Using Music Interventions in Perioperative Care

Lori Gooding, PhD, MT-BC; Shane Swezey, BM, MT-BC; Joseph B. Zwischenberger, MD

Disclosures

South Med J. 2012;105(9):486-490. 

In This Article

Abstract and Introduction

Abstract

Anxiety and pain are common responses to surgery, and both can negatively affect patient outcomes. Music interventions have been suggested as a nonpharmacological intervention to alleviate pain and anxiety during surgical treatment. Although the data are somewhat mixed, the research suggests that music-based interventions are effective in reducing anxiety, pain perception, and sedative intake. The majority of studies have focused on interventions during the postoperative period and address pain reduction, with preoperative use of music targeting anxiety reduction the second most commonly cited objective. Most of the studies found in the literature involve passive music listening via headphones. The data suggest that researcher-selected music is most effective in reducing anxiety, primarily because it incorporates evidence-based parameters such as consistent tempo and dynamics, stable rhythms, and smooth melodic lines. Finally, the literature suggests that music therapists can serve as experts to help medical personnel identify effective implementation strategies.

Introduction

Music interventions are increasingly used before, during, and after surgical procedures to address a number of patient outcomes.[1] In particular, the use of music as a nonpharmacological intervention to alleviate pain and anxiety is frequently cited in the literature.[2] Current theory suggests that music functions as a distractor, diverting attention away from a negative catalyst and focusing awareness on soothing stimuli.[3] Other tenets suggest that music activates the brain circuitry involved in reward processes, promoting an endorphin-like response.[4] Finally, neuroscience suggests that music creates changes in neural pathways at the level of the cerebral cortex, hypothalamus, limbic system, and insula, which may induce relaxation and produce physiological changes.[4–6]

Music has been advocated as a tool to manage patients' pain and anxiety, increase patient satisfaction, and address patients' emotional, spiritual, and psychological needs during medical treatment.[3,4] Music interventions found in the research literature in general fall into two categories: music as "music medicine" and "music therapy."[4] Music medicine, which constitutes the bulk of the literature, is defined as passive listening to prerecorded music provided by medical personnel.[7] Listening interventions frequently occur via headphones and patients may or may not participate in some type of music selection process.[3] Conversely, music therapy involves the "clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program."[8] Although both music medicine and music therapy involve the use of music-based interventions, the distinction between the two is worth noting because the level of training in music and its therapeutic application varies, with music therapists receiving specialized training in this area.

As stated previously, the majority of the interventions described in the literature accurately fit the definition for music medicine (ie, passive music listening provided by a medical professional);[7,9] however, many of these interventions are referred to as music therapy. Perhaps this is related to a lack of understanding about the differences between music therapy and music medicine, or to the fact that research in music therapy is still in its infancy. It also is important to note that the research data on the effectiveness of music interventions are somewhat mixed, but this could be because the effect of music on pain and stress is not well understood or that there are a number of methodological limitations in published studies and not the lack of effectiveness of music interventions themselves.[3]

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