Hubert J. Bardenheuer

Music Therapy in Palliative Care.

BACKGROUNDnMusic therapy has been used successfully for over 30 years as part of palliative care programs for severely ill patients. There is nonetheless a lack of high-quality studies that would enable an evidence-based evaluation of its psychological and physiological effects.nnnMETHODSnIn a randomized controlled trial, 84 hospitalized patients in palliative care were assigned to one of two treatment arms--music therapy and control. The music therapy intervention consisted of two sessions of live music-based relaxation exercises; the patients in the control group listened to a verbal relaxation exercise. The primary endpoints were self-ratings of relaxation, well-being, and acute pain, assessed using visual analog scales. Heart rate variability and health-related quality of life were considered as secondary outcomes. The primary data analysis was performed according to the intention-to-treat principle.nnnRESULTSnAnalyses of covariance revealed that music therapy was more effective than the control treatment at promoting relaxation (F = 13.7; p <0.001) and well-being (F = 6.41; p = 0.01). This effect was supported by a significantly greater increase in high-frequency oscillations of the heart rate (F = 8.13; p = 0.01). Music therapy did not differ from control treatment with respect to pain reduction (F = 0.4; p = 0.53), but it led to a significantly greater reduction in the fatigue score on the quality-of-life scale (F = 4.74; p = 0.03).nnnCONCLUSIONnMusic therapy is an effective treatment with a low dropout rate for the promotion of relaxation and well-being in terminally ill persons undergoing palliative care.

Music therapy to promote psychological and physiological relaxation in palliative care patients: protocol of a randomized controlled trial

BackgroundMusic therapy is one of the most frequently used complementary therapies in different palliative care settings. Despite its long tradition and high acceptance by other health-care professionals, evidence on the effectiveness of music therapy interventions for terminally ill patients is rare. Recent reviews and health-care reports consistently point out the need of music therapists to provide an evidence-based rationale for their clinical treatments in this field. Therefore, the present study evaluates the psychological and physiological response of palliative care patients to a standardized music therapy relaxation intervention in a randomized controlled trial.Methods/designA sample of 84 participants from a palliative care unit in Heidelberg is randomized to either two sessions of music therapy or two sessions of a verbal relaxation exercise, each lasting 30xa0minutes. The music therapy sessions consist of live played monochord music and a vocal improvisation, the control group uses a prerecorded excerpt from the mindfulness-based stress reduction program containing no musical elements. Outcome measures include self-report data on subjective relaxation, well-being, pain intensity, and quality of life, as well as continuous recording of heart rate variability and blood volume pulse as indicators of autonomous nervous system functioning.DiscussionTo our knowledge, this study is the first clinical trial in Europe and one of very few randomized controlled trials worldwide to systematically examine the effects of music therapy in palliative care.Trial registrationGerman Clinical Trials Register – DRKS00006137

Methodological challenges for music therapy controlled clinical trials in palliative care

Since the late 1970s, music therapy has been an important part of multidisciplinary palliative care programs. Despite its wide application and high acceptance by patients, caregivers and staff members, recent systematic reviews and reports point to a lack of research, and the need for controlled clinical trials. The present article reviews the methodological quality of controlled clinical trials on the effects of music therapy in palliative care and addresses issues regarding the implementation of such designs. We identified eight studies (both published and unpublished), conducted between 2003 and 2013, through a systematic search of the scientific literature. We present major challenges according to the PICOS taxonomy and provide recommendations for future research using controlled clinical trial designs.

Evaluating a Treatment Manual for Music Therapy in Adult Outpatient Oncology Care

Music therapy is a prevalent treatment for people with a life-threatening illness, with inpatient oncology care being one of the most common fields of application. A recently published review on this topic shows that studies examining the effects of active music therapy treatments in an outpatient setting are still rare. Based on the Phase Model of Psychotherapy Outcome, a treatment manual has been developed for outpatient music therapy cancer care, consisting of 20 individual sessions. The aim of this study was to evaluate the effectiveness of the procedures of this manual by comparing prescores and postscores of 20 patients’ self-reported general therapy outcome, quality of life, and subjective pain intensity ratings. Results show that the intervention led to a significant improvement on all 3 dependent measures. Effect sizes ranged from medium to large. The authors conclude that it is necessary to further expand outpatient cancer care in Germany and to integrate music therapy as an effective treatment into these areas.

Trajectories of Terminally Ill Patients' Cardiovascular Response to Receptive Music Therapy in Palliative Care

CONTEXTnRelaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms.nnnOBJECTIVESnThe present analysis aimed at examining the psychophysiological pathways of terminally ill patients cardiovascular response to a live music therapy vs. prerecorded mindfulness exercise.nnnMETHODSnEighty-four patients of a palliative care unit were randomly assigned to either of the two interventions. Multilevel modeling was used to analyze trajectories of physiological change. Vagally mediated heart rate variability (VM-HRV) and blood volume pulse amplitude (BVP-A) served as indices of autonomic nervous system response. Participants gender, age, baseline scores, self-rated pain, and assignment to treatment were entered to the models as predictors.nnnRESULTSnBoth VM-HRV and BVP-A showed significant linear and quadratic trends over time, as well as substantial heterogeneity among individuals trajectories. Baseline scores, pain, and treatment significantly accounted for random variation in VM-HRV intercepts. BVP-A levels were significantly higher in women than in men. Moreover, assignment to treatment significantly accounted for differences in the linear slopes of peripheral blood flow.nnnCONCLUSIONnHigher levels of VM-HRV in the music therapy group highlight the importance of a therapeutic relationship for the effectiveness of relaxation interventions in end-of-life care settings. Music therapy caused significantly stronger reductions of vascular sympathetic tone and, therefore, may be indicated in the treatment of pain and stress-related symptoms in palliative care. Initial self-ratings of pain moderated patients physiological response and need to be taken into account in clinical practice and future theory building.

Effects of vibroacoustic stimulation in music therapy for palliative care patients: a feasibility study.

BackgroundThe present study aimed at examining whether methodological strategies from a previously implemented study design could be transferred to the evaluation of the psychological and physiological effects of a music therapy intervention working with vibroacoustic stimulation in palliative care.MethodNine participants suffering from advanced cancer took part in single-sessions of music therapy, lasting for 30xa0min. The live music therapy intervention utilized singing chair sounds and vocal improvisation. Visual analogue scales (VAS) were used to assess self-ratings of pain, relaxation, and well-being before and after each session. During the intervention, we continuously recorded heart rate variability (HRV) as a measure of autonomic functioning. Data collection was complemented by a semi-structured interview to explore subjective experiences in more detail. Feasibility was defined as the ability to complete 80xa0% of the sessions in accordance with the study protocol.ResultsIn 5 out of 9 sessions (55xa0%) it was possible to deliver the intervention and obtain all data as intended. VAS assessment was feasible, although graphical and statistical examination revealed only marginal mean changes between pre and post. HRV recordings were subject to artifacts. While HRV parameters differed between individuals, mean changes over time remained relatively constant. Interview data confirmed that the individual perception was very heterogeneous, ranging from “calming” to “overwhelming”.ConclusionThe criterion of feasibility was not met in this study. Physiological data showed high attrition rates, most likely due to movement artifacts and reduced peripheral blood flow in some participants’ extremities. Examination of individual-level trajectories revealed that vibroacoustic stimulation may have an impact on the autonomic response. However, the direction and mechanisms of effects needs to be further explored in future studies.Trial registrationGerman Clinical Trials Register – DRKS00006137 (July 4th, 2014).

I Need to Hear Some Sounds That Recognize the Pain in Me: An Integrative Review of a Decade of Research in the Development of Active Music Therapy Outpatient Treatment in Patients With Recurrent or Chronic Pain

Music is widely used to reduce pain in a broad variety of clients and settings. Most studies focus on the pain-reducing effect of music- listening interventions on patients with acute pain, whereas studies investigating the effect of active therapy (ie, music making) on pain perception in patients with recurrent or chronic pain are rare. This article reviews the findings of a series of previously published studies by our work group, conducted during the past 10 years, using defined music therapy plans in the treatment of outpatients with conditions of recurrent or chronic pain. This review provides evidence that a specific music therapy concept tailored to the demands of the patient might be able to substantially reduce pain frequency and pain intensity in patients with recurrent or chronic pain. However, further studies need to investigate the nature of those beneficial effects and their specificity.

Was ist das eigentlich, Schmerz?

Schmerz ist nach der Definition der Internationalen Gesellschaft zum Studium des Schmerzes (IASP) „ein unangenehmes Sinnes- und Gefuhlserlebnis, das mit aktueller oder potenzieller Gewebeschadigung verknupft ist oder mit Begriffen einer solchen Schadigung beschrieben wird. Der akute Schmerz tritt entweder unmittelbar nach einem akuten Ereignis oder im Rahmen einer Entzundung auf. Er hat in diesen Situationen eine Warnfunktion. Schmerzen, die uber einen Zeitraum von drei bis sechs Monaten insbesondere auch nach Beseitigung der vermeintlichen Ursachen und vermeintlich abgeschlossenem Heilungsprozess bestehen bleiben, sind chronische Schmerzen. Der chronische Schmerz hat biologische (z. B. Schmerz bedingte Funktionseinschrankung), psychische (z. B. Storung von Stimmung und Befindlichkeit) und soziale (z. B. Beeintrachtigung der Arbeitsfahigkeit) Folgen und ist als eigenstandige Krankheit zu bewerten.

Wo Schmerzen behandelt werden

Das Zentrum fur Schmerztherapie und Palliativmedizin des Universitatsklinikums Heidelberg ist eine Sektion der Klinik fur Anasthesiologie und erfullt die universitaren Aufgaben des Fachgebietes in Lehre, Forschung und klinischer Versorgung. Das Zentrum fur Schmerztherapie und Palliativmedizin ist eines der vier uberregionalen Schmerzzentren in Baden-WurttembergSchmerzzentren in Baden-Wurttemberg und ubernimmt die ambulante Versorgung von erwachsenen Patienten und Kindern mit chronischen, tumorbedingten und nicht-tumorbedingten Schmerzen. Patienten mit aktiver und weit fortgeschrittener Tumorerkrankung, bei denen der Schwerpunkt der Behandlung auf dem Erhalt der Lebensqualitat durch Schmerzreduktion liegt, werden nach einem ganzheitlichen Therapiekonzept von Palliativmedizinern des Universitatsklinikums und spezialisierten Fachpflegekraften in der Palliativstation des Krankenhauses St. Vincentius behandelt.

Wie man Schmerzen behandelt

Bevor therapeutische Masnahmen geplant und eingeleitet werden, muss die Zuordnung zu einem bestimmten Schmerztyp und den zugehorigen Schmerzmechanismen durch eine sorgfaltige Erhebung der Anamnese gesichert werden. Neben der Schmerzdauer, dem Schmerzbeginn und seiner zeitlichen Entwicklung und dem Schmerzcharakter mussen auch die relevanten Begleitsymptome erfragt werden. Die Schmerzintensitat wird uber Skalen erfasst. Sie erlauben auch, den Erfolg einer Schmerztherapie abzu schatzen. Die Pharmakotherapie von Schmerzen stellt ledigleich ein Puzzleteil von vielen fur die ganzheitliche Behandlung von Patienten mit Schmerzen dar. Insbesondere bei der Behandlung chronischer Schmerzen kommt eine Vielzahl von Behandlungsmethoden zum Einsatz.