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

AORN Journal,  April, 2008  by Ulrica Nilsson

• E-mail
• Print
• Link

This systematic review shows that music intervention can have an effect on reducing patient anxiety and pain in the perioperative setting. This was demonstrated in approximately 50% of the outcomes in the studies included in this review. In quantitative measures, music intervention was found to reduce the use of sedatives and analgesics. Some minor but still significant effects of music interventions were documented in the reduction of heart rate, blood pressure, respiratory rate, and reduced blood cortisol levels. Bernadi et al (61) discovered that breathing frequency, heart rate, and blood pressure were increased when patients listened to music, and this increase was proportional to the tempo of the music. More interesting, however, was that two minutes of silence randomly interspersed between the different styles and tempos of music produced a decrease in respiratory rate, heart rate, and blood pressures below baseline levels. (61) Perhaps music functions more as a "driving input," and therefore, the effects of music with a slower tempo on a patient's vital signs are minor. Instead, music with a slower tempo might be more of a distracter from the patients' psychological and physiological experiences such as pain and anxiety.

In a study on experimentally induced cold pressor pain (ie, simulated pain created by immersing a patient's hand and forearm in ice-cold water), the results indicated that the patients' preferred music distracted their attention from pain and helped provide control over it. While listening to music, the meaning of the negative sensation can be altered, and the patient gains a sense of autonomy and an ability to cope. (62) The positive effects of music intervention has been likened to patient-controlled analgesia, (13) and music could be called "audioanalgesia," "audioanxiolytic," or "audiorelaxation."

TYPES OF MUSIC. The genre and the duration of the soothing music did not seem to influence the effectiveness of music intervention. These results are confirmed both by a review that explored the use of music and its effect on anxiety during short waiting periods (63) and a Cochrane review that explored the effects of music on pain. (64) Although patients' selection of the type of music has been advocated by some, (3,19-21) the Cochrane review found that the positive effect of music was similar in studies in which patients selected the type of music and those in which patients did not choose the type of music. (64) It appears that the tempo of the music is the most important factor, with slow and flowing music with 60 to 80 beats per minute having positive outcomes on relaxation and pain relief. It has been suggested in the literature that music used therapeutically should

* be nonlyrical,

* consist predominantly of low tones,

* comprise mostly strings with minimal brass or percussion, (1) and

* have a maximum volume level at 60 dB. (65)

FUTURE RESEARCH

It should be noted that the music used in the investigations reviewed in this article was not developed or designed for the treatment of patients in the health care setting. Based on this review, it is not possible to determine whether the use of specially designed music would further improve the beneficial effects of the music intervention for these patients. Similarly, documentation concerning music's effects on patients related to the correct dosage (eg, volume, time period, choice of sound source) is very limited. Future research should evaluate the effects of specially composed music that is designed for this specific setting or for individual patients or patient groups. Likewise, the differences in the effect of music interventions related to patient gender, age, and ethnicity should be evaluated by future studies.