Marion Good

Relief of postoperative pain with jaw relaxation, music and their combination

The aim of this randomized controlled trial was to determine the effect of jaw relaxation, music and the combination of relaxation and music on postoperative pain after major abdominal surgery during ambulation and rest on postoperative days 1 and 2. Opioid medication provided for pain, following abdominal surgery, does not always give sufficient relief and can cause undesired side effects. Thus, additional interventions such as music and relaxation may provide more complete relief. Previous studies have found mixed results due to small sample sizes and other methodological problems. In a rigorous experimental design, 500 subjects aged 18-70 in five Midwestern hospitals were randomly assigned by minimization to a relaxation, music, relaxation plus music, or control group. Interventions were taught preoperatively and tested postoperatively. The same amount of time was spent with subjects in the control group. Pain was measured with the visual analogue sensation and distress of pain scales. Demographic and surgical variables, and milligrams of parenteral or oral opioids in effect at the time of testing were not significantly different between the groups, nor did they correlate with pain scores. Controlling for pretest sensation and distress, orthogonal a priori contrasts and multivariate analysis of covariance indicated that the three treatment groups had significantly less pain than the controls, (P = 0.028-0.000) which was confirmed by the univariate analysis of covariance (P = 0.018-0.000). Post hoc multivariate analysis revealed that the combination group had significantly less sensation and distress of pain than the control group on all post-tests (P = 0.035-0.000), and the relaxation and music groups had significantly less on all tests (P = 0.022-0.000) except after ambulation. At post ambulation those using relaxation did not have significantly less pain than the controls on both days and those using music did not on day 1, although there were some univariate effects. A corresponding significant decrease in mastery of the interventions from pre to post ambulation suggests the need for reminders to focus on the intervention during this increased activity. Physicians and nurses preparing patients for surgery and caring for them afterward, should encourage patients to use relaxation and music as adjuvants to medication for postoperative pain.

Sedative music reduces anxiety and pain during chair rest after open-heart surgery

Abstract Open‐heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non‐pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three‐group pretest–posttest experimental design with 61 adult postoperative open‐heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P≤0.001) and post hoc dependent t‐tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001–0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t‐tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001–0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open‐heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.

Relaxation and music to reduce postsurgical pain

AIMS We investigated the effects of relaxation, music, and the combination of relaxation and music on postoperative pain, across and between two days and two activities (ambulation and rest) and across ambulation each day. This secondary analysis of a randomized controlled trial was conducted from 1995 to 1997. BACKGROUND After surgery, patients do not always receive sufficient relief from opioids and may have undesired side-effects. More complete relief (10-30%) was found recently with adjuvant interventions of relaxation, music, and their combination. Comparison of effects between days and treatments have not been examined longitudinally. METHODS With a repeated measures design, abdominal surgery patients (n = 468) in five US hospitals were assigned randomly to one of four groups; relaxation, music, their combination, and control. With institutional approval and written informed consent, subjects were interviewed and taught interventions preoperatively. Postoperative testing was at ambulation and rest on days 1 and 2 using visual analogue (VAS) sensation and distress of pain scales. RESULTS Multivariate analysis indicated that although pain decreased by day 2, interventions were not different between days and activities. They were effective for pain across ambulation on each day, across ambulation and across rest over both days (all P < 0.001), and had similar effects by day and by activity. CONCLUSION Nurses can safely recommend any of these interventions for pain on both postoperative days and at both ambulation and rest.

Music reduces sensation and distress of labor pain

Labor pain is often severe, and analgesic medication may not be indicated. In this randomized controlled trial we examined the effects of music on sensation and distress of pain in Thai primiparous women during the active phase of labor. The gate control theory of pain was the theoretical framework for this study. Randomization with a computerized minimization program was used to assign women to a music group (n = 55) or a control group (n = 55). Women in the intervention group listened to soft music without lyrics for 3 hours starting early in the active phase of labor. Dual visual analog scales were used to measure sensation and distress of pain before starting the study and at three hourly posttests. While controlling for pretest scores, one-way repeated measures analysis of covariance indicated that those in the music group had significantly less sensation and distress of pain than did the control group (F (1, 107) = 18.69, p <.001, effect size =.15, and F (1, 107) = 14.87, p <.001, effect size =.12), respectively. Sensation and distress significantly increased across the 3 hours in both groups (p <.001), except for distress in the music group during the first hour. Distress was significantly lower than sensation in both groups (p <.05). In this controlled study, music--a mild to moderate strength intervention--consistently provided significant relief of severe pain across 3 hours of labor and delayed the increase of affective pain for 1 hour. Nurses can provide soft music to laboring women for greater pain relief during the active phase when contractions are strong and women suffer.

Imagery reduces children's post-operative pain

&NA; This un‐blinded experimental study investigated the effectiveness of imagery, in addition to routine analgesics, in reducing tonsillectomy and/or adenoidectomy pain and anxiety after ambulatory surgery (AS) and at home. Seventy‐three children, aged 7–12, were recruited from five AS settings. Thirty‐six children randomly assigned to the treatment group watched a professionally developed videotape on the use of imagery and then listened to a 30‐min audio tape of imagery approximately 1 week prior to surgery (T1). They listened to only the audio tape 1–4 h after surgery (T2), and 22–27 h after discharge from AS (T3). The 37 children in the attention‐control group received standard care. Pain and anxiety were measured at each time‐point in both groups. Measures of sensory pain were the Oucher and amount of analgesics used in AS and home; affective pain was measured with the Facial Affective Scale (FAS). Anxiety was measured using the State Trait Anxiety Inventory for Children (STAIC). When controlling for trait anxiety and opioid and non‐opioid intake 1–4 h before the pain measures, MANCOVA showed significantly lower pain and anxiety in the treatment group at T2, but not at T3. When controlling for trait anxiety, a two‐way RM MANCOVA indicated no significant group differences in combined opioid and non‐opioid use between the groups, or between times. Appropriately trained health care providers should use imagery to reduce post‐operative pain following tonsillectomy and/or adenoidectomy in AS. Teaching parents about adequate home administration of analgesics may increase the effectiveness of imagery at home.

Sensation and Distress of Pain Scales: reliability, validity, and sensitivity.

Psychometric properties of the Sensation and Distress of Pain Visual Analogue Scales (VAS) are compared to dual numerical rating scales (NRS) with data from a randomized controlled trial of postoperative patients. On postoperative days 1 and 2, 15-minute test-retest reliability was .73 to .82 for the VAS and slightly lower for the NRS, r = .72 to .78, while convergent validity of the scales ranged from r = .90 to .92; construct validity of sensation and distress ranged from r = .72 to .85; and discriminant validity was lower, r - .65 to .78. Both instruments were significantly associated with pain reduction following treatment, p < .05 to .01. The VAS scores were significantly lower, p < .01 to .001, and more evenly distributed than NRS scores. It is recommended that the VAS be used in research to produce continuous scores that are more suited to parametric analysis.

The effectiveness of music in relieving pain in cancer patients: A randomized controlled trial

OBJECTIVES To examine effects of sedative music on cancer pain. DESIGN A randomized controlled trial. SETTINGS Two large medical centers in Kaoshiung City, in southern Taiwan. PARTICIPANTS 126 hospitalized persons with cancer pain. METHODS Participants were randomly assigned to an experimental (n=62) or a control group (n=64), with computerized minimization, stratifying on gender, pain, and hospital unit. Music choices included folk songs, Buddhist hymns (Taiwanese music), plus harp, and piano (American). The experimental group listened to music for 30 min; the control group rested in bed. Sensation and distress of pain were rated on 100mm VAS before and after the 30-min test. RESULTS Using MANCOVA, there was significantly less posttest pain in the music versus the control group, p<.001. Effect sizes were large, Cohens d=.64, sensation, d=.70, distress, indicating that music was very helpful for pain. Thirty minutes of music provided 50% relief in 42% of the music group compared to 8% of the controls. The number needed to treat (NNT) to find one with 50% sensation relief was three patients. More patients chose Taiwanese music (71%) than American music (29%), but both were liked and effective. CONCLUSIONS Offering a choice of familiar, culturally appropriate music was a key element of the intervention. Findings extend the Good and Moore theory (1996) to cancer pain. Soft music was safe, effective, and liked by participants. It provided greater relief of cancer pain than analgesics alone. Thus nurses should offer calming, familiar music to supplement analgesic medication for persons with cancer pain.

Comparison of the effects of relaxation and music on postoperative pain.

This experimental study compared the effects of jaw relaxation and music, individually and combined, on sensory and affective pain following surgery. Abdominal surgical patients (N = 84) were randomly assigned to four groups: relaxation, music, a combination of relaxation and music, and control. Interventions were taught preoperatively and used by subjects during the first ambulation after surgery. Indicators of the sensory component of pain were sensation and 24-hour narcotic intake. Indicator of the affective component of pain were distress and anxiety of pain. With preambulatory sensation, distress, narcotic intake, and preoperative anxiety as covariates, the four groups were compared using orthogonal a priori contrasts and analysis of covariance. The interventions were neither effective nor significantly different from one another during ambulation. However, after keeping the taped interventions for 2 postoperative days, 89% of experimental subjects reported them helpful for sensation and distress of pain.

The Lived Experience of Listening to Music While Recovering from Surgery

Music has been shown to have positive physiological and psychological effects on patients in previous studies. In this study, the authors looked at the lived experience of listening to music and evaluated findings from a phenomenological perspective. Specifically, the authors described the following three themes that emerged from interview data with 8 participants who listened to music during postoperative recovery: (a) comfort from a discomforting condition, (b) familiarity in a strange environment, and (c) distraction from fear, pain, and anxiety. In addition, implications for the use of music by nurses are discussed.

Cultural Differences in Music Chosen for Pain Relief

Nurses use music therapeutically but often assume that all patients will equally appreciate the same type of music. Cultural differences in music preferences are compared across five pain studies. Music preferences for pain relief are described as the most frequently chosen type of music for each culture. Findings indicate that in four studies, musical choices were related to cultural background (p = .002 to .049). Although the majority in each group chose among the other types of music, Caucasians most frequently chose orchestra music, African Americans chose jazz, and Taiwanese chose harp music. For culturally congruent care, nurses should become aware of cultural differences in music preference and provide culturally specific selections among other music expected to have a therapeutic effect.