Music Therapy for Pain Management - Essay Example

Music Therapy for Pain Management Selection of Topic Nurses take care of patients in different difficult practice situations. Sometimes, conventional care does not produce desired outcome in many clinical cases. More often, in some cases, conventional nursing management yields outcome at the cost of serious adverse effects. Pain management is such an area, where music therapy is growing as a service option. Continuous endeavour on the part of nurses to deliver care of standards demand evidence from research; however, the research and practice in music therapy are mostly empirical with paucity of structured research. While practitioners report good results with it, most of the practice is based on empiric evidence. Therefore, it would be worthwhile to explore research to find out evidence that can support current practice or can change practice. Determination To determine evidence, a literature search was undertaken on the available database with the key words "music", "therapy", "music therapy", "nursing practice", "pain management", "complementary therapy", "alternative therapy", and "palliative nursing." This resulted into 234 articles. These articles were further searched on key words "research articles." This narrowed down the number of articles to 34. Among these articles, a search was conducted with the key word "national guideline," and this revealed 0 articles. This indicated there exists no nursing practice guidelines on pain management with music therapy. Further search was conducted with the phrase "systemic review", and this resulted into 6 articles. One of these articles was chosen, and another 5 articles were chosen from the previous group. The inference from this search was that music therapy is practiced in contemporary palliative care nursing practice, but there is no national guideline for its use. However, the existence of many systemic reviews tells us about the evidence that can be used in practice. Article that Best Supports Nursing Interventions The article that best supports nursing interventions is "Music as an Intervention in Hospitals" by Evans (2001) on behalf of The Joanna Briggs Institute for Evidenced based Nursing and Midwifery. This is a systemic review of articles graded on the basis of level of evidence. The author sites evidence from literature that music has been used for all age groups in a wide variety of clinical care settings as adjuncts to conventional management. The care settings include intensive care, coronary care units, and even outpatient departments. From the evidence, it appears that it has been used universally across practice settings. In some cases, it has also been used a relaxation technique. The author presents findings from different articles and studies. Evidence suggests that music in the form of recorded music from a compact disc player was the therapeutic music of choice. The randomized controlled trials indicate that music has been used for reduction of anxiety, relaxation, reduction of pain, improvement of cognitive function, buffering noise, increasing satisfaction, improvement of mood, increment of exercise tolerance, and improvement of tolerance of some procedures. Music has also been used to alleviate symptoms of anxiety and pain. The outcome measures for pain control were decrease in the severity of pain and decreased requirement of analgesics. For procedures, the decreased requirement of sedatives was evidenced by improvement in patient satisfaction, better tolerance of procedure, and notable elevation of mood. The researchers recorded symptomatic reduction of anxiety and corroborated these through physical examination, which indicated reduction in heart rate and respiratory rate. No subjective reduction of pain symptoms was noted, although the dose of analgesics required to produce a desired pain relief was less. Similarly, reduction of required dose of sedatives during unpleasant procedures was noted. This review did not find any evidence that music improved tolerance of the procedures, but it improved mood of the patients. The improvement of patient satisfaction was not recordable. Two categories of patients, procedural and nonprocedural hospital patients were intervened with music. In nonprocedural hospital patients, music therapy was found to reduce anxiety, produced a small reduction in respiratory rate, and improved mood. On physical examination, no reductions in heart rates or blood pressures were recorded. On the contrary, for patients undergoing a procedure, it did not reduce anxiety, pain, heart rate or blood pressure, despite reduction in the need for sedatives and analgesics. The author concludes and recommends from analysis of the level I evidence that playing recorded music to non-procedural hospitalised patients resting on bed or chair, reduces anxiety and improves mood (Evans, 2001). Other Four Articles In their review article, Evans et al. (2008) reviews the evidence in favour of many alternative and complementary therapies on children in distressing and painful clinical situations. The authors accept that in clinical practice, these therapies are not widely accepted as conventional therapy modalities. This could have been due to many barriers in its widespread use, one of them being absence of consensus among practitioners about its use and efficacy. Research indicates that music therapy as an alternative form of therapy has been studied widely, but the qualities of the studies are questionable. It has been observed that there are great variations in standardizations of interventions across studies. These inherent inconsistencies in study designs resulted in unreliable outcomes, and consequently, these could not serve as evidence in favour of guidelines for practice. Research involving music therapy in children is limited when it aims to treat pain symptoms. In small ward procedures, passive music has been used when the patient only listens. However, according to the authors, active music therapy involves active musical interventions. Injections and blood draws have positive findings with musical interventions. The authors mention a randomized controlled trial involving children aged 4 to 13. In this study, the participants had lower distress and pain scores. In contrast, studies using passive listening had limited results. In contrast to adults, music had less analgesic effects on infants. Quantitative results are limited; however, reported qualitative results are promising in terms of improvement of mood, anxiety, pain, complaince, and relaxation. A study with repeated-measures design and another randomised trial revealed significantly reduced postoperative pain in children. It has also been indicated that active involvement in musical experience reduced the pain response further. The authors theorize, music may be effective in producing an analgesic effect through distraction, but these studies have a common fault of defective methodological design. Thus, the authors suggest necessity of further research with appropriate designs before deciding to use it in the clinical area (Evans, Tsao, and Zeltzer, 2008). Nilsson et al. (2005) in their study on postoperative calming music did a randomized controlled trial to examine its effects on stress reduction and analgesia. This was an experimental design to examine whether intra or postoperative music therapy could influence stress and immune response during or after general anesthesia. The secondary objective of this study was to determine whether there was a difference in response between intraoperative music therapy and postoperative music therapy. The authors concluded that intraoperative music therapy may reduce postoperative pain and postoperative music therapy may reduce anxiety, pain, and morphine consumption (Nilsson, Unosson, and Rawal, 2005). The study by Magill (2001) examines the use of music therapy to address suffering in advanced cancer pain. In this discourse, the author presents analyses of patient experiences when they were treated with music therapy for cancer or cancer pain. The author basically presents a brief description of different modalities of music therapies from literature, but there is no evident study design or experiment. The literature review in this article also highlights different aspects of suffering from cancer and attempts to correlate how music can be a suitable intervention. This article adds to the knowledge of music therapy and presents the patient experiences. These touch heart, but critically speaking, these do not add to evidence, since with subjective data, the author did not attempt to analyze the content of the patients' statements. It is true that with the impending loss of life, the patients suffer from sorrow or grief with advanced cancer, and there may be some fact in the thought that music connects to inner strengths and provides moments of release. Music can lead to improved comfort, insight, and intimacy with others, but these empiric statements cannot make music an invaluable intervention for "diminishing suffering in advanced cancer." Evidence is lacking and further research is mandated (Magill, 2001). Browning (2000) in her study examines the effect of music therapy in labor pain management in primiparas. This is a small study that particularly focused on music as a coping strategy. The music therapy was planned with training before labor about how to focus and cope using music. The patients used this as a distracter, and the author concludes that planned use of music can be an aid to prenatal preparation and can be a useful adjunct in pain management as a distressor during labor and childbirth. This study was based on descriptive design. It should be accepted that music is a noninvasive, nonmedical method with no negative side effects, and from these results, the author concludes that it can establish a strong mind-body relationship, generating a sense of control. Music can be used as a method to enhance relaxation (Browning, 2000). Best Research Design The Nilsson et al (2005) study has the best research design. The methodology clearly mentions the setting, the sample size, the intervention, and criteria of inclusion of the participants. The sample size is large, and since it was designed to study the effects of music in intraoperative and postoperative phases, the authors removed the bias by entrusting a single surgeon to perform the surgery, who was blinded. This removed the technical confounding factors. The conditions of anesthesia also remained the same. Since the intervention involved audition, all patients were checked not to be deaf. Randomization was done, and the authors used block randomization to keep the number of subjects in different groups closely balanced. The study was ethically cleared. All patients received same anesthetic protocol. Intraoperative group listened to the same music with the same audio settings to remove any bias. The most striking part is that the authors sought evidence of changes through objective means through the use of blood tests. Other physical parameters were examined with vital sign examination. Quantitative data were analyzed with statistical tests. This design increased internal validity, external validity, and reliability of the study through removal of bias, randomization, and seeking objective parameters. This study has an excellent design (Nilsson, Unosson, and Rawal, 2005). Most Clearly Developed Purpose or Problem statement Browning (2000) study has the most clearly developed problem statement. The author discloses the usefulness of music in pain management in different painful conditions including postoperative pain. The author mentions other research that suggests psycho-neurological connection between pain and music through sensory input. There is also anatomic evidence that pain and music share the same pathway. It has been suggested that through hypothalamus, emotion-based messages from the limbic system can effect responses to music. From here, the author makes her problem statement and states that music therefore can have influencing effect on alleviation of stress, pain or both. This presents a logical flow of statements that help the reader to reach a question or problem statement himself, and the need for a study involving music therapy and its effect on stress reduction and coping seem very logical. Moreover, none of the other studies could develop similar problem statement (Browning, 2000). Best Sample Size for Research Problem Only two studies actually used a research design. The study by Browning (2000) employs only 11 women, whereas the study by Nilsson et al. (2005) used 75 participants. Increased sample size increases generalizability of the study and increases chances of implementation of the study in practice. Moreover, increased sample size increases reliability of study. Given the fact that pregnancy is very common, only data from 11 women are not enough. This constricts the scope of the evidence. If subjective responses are studied, it is better to have a content analysis of the statements of a larger sample. Whereas in the other study by Nilsson et al. (2005), surgery being a common clinical practice, the sample size is appropriate in that findings from a large number of patients can generate a result with statistical significance, and a conclusion can be reached. This sample size was further adjusted with power calculations. Therefore, the study by Nilsson et al. (2005) has the best sample size for their research problem (Nilsson, Unosson, and Rawal, 2005). Best and Most Accurate Conclusions from Findings Nilsson et al. (2005) incorporated an experimental randomized controlled trial design that involved elimination of bias and confounding factors. To increase the validity of the study, they also incorporated objective blood parameters and physical findings. Therefore, the data they received could be corroborated to drawn conclusion. Moreover statistical analysis of the data and test of significance imparted accuracy to the results, which were further corroborated by corresponding analyses of the findings from physical examination. The authors also suspected within the study that power analysis might have overestimated the effect of music, and they corrected this potential error by doubling the size of the groups. The reduction in morphine requirements and the significance of anxiety and pain score were further brought to perfection by U-test with Bonferroni correction to lead to an accurate result with statistical significance with a P-value of less than 0.05 (Nilsson, Unosson, and Rawal, 2005). Comparison of Analysis Playing recorded music to patients while they are resting on bed or chair reduces anxiety and improves mood. With advanced cancer, pain that may interfere with functioning may not be lessened by music, but music may improve comfort, insight, and intimacy with others to bring about peace. Planned use of music by mothers can be an aid to prenatal preparations and during labor in the primiparas. Therefore, it can be an adjunct to pain and stress management, since music is a form of coping. Although organized data are not available and need for further research is felt before recommending music as a pain reliever in children, studies reveal that it is an effective distracter. Music therapy can be used in intraoperative patients to reduce postoperative pain, and in the postoperative period, it may reduce pain, morphine consumption, and stress response. This can be compared to findings from a systemic review by Nilsson (2008) where the author comments that the effect of music on pain and stress of surgical patients are not well understood. Further research is needed. In clinical practice, music alone should not be used in postoperative patients, but this can be an adjunct. Music intervention is useful to reduce unpleasant experiences and discomfort. Perioperative care may use music as analgesic, anxiolytic, or relaxing agent. It can help comfort perioperative patient distress (Nilsson, 2008). Protocol The patients must be educated how to use music on admission. Mainly listening and focusing attention should be the goals. Those who are not operated will be allowed their music of choice. Those who are in palliative care must listen to music. For children music may be used, but other modalities of treatment must be used along with this. For pregnant patients who are delivering, music in the antenatal period should be used. Music can be used in the perioperative period and intraoperative periods. Synthesis and conclusion The studies that were critiqued here provide an eye opener to the utility of music therapy in various areas of clinical nursing practice. All the findings have implications and can serve as evidence for future practice. It is to be remembered that research is limited in this area, and therefore practicing on music therapy must involve continuous search for evidence to create a guideline for practice. Reference List Browning, CA., (2000). Using Music during Childbirth. Birth, 27:4; 272-277. Evans, D., (2001) for The Joanna Briggs Institute for Evidenced based Nursing and Midwifery. Music as an Intervention in Hospitals. Volume 5, Issue 4: 1-7 Evans, S., Tsao, JCI., Zeltzer, LK., (2008). Complementary and Alternative Medicine for Acute Procedural Pain in Children. Alternative Therapies in Health and Medicine; 14, 5; 52-57. Magill, L. (2001). The use of music therapy to address the suffering in advanced cancer pain. Journal of Palliative Care; 17, 3, 167-174 Nilsson, U., Unosson, M., Rawal, N., (2005). Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial. European Journal of Anaesthesiology; 22: 96-102. Nilsson, U., (2008). The Anxiety- and Pain-Reducing Effects of Music Interventions: A Systematic Review. AORN Journal, Vol 87, No 4, 780-804. Read More