has the potential to become an adjunct standard of care for reducing postoperative pain.