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

Clinical Practice Implications

When looking through the research literature, a number of guidelines emerge that can be used to facilitate effective implementation of music medicine or music therapy interventions. These guidelines are, for the most part, consistent regardless of the goal (eg, anxiety, pain reduction) of the music intervention. Moreover, they highlight the need for careful consideration when selecting music for use in treating both pain and anxiety.

First, research suggests that expert-chosen or research-based musical selections are more effective than patient-selected music,[23–25] which is not to imply that patient preference should not be considered. Instead, it suggests that music that takes into account factors known to facilitate relaxation and pain reduction are more likely to be effective. Patient preference can still be accounted for by creating "playlists" consisting of different musical genres, all of which incorporate research-based factors in terms of the individual selections. Patients could then be allowed to select the playlist that best matches their own preferences.[24]

The research also highlights some effective musical parameters. In general, music used for anxiety/pain reduction should contain sustained (smooth) melodies, a general absence of strong rhythms, limited percussive instruments, and no lyrics.[24] A number of studies have shown these musical properties to be effective in reducing anxiety and/or pain.[3,24] When selecting music for anxiety and/or pain reduction, it is important to consider the following:

  • Tempo (music speed): slow; 60 to 80 beats per minute; stable, consistent tempo

  • Dynamics (volume): low level with minimal changes

  • Timbre (sound quality or tone color): gentle, without harsh contrasts

  • Texture (combination of sounds/instruments): consistent; limited instrumentation and/or changes

  • Melody (theme): legato or connected/smooth

  • Rhythm (movement): stable rhythms, absence of percussive or accented rhythms

  • Pitch (tone): simple harmonic or chord progressions

Based on findings in the literature, the above characteristics appear to be the most effective in producing positive results when using music-based interventions.[24–27]

In terms of implementation considerations, the research addresses a few important points. The literature suggests that repeated listening can increase the effectiveness of the music intervention.[24,25] It also suggests that music interventions should last at least 20 to 30 minutes without interruption.[3,24,26] Further suggestions include setting maximum volume levels at 60 decibels, using headphones, and measuring and documenting the effects of the intervention.[24] Limited data point to the possibility of using free-field music (ie, via loudspeakers) to reduce environmental noise, and data even suggest that music interventions may be useful in reducing length of stay in the intensive care unit and costs.[24,25,28] The data also suggest that the use of lyrics should be carefully considered because they may be too distracting or even arousing for some patients.[26]

Finally, it has been suggested that music therapists can serve as consultants when implementing music medicine–based interventions. Music therapists work in a number of settings, but medical music therapists have specialized training in the use of music-based interventions to address health-related outcomes such as chronic pain, physical rehabilitation, and surgery, among others.[29] In fact, at least one meta-analysis proposed that live music presented by a music therapist was more effective than recorded music, suggesting that the skills used by music therapists do affect treatment effectiveness.[30] Therefore, just like physicians who specialize in specific areas, medical music therapists' targeted knowledge can be used to provide valuable therapeutic and musical guidance to facilitate effective treatment involving music-based interventions for patients in the medical setting.[24,31,32]

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