From the National Institutes of Health
...about relaxation and music for postoperatory pain management.

Harish, John M and Eagle, Charles T. (1988) "Elements of Pain and music: The Aio Connection." . Journal of the American Association for Music Therapists, 7:15-27.
This article outlined the similarities between music and pain. Two of the most important similarities are that both can be classified as sensory input and output. Sensory input means that when music is heard, the signals sent to the brain are sensorily as real as signals sent to the brain when pain is felt. Sensory output comes from the limbic system, which is usually considered the site of emotional synthesis. If the vibration of music can be brought into close resonance with the vibration of the pain, then the psychological perception of the pain is altered and eliminated.

Marwick, Charles. (1996). "Leaving concert hall for clinic, therapists now test music's charms." - Journal of American Medical Association, 275:4 267-8.
This article discusses the profession of Music Therapy and how doctors and third party insurance payers are recognizing it as a valid adjunct to traditional therapies. It describes the research and success therapists have had with clients who have had strokes and clients who have had Parkinson's disease. It also shows that women who have used music therapy in labour and delivery have shown improved abilities to walk and reported decreased pain in childbirth. Deforia Lane, Ph.D., studied the immune response to singing and found increased levels of IgA after a vocal singing session. For children with cancer, this increase helps to stimulate their immune systems to help fight their disease.

Other references describe music therapy experiences with people who have profound cognitive impairments, autism, and mental and physical disabilities and for whom music therapy resulted in positive responses. The brain responds to the musical program more readily in these client populations than to mechanical speech.

Laird, R & Beattie, S. (1989), "Rx: Elvis," RN, 52: 44-47.
This article reinforces the old adage "Music soothes the savage beast." Several case studies demonstrated that after a few sessions, or an afternoon of listening to a patient's favorite music, patients show improvement in their mood and in coping with their illnesses and heal faster in body and spirit. Many studies have shown music alleviated physiological signs of anxiety, decreased blood pressure, palpitations, tightness in the chest and peripheral vasoconstriction. Music Therapy improves skin temperature and results in relaxation. It distracts patients from pain and worry and helps their appetite and sleeping. Ideas about how to get music therapy programming started in your health care setting are presented.
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Whipple, B. & Glynn, N. (1992), "Quantification of the effects of listening to music as a non-invasive method of pain control." Scholarly Inquiry for Nursing Practice: An International Journal, 6: 143-56.
Pain is the most common reason people seek help from the medical profession. Nursing used many approaches to treat pain such as (1) pain medication, (2) imagery, (3) deep breathing, and (4) music. Until recently, these non-invasion procedures used to cope with pain had no research data to support this use. However, this quantitative study supports the Gate Control Theory of pain and provides hard data to support using music as a modality to relieve pain.

Aldridge, David. (1996). Music Therapy Research and Practice in Medicine from Out of the Silence.
This book explores the power of music as a healing treatment for many physical and mental conditions. Aldridge looks at how music therapy can treat pain, bowel disease, life-threatening illness, children with developmental delay, and the elderly. It includes descriptions of research, how to set up a current practice, and how a therapist conducts treatment programs and is credentialed.

http://www.mayohealth.org/mayo/9709/htm/eating5.htm/ (no listed author). "Nausea and Vomiting Treatments."
When people have nausea and vomiting from medication, chemotherapy or radiation therapy, music may be used to decrease these reactions. Listening to music might help keep the mind focused off the physical symptoms.

Bral, E. (1998). "Caring for adults with chronic cancer pain." American Journal of Nursing. 98:4.27-32.
This article which focuses on cancer pain, describes music therapy as a non-intrusive intervention which allows a patient to relax, providing distraction from the pain. Music reduces pain intensity and competes with the pain impulses in the central nervous system. It is recommended to allow patients to choose the music they prefer and let them express their feelings.
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Music Therapy Used in Surgery

Thompson, J.F. (1995). "Music in the operating theatre." British Journal of Surgery, 82:12.1586-1587. http://www.pain.com/painscripts/Pain Search.dll?2

This article discusses the use of music in the operating room (OR). Music used in the OR has the potential to provide positive results for both surgeons and OR staff when they are allowed to listen to music of their choice. This listening resulted in improvement of both speed and accuracy. Familiar music increased their concentration and reduced the deterioration of vigilance over time. Music chosen by the patient before, during and after surgery yielded anxiolytic effects and improved tolerance to pain. When music was provided to anesthetized patients, they required less anesthesia during surgery and less analgesia during recovery.

Taylor, Dale. (1980-81). "Music in General Hospital Treatment from 1900-1950." The Journal of Music Therapy, 18: 62-73.

This article describes a major project initiated by Kenneth Pictrell that uses music in all phases of the surgical procedure and in other hospital departments. The goals were to eliminate fear, establish confidence and alloy apprehension by producing a congenial atmosphere for both the patient and everyone else involved in the surgery. This study found that music helped soothe and comfort the patient who was often left alone. Music played directly through earphones helped distract the patients from attending to the noise of surgical instruments and conversations related to the operation.

Euper, Jo Ann. (1965-69). "Recent Trends in the Care of Chronic Patients." The Journal of Music Therapy, 1-6: 38-41.

This article states that the most difficult phase of the illness occurs after the patient leaves the protected hospital environment to face life in an unprotected manner. The patient needs treatment in order to maintain adjustment in the face of interpersonal, social and environmental problems. The article stresses that the most important aspect in the new programs for treating chronically ill patients is the change of attitude on the part of the staff: the refusal to believe that the patient is incurable. With chronic patients, music therapists again see an opportunity for intensive therapy in the monitored aftercare in the community situation.
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Music Therapy Used in Gynecological Procedures

Colwell, Cynthia. (1997). "Music as distraction and relaxation to reduce chronic pain and narcotic ingestion case study." Music Therapy Perspectives, 15: 24-30.

This quantitative research article examined a client who had chronic gynaecological pain post operatively from endometriosis scar tissue. She attended fourteen sessions using vibration, music, singing, creative imagery and progressive relaxation exercises. These sessions were held during the usual times of the pain occurrence. Her mean scores using a tool to measure pain and feelings of control over it moved from a rating of 48% prior to these sessions to a 37% rating after the sessions. She felt more control and experienced less pain after using these tools to help her live with this type of chronic pain.

Mullooly, Virginia, Levin, Rona, F. & Feldman, Harriet R. (1988). "Music soothes post-op pain and anxiety." American Journal of Nursing, 88: 949, 951.

This study looked at post-op women who had hysterectomies. Ten-minute segments of easy listening music were used on the first two days after surgery. The women scored their anxiety, rating it on a scale of 0-5, from calm to extremely anxious. After listening to the music, the amount of anxiety reported was significantly lower. The women used these music sessions three hours after their last pain pill. Their pain lessened by the music only on the 2nd post-op day. 

Davis, Cynthia. (Winter, 1992). "The Effects of Music and Basic Relaxation Instruction on Pain and Anxiety of the Women Undergoing In-Office Gynaecological Procedures." The Journal of Music Therapy, 29-30: 202-217.

Twenty-two female patients who had to undergo certain gynecological procedures were used in this study. The study measured procedural pain and anxiety levels by behavioral observations, pulse and respiratory rates recorded at designated points during the procedures, and the subjects' self-reports following the procedures. The music used was whatever the patient chose for herself. The observed pain responses in the control group were consistently higher than in the experimental group at all points in the procedures, except upon the doctor's exit. Music therapy and basic relaxation instruction can be valuable to the patients and staff in the field of gynecology by resulting in less pain, fewer procedural complications and a decrease in time needed to complete the medical procedures.
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Music Therapy Used to Lower Blood Pressure/ Heart Rate

Hoffman, Janalea. (1997). "Tuning in to the power of music." RN, 60: 52-54.

This article focuses on the rhythm of music and how it can influence our bodies physiologically and emotionally. The author shared many experiences she had with music therapy clients. In one example she played tapes for 15 seconds prior to a session with autistic children. They were able to hold a drumstick and participate in the music therapy session. When in tachycardia, cardiac patients were able to reduce their heart rates to 50-60 beats per minute when listening to music that was exactly 50-60 beats a minute. Another client experienced a deep spiritual feeling after listening to a musical piece that was coupled with guided imagery. She gained an insight she did not have before and felt that healing was elicited. This article did not speak specifically about pain, but music can be used for distraction, or relaxation.

Wong, Donna. (1988). "Changing what children hear in the ICU can lower intracranial pressure," America Journal of Nursing. 88: 279-280.

Clinical nurse specialist Jennifer Wincek in the pediatric critical care unit conducted this study from the Children’s Hospital of Wisconsin-Milwaukee. Stimulation of the pituitary-adrenal axis occurred at 70 decibels (dB). This stress response led to increasing blood pressure, heart rate, and cerebral blood flow, thus increasing intracranial pressure, ICP. Wincek used two methods to decrease this noise: (1) blocking the noise by headphones and (2) adding music. Measures of heart rate, ICP and blood pressures were taken 15 minutes before and after the two methods, and a dramatic drop from 29% to 16% was experienced when the music was used.
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Music and Pain Management
by Cheryl Bombei RN
Edited by Debra Wirth RN

Music surrounds us in every aspect of our lives. What is music? According to Webster's dictionary, music is "the art of combining sounds or sequences of notes into harmonious patterns pleasing to the ear and satisfying to the emotions."

Music is also an ancient art form used as a healing therapy in today's healthcare settings. It is an attempt to bring harmony back into the whole self by eliminating that which is causing disharmony (DeRungs, 1986). Music can be a powerful distraction, turning the patient's attention away from pain and promoting relaxation. It can be used in conjunction with pharmacological interventions and offer additional help to the patient in pain. Letting the patient choose the type of music they prefer is also important, giving them choices in their quest for pain relief.

Music therapy is the formalized use of musical interventions to restore and improve the emotional, physical, and spiritual health and well being of people (Lindberg, 1997). Using music therapy began in the 1950's as an organized profession and flourishes today with many schools and individuals dedicated to this area of healthcare. Steve Halpern, Ph.D., offers music as therapy for both physical and emotional pain and healing. Music therapists work with a wide variety of people in psychiatric, acute care and long term facilities. Some offer services in the home and hospice setting for the terminal patient approaching death.

The music therapist determines the needs of the patient, then develops a treatment plan. Some methods used are singing, rhythmic movements, composing, listening and playing instruments (Canadian Association for Music Therapy).

• Further information on music therapy can be found on the World Wide Web.
• Music therapists can be found in the yellow pages of the telephone directory.
• Musical selections for healing can be found in larger music stores.
  

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References
DeRungs, Maria, D.M.A., (1986). The Healing Tones of Music Casa de Maria Research Center, pg. 1.

Good, M. (1995). A comparison of the effects of jaw relaxation and music on postoperative pain. Nursing Research. 44(1): 52-57.

Good, M. (1996). Effects of relaxation and music on postoperative pain: a review. Journal of Advanced Nursing. 24 (5): 905-914.

http://members.aol.com/kathysl/def.html

Wipple, R. Glynn NJ., (1992). Quantification of the effects of listening to music as a noninvasive method of pain control....including commentary by MaCaffery M., Scholarly Inquiry for Nursing Practice. 6(1) 43-62.

From “PediatricOnCall.com”
Parent Corner
Pain Management in Children

  15. Music therapy: Use of music to modify mood and distract the child from pain. 
       Examples: having the child sing a song or listen to favorite music.

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