Music therapy: another choice in managing pain*

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*) The article explains specifically on one research and summarizes it briefly about how music effects on power, pain, depression and disability on patient.

The journal is written by Sandra L. Siedliecki PhD RN CNS and Marion Good PhD RN FAAN and publicized in January 13th 2006.

Patient with chronic non-malignant pain (CNMP) syndromes usually have experiences of pain, depression, disability and feelings of powerlessness; which usually comes from avoidance of family, social, recreational, and employment activities because of pain fear. Medications that used to manage pain have limited usefulness because of their side effect. Music-listening intervention can increase the effects of analgesics, decrease depression and disability, and promote beliefs of personal power.

The use of music in acute, cancer, and procedural pain management has been noticed effective. But only one quasi-experimental study and one clinical trial that have been examined the effect of music on CNMP out of its effect on power, depression or disability. The quasi-experimental study by Schoor (1993) state a statistically significant decrease in pain in women with rheumatoid arthritis after listen their self-selected music for 20 minutes; with limitations in lack of control group, random selection, differences between pretest and post-test scores, selection bias or maturation. The clinical trial by McCaffrey and Freeman (2003) in two sample group of older men and women with osteoarthritis, discover statistically significant reduction in pain from group that listened to researcher-provided of classical relaxing music 20 minutes each day for 14 days, as compared to control group on the contrary. The previous music-CNMP studies have limitations in not-studying effects on other CNMP variables; not-discovering if there any similarities or differences effect with younger patients; and not-comparing effect of different music styles.

The aim of the study were to test the effect of music on levels of power, pain, depression and disability; compare the effect of subject-selected music with researcher-provided music; test the relationship between power and combined dependent variable of pain, depression and disability.

The randomized controlled trial was used to examine the hypotheses of: (1) CNMP-individuals who use music an hour each day for 7 days will have more power, and less pain, depression and disability than those who do not use music; (2) CNMP-individuals who use patterning music (PM) will have more power and less pain, depression and disability than those who use standard music (SM); and (3) when power is statistically controlled, there will be no differences in pain, depression and disability between groups who use music and those who do not use music.

This study uses the theoretical framework from Roger’s science of unitary human beings (1990) and Barrett’s theory of power (1986). Rogers describes human beings as energy fields characterized by pattern and in continuous mutual process and integral with environmental energy fields. Barrett defined power as knowing participation in change characterized by awareness, choices, freedom and involvement in making changes. In this model, music is the type of patterning and the two music interventions represent two levels of knowing participation in change.

A convenience sample (n ¼ 64) of patients with CNMP was recruited over a 24-month period from 2001 to 2003, from pain clinics and a chiropractic office in northeast Ohio, USA. Patients that proper to study were in ages of 21 until 65; had back, neck or joint pain for at least 6 months; receiving at least one medical pain management; could speak, read and write in English. To assign participants randomly to one of three study groups, it used the stratified random assignment using the Min-8 program in order to ensure homogeneity between groups and control potential differences related to age, gender, race or duration of pain.

The experimental interventions represented two levels of knowing participation in change (power) included PM and SM intervention. Participants used their assigned intervention for 1 hour a day for seven days with all music delivered through same type of tape player and headset which provided by researcher. The PM group use protocols develop by Hanser (1990) which contain these: to ease muscle tension and stiffness use upbeat, familiar, instrumental or vocal music; to facilitate sleep and relaxation or to decrease anxiety use slow, melodious and pleasant familiar instrumental or vocal music or sounds of nature; to improve mood when feeling angry or depressed use upbeat, familiar, instrumental or vocal music; to promote energy when feeling fatigued use energetic, rhythmic, familiar, instrumental or vocal music. Researcher transferred it to four 60-minute tapes.

The SM group was offered choice of one 60-minute relaxing instrumental music tape from collection of five tapes (piano, jazz, orchestra, harp and synthesizer) used in several music and acute pain studies. Those in the control group received standard care that did not include music intervention, and all participants kept a diary for 7 days.

The results from this study stated that listening to self-selected music and researcher-provided music for 1 hour over a period of 7 days increased feelings of power, and decreased pain, depression, and disability for African American and Caucasian men and women with chronic back, neck, and/or joint pain. Music interventions increased feelings of power, and post-test feelings of power predicted post-test depression scores, but not post-test pain or disability scores. Perceptions of depression may be more responsive to interventions that facilitate power than perceptions of pain and disability.

The results showed a statistically significant effect for music, with the two music groups combined having more power, and less pain, depression, and disability than the control group. No statistically significant differences were found between the two music groups, and power was not found to be a mediating variable. Power was found to be a predictor of the combined dependent variable, which supported the model that posited a direct effect for music on power, and both a direct and indirect effect for music on the combined dependent variable of pain, depression and disability.

Findings for the effect of different types of music were consistent in both self-selected music and researcher-provided music. The study showed that different types of music not only decreased pain intensity, but also decreased the frequency of depressive symptoms and perceptions of pain-related disability in patients with CNMP.

The limitations of this study are relatively small sample size; unexpected similarities between two music groups, which resulting in a possible type II error; inability to generalize findings to larger CNMP population; not-knowing the effect of music on CNMP-individual from different ethnic group.

The conclusion from the study is CNMP characterized by low levels of power and high levels of pain, depression and disability. Music is safe, inexpensive and easy for nurses to teach patients to use. Music-listening intervention alters patterns of pain, depression and disability.. The self-selected music interventions allow patients to choose their own music and schedule. Nurses have to aware about age, cultural, ethnic and gender differences in music preferences. Music can have different effects for different people or for same people at different times.