Music as an Intervention for Postoperative Pain

Juliette Blanchard, SN
Cedar Crest College, Allentown, PA
Abstract
Music is a source of pleasure for many people and has been used
throughout history to alleviate sickness and suffering. In the early
eighteenth century, Florence Nightingale recognized the power of music
in the early 1800s. Nightingale believed that music, that had a
continued harmony, performed by the human voice, on wind
instruments, and on string instruments, had a beneficial effect. Music
therapy as a non-pharmacological adjuvant and can be implemented as
a nursing intervention. A search of literature was narrowed to three
studies. A synthesis of the evidence was performed. Recommended
changes for practice and ways to implement changes to practice are
described. The purpose of this paper is to assess the effectiveness of
listening to music as an intervention to decrease post-operative pain.

Clinical Question

Recommendations for Practice

In postoperative patients, will playing music, as an adjunct to standard care, when compared to standard care alone,
result in lower reported pain scores?

Musicisauniqueexperiencefortheindividual.Theindividuals
musicalpreferencesandresponsetomusicareinfluencedbyearlier
experiencesofmusicandbygender,age,culture,mood,and
attitude.Considerationfortheindividualsmusicalpreferencesand
accuracyinthechoiceofmusicarecrucialandcontributetothe
therapeuticeffect(Engwall&Duppils,p.3712009).
Bycarryingoutmeasuresforpainrelief,identifyingneedsfor
additionalmeasures,andinterveningandassessingtheeffecton
patients,nursescanprovideoptimalpaincontrol(Engwall&
Duppils,p.371,2009)
Itisrecommendedforlocalnursestoassistwithtaichiintervention
programs(Gregory&Watson,2009).Nursingassessmentscanbe
usedtoassessstrength,gaitandbalancetodeterminetheriskfor
fallsineacholderadultbeforetheyparticipateinthetaichiexercise
program(Gregory&Watson,2009).

Synthesis of Evidence
Author(s)/
Year/Journal

Title

Introduction
Ensuring adequate pain relief for the postoperative patient population should be a
priority for health care providers (Engwall & Duppils, 2009).
Non-pharmacologic interventions have been proposed due to the recognized as value,
simplicity, and inexpensive qualities. Non-pharmacological interventions are best
served as adjuvants to pharmacologic approaches to pain management (Engwall &
Duppils, 2009).
Nurses play a large role in patient care and pain relief. By offering the combination of
non-pharmacological and standard care pain relief methods, may make a significant
contribution to pain control (Allred, Byers, & Sole, 2010).
Music is a common choice of non-pharmacological/nonchemical methods used
adjunctly to traditional care in the management of postoperative pain (Engwall &
Duppils, 2009). Music therapy can be implemented as a nursing intervention (Liu &
Petrini, 2015).
Current research substantiates that listening to music can increase comfort and
relaxation, relieve pain, lower distress, reduce anxiety, improve positive emotions and
mood, and decrease psychological symptoms (Liu & Petrini, 2015).

Purpose

Effects of music therapy on pain, anxiety, and vital

signs in patients after thoracic surgery.

Music as a nursing intervention for postoperative pain: A

Systematic Review

To examine the effect of music on postoperative To o examine the effectiveness of music listening on
pain, anxiety, and physiologic parameters in
pain, anxiety, and vital signs among patients after
thoracic surgery
patients undergoing total knee arthroplasty
(TKA)

To examine the effect of music on postoperative pain

Design: Experimental from 2007

Randomized Control Trial (RCT) from November

2013 to March 2014 for the clinical trial for the
clinical trial

Systematic review of data ranging from 1998 to 2007

56 patients scheduled for a TKA

112 patients

18 studies

32 bed orthopedic unit in a hospital in central

Florida

Thoracic surgery department of two tertiary hospitals Clinical Environment

in Wuhan, China

IV: Music intervention

IV: Music intervention

IV: Tai chi

DV: Pain and anxiety

DV: Pain, anxiety, and vital signs

DV: Pain

RV: Age

Gender

Ethnicity

Education

RV: Age

Gender

Education

Marital status

Job

Hospitalization payment

Religious belief

Previous surgery

RV: Age

McGillPainQuestionnaire

Faces pain scale

Thestatetraitanxietyinventory(STAI)

Visualanaloguescale(VAS)

Sample

Setting

Study Variables

ShortForm(MPQSF)
VisualAnalogueScale(VAS)forpain
Instruments

VisualAnalogueScale(VAS)foranxiety

Numericratingscale(NRS)

Verbalratingscale(VRS)
Vitalsigns:bloodpressure,heartrat,andrespiratory
WongBakerFacesScale
rate
Graphicnumericpainintensityscale
Patientcontrolledanalgesia(PCA)pumprecordings
Patientrecords

Process of Literature Search

Databases used: Cumulative Index for Nursing and Allied Health
Literature (CINAHL) and Google Scholar
Keywords: postoperative, surgery, pain, and music
Limitations: full text articles, year of publication 2008-2015, academic
journals, geographical location: United States, nursing journals,
evidenced-based practice
Results: Limiters narrowed results to 49 overall journals. Eight out of
49 journals were selected because music was the primary intervention
studied regarding pain management in postoperative patients.
The main three studies were chosen based on their Level and
Quality of evidence
All three studies concluded with similar results and provided beneficial
practice changes to nursing interventions and valuable knowledge
regarding pain management after post-operative intervention.

The effect of music on postoperative pain and

anxiety

Engwall, M., & Duppils, G. (2009)

Journal of PeriAnesthesia Nursing

Liu, Y., & Petrini, M. (2015) Complementary

Therapies in Medicine

Research Design

Significance of the Problem

Several studies have been done using music to treat postoperative pain; however, these
studies have mixed results, with some showing improved pain relief and others showed
no improvement in pain (Allred, Byers, & Sole, 2010).
Many patients experience unrelieved postoperative pain, despite increased knowledge
regarding pain and pain management among healthcare teams (Allred, Byers, & Sole,
2010).
Post-op atients often experience anxiety which can lead to these symptoms: fatigue,
have difficulty sleeping and digesting, lose appetite and weight, have elevated heart
rate, develop more stress, feel helpless and pessimistic, lose confidence to fight against
disease, all are adverse effect that harm the patient and delay their recovery (Liu &
Petrini, 2015).
It is also understood that pain causes stress, which in turn causes the cardiovascular
system to respond by activating the sympathetic nervous system, resulting in increased
heart rate, blood pressure, and oxygen demand (Liu & Petrini, 2015).
Unrelieved postoperative pain has a negative influence on patient satisfaction, recovery
can be prolonged, and the length of hospital stay and the health care costs can be
increased (Allred, Byers, & Sole, 2010).
Important goals for postoperative pain management are to eliminate discomfort, to make
recovery easier, and to avoid complications associated with the therapy (Engwall &
Duppils, 2009).

Allred, K., Byers, J., & Sole, M., (2010)

American Society for Pain Management
Nursing

TheresultsprovideevidencetoTheresults
provideevidencetosupporttheuseof
musicand/oraquietrestperiodtodecrease
painandanxiety
Results/Findings

Theinterventionsposenorisksandhavethe
benefitsofimprovedpainreportsand
decreasedanxiety.
Itpotentiallycouldbeopioidsparingin
someindividuals,limitingthenegative
effectsfromopioids.
Occasionaldisruptionsoccurred

Limitations

Inconsistentadministrationofas
needed/PRNpainmedications
Smallsamplesize/smalleffectsize

OutcomeMeasures
Thefindingsprovidefurtherevidencetosupportthe LimitedMusicchoice
practiceofmusictherapytoreducepostoperative
Specializedattentiontowardsinterventiongroup
painandanxiety,andlowersystolicbloodpressure
Researchconductedforonly3days
andheartrateinpatientsafterthoracicsurgeryin
China

Theresultsindicatethatmusicintervention
alleviatespostoperativepain
Thefindingscanberelatedtothepowerofmusicto
enhancedistractionandwellbeing,asa
psychologicalsupport,andtoincreaserelaxation.

None

Conclusion

Research substantiates the positive effects of music therapy among

varying types of post-operative patients.
Inadequate pain relief and control can lead to poor patient recovery.
A synergistic relationship between non-pharmacological and
pharmacological for pain management/patient care needs further
investment and this is a significant problem.
Nurses or therapists can utilize music as an intervention in order to
develop a therapeutic relationship among patients, provide pain
distraction, pain relief, decrease anxiety, improve sleep patterns,
among other outcomes.
Nurses can and should be informed that there is evidence to suggest
that music and rest are both options to lower pain and anxiety scores,
and these options should be considered when treating patients in
pain.
In conclusion, music, as an intervention to manage postoperative
pain, can be a powerful intervention when implemented in
healthcare settings.
References

Allred, K., Byers, J., & Sole, M. (2010). The effect of music
on
postoperative pain and anxiety. Pain Management
Nursing, 11(1), 15-25. doi:10.1016/j.pmn.2008.12.002
Melnyk, B.M. & Fineout-Overholt, E. (2011). Evidence-based
practice in nursing and healthcare: A guide to best practice.
Philadelphia: Lippincott, Williams & Wilkins.
Engwall, M., & Duppils, G. (2009). Music as a nursing
intervention for postoperative pain: A Systematic Review.
Journal of PeriAnesthesia Nursing, 24(6), 370-383.
doi:10.1016/j.jopan.2009.10.013
Liu, Y., & Petrini, M. (2015). Effects of music therapy on pain,
anxiety, and vital signs in patients after thoracic surgery.
Complementary Therapies in Medicine, 23(5), 714-718.
doi:10.1016/j.ctim.2015.08.002
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