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The anxiety- and pain-reducing effects of music interventions: a systematic review

AORN Journal, April, 2008 by Ulrica Nilsson

Nurses face many challenges as they care for the needs of hospitalized patients, and they often have to prioritize physical care over the patient's emotional, spiritual, and psychological needs. Meeting these additional needs is a challenge. In clinical practice, music intervention can be a tool to support these needs by creating an environment that stimulates and maintains relaxation, well-being, and comfort. Music can be used as a self-management technique to reduce or control distress. (1) This article provides a systematic review of recent studies describing the clinical effects of music interventions for hospitalized patients in perioperative settings.

THE HISTORY OF MUSIC IN HEALTH CARE

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Music has been used since ancient times to influence human health. (1) Archaeological findings show that primitive man used music as a way to "appease the gods." (2) In the sixth century, the Greek philosopher Pythagoras, who is considered the founder of music therapy and geometry, believed that music greatly contributed to health. Pythagoras prescribed music and a specific diet to restore and maintain the harmony of the body and soul. (3)

In the mid 1800s, Florence Nightingale recognized the power of music in hospital wards to aid in the healing process for soldiers injured in the Crimean War. Nightingale also noted the effects of different types of music. She observed that wind instrument pieces with continuous sound or air generally had a beneficial effect on patients. She also observed that instruments that do not produce continuous sounds had the opposite effect. Nightingale believed it was the responsibility of nurses to control the patient's environment in order for healing to take place. (1,3-5)

After the invention of the phonograph in the late 1800s, recorded music could be used in the hospital setting. The most extensive account of music in general hospitals appeared during the first half of the 1900s when health care practitioners used music in conjunction with anesthesia and analgesia. (6) In 1914, Kane was the first person to provide intraoperative music to distract patients from the "horror of surgery." (7) (p1829)

In 1926, Ilsen established the National Association for Music in Hospitals. Ilsen, a nurse, advocated for the implementation of specific musical prescriptions or treatment regimes. She identified rhythm as the basic therapeutic element in music. (8)

In 1949, a group of surgeons studied the use of music in conjunction with psychosomatic factors in physical illness. They performed a series of procedures and observed that music had a calming effect on patients who were normally tense and nervous and for whom routine medications did not work. (9)

THE THERAPEUTIC EFFECTS OF MUSIC

Various complex theories, hypotheses, and assumptions have been proposed regarding how music works in the health care setting. In 2006, Sacks (10) indicated that the power of music scarcely has been examined, even though significant advances had been made in the preceding 20 years. Sacks believed that the power of music goes to the heart of being human. (10)

In 1990, Thaut (11) proposed that music stimuli have biological effects on human behavior by engaging specific brain functions involved in memory, learning, and multiple motivational and emotional states. The effects of music are seen in the right hemisphere of the brain; however, the left hemisphere may play a major role in the analytical aspects of cerebral interpretation of the music. Auditory perception of music occurs in the auditory center of the temporal lobe of the brain, which then signals the thalamus, midbrain, pons, amygdala, medulla, and hypothalamus. (11)

The commonly accepted theory explaining the pain-, anxiety-, and stress-reducing effects of music is that music acts as a distracter, focusing the patient's attention away from negative stimuli to something pleasant and encouraging. Music occupies the patient's mind with something familiar and soothing, which allows the patient to escape into his or her "own world." Additionally, patients can focus their awareness on the music to aid relaxation. (3,12-14)

It is important to provide perioperative nurses and managers with evidence that these interventions help reduce patients' experience of unpleasant symptoms and discomfort. In perioperative settings, patients often are in a transitional zone between consciousness and sleep. Many senses are impaired, but the patient's sense of hearing still functions. (1)

This systematic review of the literature, therefore, was conducted to identify randomized controlled trials (RCTs) that have assessed the effect of music interventions on perioperative patients' pain and anxiety. The definition of an RCT is a study in which patients are as signed to treatment groups or a control group based on a random or quasi-random method (eg, using random days, weeks, numbers).

SEARCH STRATEGY METHODS

A search of research articles published between January 1995 and January 2007 was performed on the Allied and Complementary Medicine Database (AMED), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Medline. Only articles written in English containing the following search terms were included:

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The anxiety- and pain-reducing effects of music interventions: a systematic review

AORN Journal, April, 2008 by Ulrica Nilsson

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