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Last week, we talked about music in the operating room and its potentially positive effect on surgeon and operating room staff, possibly by decreasing stress. Let’s change our focus now to the patient. What effect does music have on patients undergoing surgical procedures? Should we consider greater use of music in our offices and operating rooms? If beneficial, by what mechanism does it work? Finally, does the medical literature provide these answers?
Is Music Effective on Patients? In fact, the medical literature is replete with studies demonstrating the benefits of music on patients undergoing surgery. Take for example a single-blinded randomized control trial of music played before and during colonoscopies. Researchers found a statistically significant decreased mean pain score, decreased administration of sedating medication, and overall improved satisfaction of patients (Costa, et al. 2010).
Similarly, music therapy was found to significantly reduce pain and anxiety levels in patients undergoing spinal surgery, though no statistically significant difference was noted in urine cortisol, norepinephrine, epinephrine, or blood pressure levels (Lin, et al. 2011) indicating a psychological, if not strictly biological response. A systematic review looked at the available literature on active and passive music therapy for pain and anxiety reduction in children. Nineteen studies with a total of 1513 subjects were analyzed, and these did, in fact, demonstrate that music reduced pain and anxiety in children undergoing invasive procedures (Klassen, et al. 2008).
Finally, a Cochrane database review of 51 studies with 1867 patients exposed to music during medical procedures found a decrease in pain levels and opioid use compared with controls. They found the overall effect to be small and raised questions about its clinical utility (Cepeda, et al. 2008). Despite this last review, the overall literature seems to point to music’s positive effect on decreasing pain and anxiety in patients undergoing surgical procedures (particularly when allowed to choose their own music), though more high quality research remains to be done. What’s the Mechanism?
Since music seems to have a positive effect on patients, the next logical question is what is the mechanism of action? From a neurobiological standpoint, music seems to stimulate multiple neural pathways and locations involving emotional function, including the insular and cingulate cortex, hypothalamus, hippocampus, amygdala, and prefrontal cortex. Additionally, activation of endorphins, endocannabinoids, dopamine, and nitric oxide have been found in patients listening to music (Boso, et al. 2006). Music is also theorized to act as a distractor, focusing the attention onto something more positive and away from the stressors of the medical environment (Nillson 2008). Combine these two mechanisms, a neuropharmacological reward system and a distractor, and the result is a potentially powerful mediation of stress, anxiety, and pain that may have a significant benefit for our patients undergoing surgical procedures. Conclusions Based on this information we can make some reasonable conclusions on the use of music. First, music does seem beneficial in reducing anxiety, stress, and some degree of pain related to surgical procedures. Second, the true extent of this effect is not well known and needs better delineation by higher quality research studies including randomized controlled trials. Third, for those interested in using music during procedures, consider allowing patients to choose their music and have them begin listening to it prior to and during the procedure. For your patients’ benefit – and perhaps for yours too - consider using music as a value-added component to your perioperative routine.
At the conclusion of this article, please scroll down for a very special awards announcement. Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum. Best wishes.
References
SPECIAL AWARDS ANNOUNCEMENT
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