Music for pain relief

Music Therapy as a Topic in Medical Education: Course Concept and Student Evaluation of an Elective Course for Medical Students

OBJECTIVES

Music therapy has been proven as a safe and well-established intervention in healthcare to relieve symptoms and improve quality of life. While music therapy is already established in several settings to supplement medical care, there is a lack of integration in the field of medical education.

METHODS

We report on the implementation and evaluation of a teaching concept for a five-day-intensive-course on music therapy. The course was offered as an elective course for medical students at the University Duisburg-Essen. At the end of the course, students filled out a free text questionnaire to assess the students' perception of the course, and additionally answered standardized questions by the structured EVALuna online evaluation tool of the University of Duisburg-Essen.

RESULTS

All students (N = 35) who participated in the music therapy course between September 2019 and March 2023 completed the questionnaires and N = 21 students filled out the EVALuna. Most students (89%) chose the course because of their interest in alternative and supportive therapy options to improve patients' well-being. About 46% had previous musical experience and passion and fun with music and 37% of the students were interested in the interdisciplinary academic subject that combined music and medicine. EVALuna online evaluation reflected high satisfaction with the course.

CONCLUSION

Due to the well-proven effectiveness and evidence of music therapy as well as the positive perception of medical students, music therapy should be further established in medical care and medical education.

Arts Therapy and Its Implications in Chronic Pain Management: A Narrative Review

Chronic nonmalignant pain is recognized as a complex, dynamic, phenomenological interplay between biological, psychological, and social factors that are individual to the person suffering from it. Therefore, its management and treatment ought to entail the individual's biopsychosocial aspects that are often addressed by collaborative, inter/multidisciplinary multimodal care, as there is no biologic treatment. In an effort to enhance inter/multidisciplinary multimodal care, a narrative review of arts therapy as a mind-body intervention and its efficacy in chronic pain populations has been conducted. Changes in emotional and physical symptoms, especially pain intensity, during arts therapy sessions have also been discussed in in the context of attention distraction strategy. Arts therapy (visual art, music, dance/movement therapy, etc.) have been investigated to summarize relevant findings and to highlight further potential benefits, limitations, and future directions in this area. We reviewed 16 studies of different design, and the majority reported beneficial effects of art therapy in patients' management of chronic pain and improvement in pain, mood, stress, and quality of life. However, the results are inconsistent and unclear. It was discovered that there is a limited amount of high-quality research available on the implications of arts therapy in chronic nonmalignant pain management. Due to the reported limitations, low effectiveness, and inconclusive findings of arts therapy in the studies conducted so far, further research with improved methodological standards is required.

Effect and safety of listening to music or audiobooks as a coadjuvant treatment for chronic pain patients under opioid treatment: a study protocol for an open-label, parallel-group, randomised, controlled, proof-of-concept clinical trial in a tertiary hospital in the Barcelona South Metropolitan area

BACKGROUND

Chronic non-cancer pain (CNCP) treatment's primary goal is to maintain physical and mental functioning while improving quality of life. Opioid use in CNCP patients has increased in recent years, and non-pharmacological interventions such as music listening have been proposed to counter it. Unlike other auditive stimuli, music can activate emotional-regulating and reward-regulating circuits, making it a potential tool to modulate attentional processes and regulate mood. This study's primary objective is to provide the first evidence on the distinct (separate) effects of music listening as a coadjuvant maintenance analgesic treatment in CNCP patients undergoing opioid analgesia.

METHODS AND ANALYSIS

This will be a single-centre, phase II, open-label, parallel-group, proof-of-concept randomised clinical trial with CNCP patients under a minimum 4-week regular opioid treatment. We plan to include 70 consecutive patients, which will be randomised (1:1) to either the experimental group (active music listening) or the control group (active audiobooks listening). During 28 days, both groups will listen daily (for at least 30 min and up to 1 hour) to preset playlists tailored to individual preferences.Pain intensity scores at each visit, the changes (differences) from baseline and the proportions of responders according to various definitions based on pain intensity differences will be described and compared between study arms. We will apply longitudinal data assessment methods (mixed generalised linear models) taking the patient as a cluster to assess and compare the endpoints' evolution. We will also use the mediation analysis framework to adjust for the effects of additional therapeutic measures and obtain estimates of effect with a causal interpretation.

ETHICS AND DISSEMINATION

The study protocol has been reviewed, and ethics approval has been obtained from the Bellvitge University Hospital Institutional Review Board, L'Hospitalet de Llobregat, Barcelona, Spain. The results from this study will be actively disseminated through manuscript publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT05726266.

Sensorimotor synchronization to music reduces pain

Pain-reducing effects of music listening are well-established, but the effects are small and their clinical relevance questionable. Recent theoretical advances, however, have proposed that synchronizing to music, such as clapping, tapping or dancing, has evolutionarily important social effects that are associated with activation of the endogenous opioid system (which supports both analgesia and social bonding). Thus, active sensorimotor synchronization to music could have stronger analgesic effects than simply listening to music. In this study, we show that sensorimotor synchronization to music significantly amplifies the pain-reducing effects of music listening. Using pressure algometry to the fingernails, pain stimuli were delivered to n = 59 healthy adults either during music listening or silence, while either performing an active tapping task or a passive control task. Compared to silence without tapping, music with tapping (but not simply listening to music) reduced pain with a large, clinically significant, effect size (d = 0.93). Simply tapping without music did not elicit such an effect. Our analyses indicate that both attentional and emotional mechanisms drive the pain-reducing effects of sensorimotor synchronization to music, and that tapping to music in addition to merely listening to music may enhance pain-reducing effects in both clinical contexts and everyday life. The study was registered as a clinical trial at ClinicalTrials.gov (registration number NCT05267795), and the trial was first posted on 04/03/2022.

The Effect of Guided Imagery on Postoperative Pain Management in Patients Undergoing Lower Extremity Surgical Operations: A Randomized Controlled Trial

Guided imagery distracts patients from disturbing feelings and thoughts, positively affects emotional well-being, and reduces pain by producing pleasing mental images. This study aimed to determine the effects of guided imagery on postoperative pain management in patients undergoing lower extremity surgery. This randomized controlled study was conducted between April 2018 and May 2019. This study included 60 patients who underwent lower extremity surgery. After using guided imagery, the posttest mean Visual Analog Scale score of patients in the intervention group was found to be 2.56 (1.00 ± 6.00), whereas the posttest mean score of patients in the control group was 4.10 (3.00 ± 6.00), and the difference between the groups was statistically significant (p <.001). Guided imagery reduces short-term postoperative pain after lower extremity surgery.

Enhanced Recovery After Aesthetic Breast Surgery Under Sedation, Intercostal Block and Tumescent Anaesthesia: A Prospective Cohort Study of the Early Postoperative Phase

BACKGROUND

Comfort and recovery are major concerns of patients seeking aesthetic surgery. This study aimed to assess postoperative pain and recovery after outpatient breast surgery under sedation, intercostal block, and local anaesthesia.

METHODS

This prospective cohort study included all consecutive patients who underwent aesthetic breast surgery between April 2021 and August 2022. Epidemiological data, anaesthesia, pain, and patients' satisfaction were systematically assessed with standardized self-assessment questionnaires.

RESULTS

Altogether, 48 patients [median (IQR) age: 30 (36-25)] were included. The most frequent surgery was mastopexy. 69% of surgeries involved additional procedures. The mean intercostal block and local anaesthesia time was 15 min. Patients received a median (IQR) of 19 (34-2) mg/kg lidocaine and 2.3 (2.5-2.0) mg/kg ropivacaine. The median (IQR) consumption of propofol and alfentanil was, respectively, 4.89 (5.48-4.26) mg/kg/h and 0.27 (0.39-0.19) µg/kg/min. No conversion to general anaesthesia or unplanned hospital admission occurred. Patients were discharged after a median (IQR) of 2:40 (3:43-1:58) hours. Within the first 24 postoperative hours, 17% required once an antiemetic medication and 38% an opioid. Patients were very satisfied with the anaesthesia and 90% of the patients had not wished more analgesia in the first 24 h.

CONCLUSIONS

Aesthetic breast surgery under sedation, intercostal block, and tumescent anaesthesia can safely be performed as an ambulatory procedure and is associated with minimal intra- and postoperative opioid consumption and high patient satisfaction. These data may be used to inform patients and clinicians and improve the overall quality of care.

LEVEL OF EVIDENCE IV

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Listening to music for insomnia in adults

BACKGROUND

Insomnia is a common problem in modern society. It is associated with reduced quality of life and impairments in physical and mental health. Listening to music is widely used as a sleep aid, but it remains unclear if it can actually improve insomnia in adults. This Cochrane Review is an update of a review published in 2015.

OBJECTIVES

To assess the effects of listening to music on sleep in adults with insomnia and to assess the influence of specific variables that may moderate the effect.

SEARCH METHODS

For this update, we searched CENTRAL, MEDLINE, Embase, nine other databases and two trials registers up to December 2021. In addition, we handsearched reference lists of included studies, and contacted authors of published studies to identify additional studies eligible for inclusion, including any unpublished or ongoing trials.

SELECTION CRITERIA

Randomised controlled trials comparing the effects of listening to music with no treatment or treatment as usual (TAU) in adults complaining of sleep difficulties.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened records for eligibility, selected studies for inclusion, extracted data and assessed risk of bias of the included studies. We assessed the certainty of the evidence using GRADE. The primary outcomes were sleep quality, insomnia severity, sleep-onset latency, total sleep time, sleep interruption, sleep efficiency and adverse events. Data on the predefined outcome measures were included in meta-analyses when consistently reported by at least two studies that were homogeneous in terms of participants, interventions and outcomes. We undertook meta-analyses using random-effects models.

MAIN RESULTS

We included 13 studies (eight studies new to this update) comprising 1007 participants. The studies examined the effect of listening to prerecorded music daily, for 25 to 60 minutes, for a period of three days to three months. The risk of bias within the studies varied, with all studies being at high risk of performance bias, because of limited possibilities to blind participants to the music intervention. Some studies were at high risk of detection bias or other bias. Four studies reported funding from national research councils, three studies reported financial support from university sources and one study reported a grant from a private foundation. Five studies did not report any financial support. At the end of the intervention, we found moderate-certainty evidence for improved sleep quality measured with the Pittsburgh Sleep Quality Index (PSQI) in themusic groups compared to no intervention or TAU (mean difference (MD) -2.79, 95% confidence interval (CI) -3.86 to -1.72; 10 studies, 708 participants). The PSQI scale ranges from 0 to 21 with higher scores indicating poorer sleep. The size of the effect indicates an increase in sleep quality of the size of about one standard deviation in favour of the intervention. We found no clear evidence of a difference in the effects of listening to music compared to no treatment or TAU on insomnia severity (MD -6.96, 95% CI -15.21 to 1.28; 2 studies, 63 participants; very low-certainty evidence). We found low-certainty evidence that, compared to no treatment or TAU, listening to music may reduce problems with sleep-onset latency (MD -0.60, 95% CI -0.83 to -0.37; 3 studies, 197 participants), total sleep time (MD -0.69, 95% CI -1.16 to -0.23; 3 studies, 197 participants) and sleep efficiency (MD -0.96, 95% CI -1.38 to -0.54; 3 studies, 197 participants), but may have no effect on perceived sleep interruption (MD -0.53, 95% CI -1.47 to 0.40; 3 studies, 197 participants). In addition, three studies (136 participants) included objective measures of sleep-onset latency, total sleep time, sleep efficiency and sleep interruption and showed that listening to music may not improve these outcomes compared to no treatment or TAU. None of the included studies reported any adverse events.

AUTHORS' CONCLUSIONS

The findings of this review provide evidence that music may be effective for improving subjective sleep quality in adults with symptoms of insomnia. More research is needed to establish the effect of listening to music on other aspects of sleep as well as the daytime consequences of insomnia.

Therapeutic Suggestions During General Anesthesia Reduce Postoperative Nausea and Vomiting in High-Risk Patients – A Post hoc Analysis of a Randomized Controlled Trial

Postoperative nausea and vomiting (PONV) are one of the most adverse events after general anesthesia, a distressing experience, and pose a risk to the patient. Despite advances in drug prophylaxis and PONV treatment, the incidence remains high and additional non-pharmacological treatments are needed. In this post hoc analysis of a recently published double-blind multicenter randomized controlled trial on the efficacy of intraoperative therapeutic suggestions on postoperative opioid dosage, we analyzed the effects of intraoperative therapeutic suggestions on PONV. We focus on patients with a high risk of PONV (Apfel risk score of 3–4) and distinguished early (first two postoperative hours) and delayed PONV (2–24 h). A total of 385 patients with a moderate or high risk for PONV were included. The incidence of early and delayed PONV was reduced (22.7–18.3 and 29.9–24.1%, respectively), without statistical significance, whereas in high-risk patients (n = 180) their incidence was nearly halved, 17.2 vs. 31.2% (p = 0.030) and 20.7 vs. 34.4% (p = 0.040), corresponding to a number needed to treat of 7 to avoid PONV. In addition, there was a significant reduction in PONV severity. In a multivariate logistic regression model, assignment to the control group (OR 2.2; 95% CI: 1.1–4.8) was identified as an independent predictor of the occurrence of early PONV. Our results indicate that intraoperative therapeutic suggestions can significantly reduce the incidence of PONV in high-risk patients. This encourages the expansion of therapeutic suggestions under general anesthesia, which are inexpensive and virtually free of side effects.

Clinical Trial Registration: German Clinical Trials Register, https://drks.de, registration number: DRKS00013800.

Music to My Senses: Functional Magnetic Resonance Imaging Evidence of Music Analgesia Across Connectivity Networks Spanning the Brain and Brainstem

Pain is often viewed and studied as an isolated perception. However, cognition, emotion, salience effects, and autonomic and sensory input are all integrated to create a comprehensive experience. Music-induced analgesia has been used for thousands of years, with moderate behavioural effects on pain perception, yet the neural mechanisms remain ambiguous. The purpose of this study was to investigate the effects of music analgesia through individual ratings of pain, and changes in connectivity across a network of regions spanning the brain and brainstem that are involved in limbic, paralimbic, autonomic, cognitive, and sensory domains. This is the first study of its kind to assess the effects of music analgesia using complex network analyses in the human brain and brainstem. Functional MRI data were collected from 20 healthy men and women with concurrent presentation of noxious stimulation and music, in addition to control runs without music. Ratings of peak pain intensity and unpleasantness were collected for each run and were analysed in relation to the functional data. We found that music alters connectivity across these neural networks between regions such as the insula, thalamus, hypothalamus, amygdala and hippocampus (among others), and is impacted by individual pain sensitivity. While these differences are important for how we understand pain and analgesia, it is essential to note that these effects are variable across participants and provide moderate pain relief at best. Therefore, a therapeutic strategy involving music should use it as an adjunct to pain management in combination with healthy lifestyle changes and/or pharmaceutical intervention.

Does art reduce pain and stress? A registered report protocol of investigating autonomic and endocrine markers of music, visual art, and multimodal aesthetic experience

The pain- and stress-reducing effects of music are well-known, but the effects of visual art, and the combination of these two, are much less investigated. We aim to (1) investigate the pain- and (2) stress-reducing effects of multimodal (music + visual art) aesthetic experience as we expect this to have stronger effects than a single modal aesthetic experience (music/ visual art), and in an exploratory manner, (3) investigate the underlying mechanisms of aesthetic experience, and the (4) individual differences. In a repeated-measures design (music, visual art, multimodal aesthetic experience, control) participants bring self-selected “movingly beautiful” visual artworks and pieces of music to the lab, where pain and stress are induced by the cold pressor test. Activity of the pain and stress responsive systems are measured by subjective reports, autonomic (electrocardiography, electrodermal activity, salivary alpha-amylase) and endocrine markers (salivary cortisol).

Exploring vibroacoustic therapy in adults experiencing pain: a scoping review

OBJECTIVE

To explore the characteristics and outcomes of vibroacoustic therapy (VAT) in adults experiencing pain. To give directions for future research and clinical applications of VAT in pain management for adults.

DESIGN

Scoping review.

DATA SOURCES

BMČ, CINAHL Plus, Cochrane Library, EBSCOhost, EBM Reviews, EMBASE, Epistemonikos, ERIC, MEDLINE complete, Scopus, Web of Science, Google Scholar, ProQuest, hand search in unpublished sources.

STUDY SELECTION

All quantitative and qualitative research studies and systematic reviews, without any date or language limit.

DATA EXTRACTION

Two independent reviewers extracted data on the study design, location and setting, the causes of pain, participants, vibroacoustic intervention, measurement tools, and key findings related to pain.

RESULTS

From 430 records, 20 were included for narrative synthesis. Fifteen studies researched chronic pain, two studies acute pain, two studies both types of pain and one study experimentally induced pain. The description of VAT applied in studies usually included the description of research experiments, vibroacoustic devices and frequencies of sinusoidal sound. There was high heterogeneity in study protocols, however, 40 Hz was predominantly used, most sessions ranged between 20 and 45 min, and the frequency of treatment was higher for acute pain (daily) compared with chronic pain (daily to once a week). Outcomes related to pain focused mainly on perceived pain; however, other surrogate measures were also considered, for example, an increased number of treatment days or pain medication usage.

CONCLUSIONS

Research in this area is too sparse to identify properties of VAT that are beneficial for pain management. We suggest VAT researchers describe a minimum of four measurements-frequency, amplitude, pulsation and loudness. Randomised controlled trials are needed to establish reliable scientific proof of VAT effectiveness for both acute and chronic pain. Furthermore, clinical practice would benefit from researching patients' experiences and preferences of vibroacoustic treatment and its psychosocial components.

Music Intervention for Pain Control in the Pediatric Population: A Systematic Review and Meta-Analysis

Music intervention (MI) has been applied as an effective adjunctive treatment for pain control in various clinical settings. However, no meta-analysis has yet been published on the analgesic effects of MI in infants and children. We performed a systematic review of PubMed, EMBASE, Web of Science, and Cochrane Library databases to identify randomized controlled trials (RCTs) with the keywords "pain" AND "music therapy" from inception to January 2022. Primary outcomes were pain intensity and vital signs. Standardized mean difference (SMD) values and the corresponding 95% confidence intervals (CIs) were computed using a random effect model. Subgroup analyses with age groups, types of pain, and music styles were conducted. A total of 38 RCTs involving 5601 participants met the selection criteria. MI significantly decreased the pain levels (SMD = -0.57, p < 0.001), both in the newborn group (p = 0.007) and in the infant/children group (p < 0.001). MI significantly reduced heart rate (SMD = -0.50, p < 0.001) and respiratory rate (SMD = -0.60, p = 0.002) and increased peripheral capillary oxygen saturation (SMD = 0.44, p < 0.001). In subgroup analyses of types of pain, MI had significant effects on prick pain (p = 0.003), chronic and procedural pain (p < 0.001), and postoperative pain (p = 0.018). As for music styles, significant analgesic effects were observed for classical music (p < 0.001), kids' music (p < 0.001), and pop music (p = 0.001), but not for world music (p = 0.196), special composition (p = 0.092), and multiple music combinations (p = 0.420). In conclusion, our analysis provides supportive evidence about the efficacy of MI, especially classical, kids', and pop music, in controlling prick, procedural, and postoperative pain in the pediatric population.

Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery

Clinical-experimental considerations and an approach to understanding the autonomic basis of improved surgical outcomes using Perioperative Music Medicine (PMM) are reviewed. Combined surgical, psycho-physiological, and experimental perspectives on Music Medicine (MM) and its relationship to autonomic nervous system (ANS) function are discussed. Considerations are given to the inter-related perioperative effects of MM on ANS, pain, and underlying vagal and other neural circuits involved in emotional regulation and dysregulation. Many surgical procedures are associated with significant pain, which is routinely treated with post-operative opioid medications, which cause detrimental side effects and delay recovery. Surgical trauma shifts the sympathetic ANS to a sustained activation impairing physiological homeostasis and causing psychological stress, as well as metabolic and immune dysfunction that contribute to postoperative mortality and morbidity. In this article, we propose a plan to operationalize the study of mechanisms mediating the effects of MM in perioperative settings of orthopedic surgery. These studies will be critical for the implementation of PMM as a routine clinical practice and to determine the potential limitations of MM in specific cohorts of patients and how to improve the treatment.

Prescribed opioid use is associated with increased all-purpose emergency department visits and hospitalizations in community-dwelling older adults in the United States

BACKGROUND

The geriatric and health characteristics of older adults make them more susceptible to the effects of opioids than younger groups. The number of older adults in the United States visiting the emergency department (ED) and overusing opioids has increased in recent years. Research examining their relationship is, however, limited.

METHODS

Using information from the 2020 National Health Interview Survey (NHIS), we included older adults aged 65 and older. To investigate the relationship between prescribed opioid use and 12-months ED visits and hospitalizations, linear regression and logistic regression models were built while adjusting for age, sex, ethnicity, education, employment, general health status, history of depression, and living arrangement.

RESULTS

Our study population consisted of 8,631 participants (mean age 74.3). Most of them were females (58.3%) and Caucasian (81.6%). About 16% of the participants used prescribed opioids over the past 12 months. Of the participants with prescribed opioid use, 65.1% of them did so to treat chronic pain. The adjusted regression models revealed that prescribed opioid use was independently and positively associated with 12-months ED visits (β = 0.22, 95% confidence interval [CI] 0.18, 0.26) and hospitalizations (Odds ratio [OR] = 3.78, 95% CI 3.29, 4.35). Other risk factors for 12-months ED visits and/or hospitalizations included advanced age, male gender, unemployment/retirement, African American ethnicity, living alone, fair or poor general health status, and history of depression.

DISCUSSIONS

Clinicians should screen older adults at high risk for ED visits and hospitalizations and explore multimodal pain management with them to help them reduce/stop using opioids. These efforts may decrease their chronic pain, opioid use, opioid use-related adverse health outcomes, ED visits, as well as hospitalizations.

Effect of slow tempo music on markers of anxiety during cataract surgery: Randomized control trial

PURPOSE:

This study aims to objectively measure the effect of slow tempo music on various markers for anxiety.

MATERIALS AND METHODS:

This is a repeated measure randomized control trial of patients with age-related cataracts undergoing cataract extraction through phacoemulsification under local anesthesia. Patients were randomized into two groups: music group where a standardized piano music was played and control group. Salivary alpha-amylase (sAA) levels were measured at the beginning and at the end of surgery. Blood pressure and heart rate were also measured at 5 min before surgery and at four other standardized points during and after surgery. Visual Analog Scale for anxiety was also gauged: preoperatively, perioperatively, and 15 min postoperatively.

RESULTS:

Ninety-two patients were randomized equally to the music group and control group. Paired sample t-test showed a reduction in the level of sAA during surgery in the music group (P = 0.019). The odds ratio for a drop in sAA with music was 4.407 (P = 0.001). Lower systolic blood pressure was observed in the music group: at delivery of local anesthesia (P = 0.047), at first incision (P = 0.023), and during sculpting (P = 0.15). Similarly, diastolic blood pressure was lower at first incision (P = 0.019) in the music group. The visual analog scale for anxiety during surgery was found to be lower in the music group (P = 0.046).

CONCLUSION:

A slow tempo music during cataract surgery was shown to significantly reduce several indicators for anxiety at various points during cataract surgery.

Music reduces patient-reported pain and anxiety and should be routinely offered during flexible cystoscopy: Outcomes of a systematic review

Objective: To conduct a systematic review of the literature to assess whether music reduces the use of analgesics and anxiolytics during flexible cystoscopy.

Methods: The systematic review was performed in line with the Cochrane guidelines and Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist. The databases searched included the Medical Literature Analysis and Retrieval System Online (MEDLINE), Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Clinicaltrials.gov, the Excerpta Medica dataBASE (EMBASE), Cochrane library, Google Scholar, and Web of Science from inception of the databases to February 2020. The primary outcome measure was the effect of music on pain and anxiety, and secondary outcome measures were patient heart rate and blood pressure.

Results: The initial search yielded 234 articles and after going through titles and abstracts, four studies (399 patients, 199 in the music group and 200 in no music group) were included for the final review. There were three randomised controlled trials and one prospective study published between 2014 and 2017. These studies were done in China, the USA and Italy, with the study duration between 9 and 24 months. All patients had 2% topical lignocaine jelly given per-urethra before the procedure. The choice of music was classical in three studies and a mixture of different music types in one study. Three of the four studies showed significantly reduced pain and anxiety with the use of music for flexible cystoscopy procedures. Heart rate was noted to be higher for the no music group, reflecting a higher pain perceived by these patients.

Conclusion: The present review showed that listening to music was associated with reduced anxiety and pain during flexible cystoscopy. Listening to music is therefore likely to increase procedural satisfaction and willingness to undergo the procedure again, considering repeated flexible cystoscopy is often needed for surveillance. As music is simple, inexpensive and easily accessible, it should be routinely offered to patients for outpatient and office-based urological procedures.

Abbreviations: IQR: interquartile range; NRS: numerical rating scale; PTSD: post-traumatic stress disorder; RCT: randomised control trial; STAI: State–trait Anxiety Inventory; VAS: visual analogue scale

Multimodal Analgesia in the Era of the Opioid Epidemic

This article attempts to review the key components of a multimodal analgesic regimen for the treatment of acute pain. Adhering to these key components will help reduce the opioid burden to surgical patients while reducing acute pain. As well, this regimen is intended to reduce further negative contributions to the opioid crisis.

Pilot Study on Music in the Waiting Room of Outpatient Pain Clinics

BACKGROUND

This study explores live and recorded music listening in the outpatient pain clinic. There is evidence demonstrating the effectiveness of live and recorded music in a hospital setting but a comparison study of this kind has yet to be conducted.

METHODS

A multimethod survey study design was used. A questionnaire utilizing rating scales was self-administered across two outpatient pain clinic waiting rooms. Patients were included through convenience sampling. In one clinic, a playlist of recorded music curated by two of the authors was provided. In the second clinic, a music therapy student played live music using guitar, flute, and voice. The questionnaire gathered data on music's impact on pain and emotional states, as well as attitudes toward music in the waiting room. Quantitative data was analyzed using descriptive statistics and qualitative data, gathered in the questionnaires open ended question, was analyzed using thematic analysis.

RESULTS

The questionnaire was completed by 200 adult patients. Patients reported lowered levels of anxiety, stress, and pain in both clinics, as well as a shorter waiting time and more caring experience. Patients in the live music clinic reported that music lowered levels of stress, nervousness, agitation, and pain more than in the recorded music clinic.

CONCLUSIONS

Participants in this study identified that music is a useful tool in the pain clinic waiting room. This study contributes to evidence that music should be considered as a complimentary treatment for people living with pain and in the wider hospital setting. Additional research is warranted with a control group, pre- and posttesting, and studies of music in hospitals in a range of cultural contexts.

A role for music in cataract surgery: a systematic review

PURPOSE

There have been several studies that explore the anxiolytic effects of music during cataract surgery. This is the first systematic review of literature highlighting the effects of music on patients undergoing cataract surgery without pharmacological anxiolytics.

METHODS

A systematic review of literature using PRISMA methodology identified randomized controlled trials involving patients undergoing cataract surgery with music as an intervention during the procedure with outcomes measured using at least one assessment of anxiety level, pain score, satisfaction, or vital sign measurements. Studies using pharmacological anxiolytics or additional pain-relieving medications besides local anesthetic were excluded.

RESULTS

Three studies, involving 523 patients, were included with patients undergoing cataract surgery with music intervention. Music intervention during cataract surgery has demonstrated use in reducing perceived pain, reducing anxiety, and improving vitals with increased benefit of reduced heart rate and blood pressures with binaural beat embedded music.

CONCLUSIONS

The clinical implications of this review identify non-traditional approaches to reducing anxiety intraoperatively for cataract surgeries, offering clinicians alternatives to minimizing benzodiazepine and medication use risks.

Music's effect on pain relief during outpatient urological procedures: a single center, randomized control trial focusing on gender differences

Background

Listening to preferred music can provide distraction and reduce the feeling of pain and negative emotions associated with an uncomfortable experience. Several studies have examined how music can reduce pain and anxiety related to urological procedures that are not typically performed under anesthesia, such as cystoscopy, cystoscopy with stent pull, and urodynamic studies. To our knowledge, no studies have been done to examine the effect of listening to preferred music generalized across a variety of these procedures. Therefore, we looked to combine multiple factors from prior studies to determine if listening to music of a patient’s choice would decrease pain during various outpatient clinic urological procedures, and to examine differences between men and women.

Methods

This was a single investigator series randomized controlled trial with 91 subjects in an academic outpatient urology clinic. After applying exclusion criteria, eligible patients were randomized to a music group or non-music group via coin flip. Fifty-three patients were in the music group (16 men, 37 women) and 38 patients were in the non-music group (16 men, 22 women). Subjects in the music group selected a song to play during the procedure, which was stopped at the conclusion of the procedure. Pre- and post-procedure Visual Analog Pain Scale were completed by the subjects of each group and subsequently analyzed. Where appropriate either Pearson’s Chi-Square or Independent-Sample t-test were used to compare the groups as well as randomized-repeated analysis of variance (ANOVA).

Results

For men, pain scores worsened in both groups, however the music group experienced a statistically significant increase in pain (mean change =1.0, P=0.05), while the non-music group only clinically worsened (mean change =0.38, P=0.459). For women, the music group noticed an improvement in the pain score (mean change =−0.14, P=0.590), while the non-music group significantly worsened (mean change =1.14, P=0.008).

Conclusions

Women who listened to music of their choosing experienced significant improvement in overall perceived pain compared to women who did not listen to music. Women may benefit from music as a novel tool to alleviate pain during outpatient clinic urological procedures.

Effects of anxiety-related psychological states on music-induced analgesia in cold pressor pain responses

CONTEXT

The analgesic effect of music has long been reported.

OBJECTIVE

To assess how anxiety-related psychological states affect the analgesic effect of music using the cold pressor task (CPT).

DESIGN

A 3-period × 3-sequence crossover design was adopted; three conditions were used: "no sound," "music-listening," and "news-listening."

SETTING

PARTICIPANTS: Forty-nine participants were included.

INTERVENTIONS

After completing five anxiety-related psychological instruments (Anxiety Sensitivity Index [ASI]-16, ASI-Revised, State-Trait Anxiety Inventory [STAI]-S, STAI-T, and Pain Anxiety Symptoms Scale-20), the participants were allocated to the low- or high-anxiety group. The high- and low-anxiety groups were defined based on cutoff points according to the distributions and characteristics of the five instruments.

MAIN OUTCOME MEASURES

Pain responses, such as pain tolerance time, pain intensity, and pain unpleasantness, were measured on the CPT. Pain responses in the music-listening condition were also compared to those in the other two conditions via pairwise comparisons within each anxiety group.

RESULTS

The Cronbach alpha of the five instruments ranged from 0.866 to 0.95, indicating that they were reliable. Pain responses in the music-listening condition in the low-anxiety groups based on any of the five scales were significantly different from those in the other conditions, but this effect was not found in the high-anxiety groups. This study demonstrates that anxiety-related psychological states can predict the analgesic effect of music on pain responses measured by the CPT and suggests that music may be beneficial as a pain management tool in low-anxiety groups.

Neuronal Effects of Listening to Entrainment Music Versus Preferred Music in Patients With Chronic Cancer Pain as Measured via EEG and LORETA Imaging

Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta (6–9 Hz) and low beta (12–16 Hz) power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three clinical cases. Effectiveness of personalized music therapy improvisations (entrainment music – EM) versus preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM (depicting both “pain” and “healing”), preferred (commercially available) music, and a non-participant’s EM as a control. Participants rated their pain before and after the EEG on a 1–10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions. Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his personalized EM which may reflect active recollection of creating the EM. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus. We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top–down neural processes associated with active coping for pain.

The effects of a music intervention during port catheter placement on anxiety and stress

Studies have shown that perioperative music interventions can reduce patients' anxiety levels. However, in small operations like port catheter surgery evidence is sparse. The present single-blinded, randomised controlled two-armed study included 84 female patients undergoing port catheter placement who were randomly assigned to either listening to music during surgery vs. no music intervention. The medical staff was blind to group allocation. On the day of the surgery anxiety and stress levels were evaluated using subjective (STAI questionnaire, visual analogue scales) and objective (vital parameters, salivary cortisol) parameters at different time points (before the surgery, at the end of the surgery and 1 h post-surgery). The music group showed significant reductions of systolic blood pressure (from 136.5 mmHg ± 26.1 to 123.3 mmHg ± 22.0, p = .002) and heart rate (from 75.6 bpm ± 12.3 to 73.1 bpm ± 12.2, p = .035) from beginning of the surgery to skin suture, whereas the control group did not. No significant effects of the music intervention on subjective anxiety measures or salivary cortisol were revealed. In sum, the study demonstrates that a music intervention during port catheter placement positively influences physiological anxiety levels, whereas no effects were revealed for subjective anxiety and salivary cortisol. Thus, music can be considered as a low cost addition in clinical routine in order to reduce patients' heart rate and blood pressure. Future studies are encouraged to further explore the differential effects of intraoperative music interventions on physiological, endocrinological and subjective anxiety levels.

The Effect of Music on aEEG Cyclicity in Preterm Neonates

Several methods can be used in the neonatal intensive care unit (NICU) to reduce stress and optimize the quality of life during this period of hospitalization. Among these, music could play an important role. We investigated the effect of different kinds of music therapies on the brain activity of very preterm infants using amplitude-integrated EEG. Sixty-four patients were included and randomly assigned to three different groups: live music group, recorded music group, and control group. In both intervention groups, music was started after the appearance of the first quiet-sleep phase, with a subsequent duration of 20 min. Changes between the first and second quiet-sleep epochs were analyzed using the amplitude-integrated EEG. When looking at single parameters of the amplitude-integrated EEG trace, no differences could be found between the groups when comparing their first and second quiet-sleep phase regarding the parameters of change from baseline, quality of the quiet-sleep epoch, and duration. However, when looking at the total cyclicity score of the second quiet-sleep phase, a difference between both intervention groups and the control group could be found (live music therapy vs. control, p = 0.003; recorded music therapy vs. control, p = 0.006). Improvement within the first and second quiet-sleep epochs were detected in both music groups, but not in the control group. We concluded that our study added evidence of the beneficial effect of music on the amplitude-integrated EEG activity in preterm infants.

Efficacy, Treatment Characteristics, and Biopsychological Mechanisms of Music-Listening Interventions in Reducing Pain (MINTREP): Study Protocol of a Three-Armed Pilot Randomized Controlled Trial

Background: Pain can severely compromise a person's overall health and well-being. Music-listening interventions have been shown to alleviate perceived pain and to modulate the body's stress-sensitive systems. Despite the growing evidence of pain- and stress-reducing effects of music-listening interventions from experimental and clinical research, current findings on music-induced analgesia are inconclusive regarding the role of specific treatment characteristics and the biopsychological mechanisms underlying these effects. Objective: The overall aim of this pilot randomized controlled trial is to test and compare the differential effects of frequency-modulated and unmodulated music (both researcher-selected) on experimentally induced perception of acute pain and to test the efficacy of the interventions in reducing biological and subjective stress levels. Moreover, these two interventions will be compared to a third condition, in which participants listen to self-selected unmodulated music. Methods and Analysis: A total of 90 healthy participants will be randomly allocated to one of the three music-listening intervention groups. Each intervention encompasses 10 sessions of music listening in our laboratory. Frequency-modulation will involve stepwise filtering of frequencies in the audible range of 50-4,000 Hz. Acute pain will be induced via the cold pressor test. Primary (i.e., pain tolerance, perceived pain intensity) and secondary (i.e., heart rate variability, electrodermal activity, hair cortisol, subjective stress) outcomes will be measured at baseline, post, and follow-up. In addition, intermittent measurements as well as a follow-up assessment and a range of tertiary measures (e.g., music-induced emotions) are included. Discussion: This is the first study to systematically test and compare the effects of music frequencies along with the control over music selection, both of which qualify as central treatment characteristics of music-listening interventions. Results will be highly informative for the design of subsequent large-scale clinical trials and provide valuable conclusions for the implementation of music-listening interventions for the reduction of perceived pain. Clinical Trial Registration: Clinical Trials Database of the U.S. National Library of Medicine: Identifier NCT02991014.

Favorite Music Mediates Pain-related Responses in the Anterior Cingulate Cortex and Skin Pain Thresholds

Purpose

Music therapy is widely used to enhance well-being, reduce pain, and distract patients from unpleasant symptoms in the clinical setting. However, the degree to which music modulates pain perception is unknown. The medial pain pathway including the limbic system is associated with emotion, but how music alters pathway activity is unclear. The aim of the study was to investigate pain thresholds and pain-related responses in the anterior cingulate cortex (ACC) and whether they were modulated when subjects listened to their favorite music genre.

Subjects and Methods

First, 30 subjects were examined for left forearm pain threshold using electrical stimulation with Pain Vision PS-2011N. The pain thresholds with and without music were compared. Second, when an 80-μA current from Pain Vision was applied to the left ankle of eight women, the pain-related responses of the ACC with and without music were observed with functional magnetic resonance device (fMRI). The changes in the pain-related activity in both parameters were discussed.

Results

The median pain threshold with favorite music was 38.9 μA, compared to 29.0 μA without, which was significantly different (p<0.0001). The men’s thresholds were significantly higher than women’s both with music (p<0.05) and without music (p<0.01). The pain threshold in women was more strongly affected by music than in men. The fMRI results showed that the pain-related response in the ACC in five of eight subjects was attenuated while they listened to their favorite music. No change was observed in the other three subjects.

Conclusion

The present findings suggest that pain perception might be strongly affected by listening to favorite music, possibly through modulation of pain-related responses in the ACC.

Interaction of auditory and pain pathways: Effects of stimulus intensity, hearing loss and opioid signaling

Moderate intensity sounds can reduce pain sensitivity (i.e., audio-analgesia) whereas intense sounds can induce aural pain, evidence of multisensory interaction between auditory and pain pathways. To explore auditory-pain pathway interactions, we used the tail-flick (TF) test to assess thermal tail-pain sensitivity by measuring the latency of a rat to remove its tail from 52 °C water. In Experiment 1, TF latencies were measured in ambient noise and broadband noise (BBN) presented from 80 to 120 dB SPL. TF latencies gradually increased from ambient to 90 dB SPL (audio-analgesia), but then declined. At 120 dB, TF latencies were significantly shorter than normal, evidence for audio-hyperalgesia near the aural threshold for pain. In Experiment II, the opioid pain pathway was modified by treating rats with a high dose of fentanyl known to induce post-treatment hyperalgesia. TF latencies in ambient noise were normal 10-days post-fentanyl. However, TF latencies became shorter than normal from 90 to 110 dB indicating that fentanyl pre-treatment had converted audio-analgesia to audio-hyperalgesia. In Experiment III, we tested the hypothesis that hearing loss could alter pain sensitivity by unilaterally exposing rats to an intense noise that induced a significant hearing loss. TF latencies in ambient noise gradually declined from 1- to 4-weeks post-exposure indicating that noise-induced hearing loss had increased pain sensitivity. Our results suggest that auditory and pain pathways interact in ways that depend on intensity, hearing loss and opioid pain signaling, results potentially relevant to pain hyperacusis.

Indian classical music with incremental variation in tempo and octave promotes better anxiety reduction and controlled mind wandering-A randomised controlled EEG study

Studies have reported the benefits of music-listening in stress-reduction using musical pieces of specific scale or 'Raaga'. But the influence of lower-level musical properties (like tempo, octave, timbre, etc.) lack research backing. Carnatic music concerts use incremental modulations in tempo and octave (e.g.: 'Ragam-Tanam-Pallavi') to elevate the mood of audiences. Therefore, the current study aimed to examine the anxiolytic effect of this musical property. A randomised controlled cross-over study with 21 male undergraduate medical students was followed. 11 participants listened to 'Varying music' (VM: instrumental music with incremental variations in tempo and octave) and 10 listened to 'Stable music' (SM: instrumental music without such variations), thrice daily for 6 days, both clips recorded in Raaga-Kaapi and silence being the control intervention. Electroencephalography (EEG) and Electrocardiography (for heart rate variability or HRV) were done on all 6 days. Beck's Anxiety inventory and State-trait anxiety scale were administered on Day-1 and Day-6. A significant anxiety score reduction was seen only in VM. VM showed marked decrease in lower frequency EEG power in bilateral temporo-parieto-occipital regions compared to silence, whereas SM showed increase in higher frequencies. Relatively, VM showed more midline power reduction (i.e., lower default mode network or DMN activity) and SM showed greater left-dominant alpha/beta asymmetry (i.e., greater right brain activation). During both music interventions HRV remained stable, unlike silence intervention. We speculate that, gradual transition between lower-slower and higher-faster music portions of VM induces a 'controlled-mind wandering' state involving balanced switching between heightened mind wandering ('attention to self') and reduced mind wandering ('attention to music') states, respectively. Therefore, music-selection has remarkable influence on stress-management and warrants further research.

Effects of Music and Relaxation Suggestions on Experimental Pain

Pain is a significant public healthcare challenge. There is growing support for the use of music and suggestive techniques as adjuvant pain treatments. The purpose of this study was to (1) examine the effects of music listening combined with relaxation suggestions compared to music alone and silence on experimental pain, and (2) to explore the potential mechanisms of music-induced analgesia. Sixty-six healthy females were randomized to receive either (1) music plus relaxation suggestions, (2) music alone, or (3) silence. Pain and psychological constructs were assessed following two cold-pressor trials. Between-group comparisons indicated that music and suggestions for relaxation are not superior to music alone for pain. More research is needed to explore the effect of analgesic suggestions in combination with music to further investigate music's potential in clinical pain management.

Music Use for Sedation in Critically ill Children (MUSiCC trial): study protocol for a pilot randomized controlled trial

Background

Stress induced by pain and anxiety is common in pediatric intensive care unit (PICU) patients. Sedation/analgesia in PICU is usually achieved through various analgesics and sedatives. Excessive use of these drugs can put patients at risk for hemodynamic/respiratory instability, prolonged ventilation, withdrawal, delirium, and critical illness polyneuromyopathy.

The use of non-pharmacologic interventions has been recommended by sedation guidelines. However, non-pharmacological measures in PICU, including music and noise reduction, have been inadequately studied.

Methods

The Music Use for Sedation in Critically ill Children (MUSiCC trial) pilot study is an investigator-initiated, three-arm, randomized controlled trial (RCT) on the use of music for sedation in PICU. The main goal of the study is to demonstrate feasibility of a music trial in PICU and to obtain the necessary information to plan a larger trial. The study compares music versus noise cancelation versus control in sedated and mechanically ventilated children admitted to PICU. In the music group, children receive the music (modified classical music) three times a day for 30 min at a time. Music is delivered with noise cancelation headphones. The noise cancelation group receives the same intervention but with a no music (sham playlist). The control group receives usual care with no specific intervention. Children remain in the study until extubation or a maximum of 7 days. The primary outcomes of the study are feasibility and sedation/analgesia requirements. Secondary outcomes include change in vital signs before and during the intervention, ICU delirium, and adverse effects related to the intervention. The estimated sample size is 20 subjects per group for a total of 60 children.

Discussion

Despite being recommended by current guidelines, evidence to support the use of music in PICU is lacking. Music has the potential to reduce sedation requirements and their negative side effects. This pilot RCT will demonstrate feasibility and provide the necessary information to plan a larger trial focusing on the effectiveness of the intervention.

Trial registration

The study was registered at ClinicalTrials.gov (NCT03497559) on April 13, 2018.

Effects of Patient-Directed Interactive Music Therapy on Sleep Quality in Postoperative Elderly Patients: A Randomized-Controlled Trial

PURPOSE

This study aimed to investigate the effects of patient-directed interactive music on saliva melatonin levels and sleep quality among postoperative elderly patients in the intensive care unit (ICU).

PATIENTS AND METHODS

A total of 133 elderly patients were randomized into three groups: interactive music therapy (IMT), passive listening (PL), and the control group. The control group (n = 45) received routine medical care, while IMT and PL groups received music therapy on ICU day 1. The IMT group received up to 20 mins of interactive music sessions, including relaxation techniques. The PL group received only pre-selected relaxing music-listening for 30 mins. Saliva melatonin and cortisol levels were measured three times at 11 p.m. (preoperative, operation day, and postoperative day [POD] 1). The Richards-Campbell Sleep Questionnaire (RCSQ) and Quality of Recovery-40 questionnaire (QoR40) were administered on the preoperative day, as well as PODs 1 and 2.

RESULTS

The RCSQ showed a significant improvement in the IMT group compared to the control group on POD2 (71.50 vs 56.89, p=0.012), but the QoR40 did not show any difference between groups. The quality control of the saliva sample was not available due to the immediate postoperative patient's condition, resulting in a higher dropout rate. Saliva melatonin levels on POD 1 were elevated in the IMT group compared to the control group (1.45 vs 0.04, p=0.0068). The cortisol level did not show a significant difference between groups.

CONCLUSION

Single IMT intervention improved subjectively assessed short-term sleep quality in postoperative elderly patients. It is difficult to conclude whether music therapy intervention affects the level of melatonin and cortisol.

TRIAL REGISTRATION

The study was registered at ClinicalTrials.Gov (number NCT03156205).

Music Reduces Pain Unpleasantness: Evidence from an EEG Study

BACKGROUND

Music is sometimes used as an adjunct to pain management. However, there is limited understanding of by what means music modulates pain perception and how the brain responds to nociceptive inputs while listening to music, because clinical practice typically involves the coexistence of multiple therapeutic interventions. To address this challenge, laboratory studies with experimental and control conditions are needed.

METHODS

In the present investigation, we delivered nociceptive laser stimuli on 30 participants under three conditions - participants were sitting in silence, listening to their preferred music, or listening to white noise. Differences among conditions were quantified by self-reports of pain intensity and unpleasantness, and brain activity sampled by electroencephalography (EEG).

RESULTS

Compared with the noise and silence conditions, participants in the music condition reported lower ratings on pain unpleasantness, as reflected by reduced brain oscillations immediately prior to the nociceptive laser stimulus at frequencies of 4-15 Hz in EEG. In addition, participants showed smaller P2 amplitudes in laser-evoked potentials (LEPs) when they were listening to music or white noise in comparison to sitting in silence. These findings suggest that a general modulation effect of sounds on pain, with a specific reduction of pain unpleasantness induced by the positive emotional impact.

CONCLUSION

Music may serve as a real-time regulator to modulate pain unpleasantness. Results are discussed in view of current understandings of music-induced analgesia.

Vocal Music Therapy for Chronic Pain: A Mixed Methods Feasibility Study

Objective: The purpose of this study was to determine the feasibility and preliminary effects of a vocal music therapy (VMT) program on chronic pain management.

Design: A mixed methods intervention design was used in which qualitative data were embedded within a randomized controlled trial.

Setting: An urban nurse-management health center on the East Coast of the United States.

Subjects: Participants (N = 43) were predominantly Black (79%) and female (76.7%) with an average pain duration of 10 years.

Intervention: Participants were randomly allocated to a 12-week VMT program or a waitlist control.

Outcome measures: We tracked consent rate (percentage of participants enrolled out of total number screened), attrition rate, and treatment adherence. We used PROMIS^® (Patient Reported Outcomes Measurement Information System) tools to measure pain interference, pain-related self-efficacy, pain intensity, depression, anxiety, positive effect, and well-being, ability to participate in social activities, and satisfaction with social roles at baseline and week 12. VMT participants also completed the Patient Global Impression of Change Scale. We conducted semistructured interviews to better understand participants' experience of the intervention.

Results: The consent rate was 56%. The attrition rate was 23%. Large treatment effects (partial eta squared) were obtained for self-efficacy (0.20), depression (0.26), and ability to participate in social activities (0.24). Medium effects were found for pain intensity (0.10), anxiety (0.06), positive effect, and well-being (0.06), and small effects for pain interference (0.03) and satisfaction with social roles (0.03). On average, participants felt moderately better after completion of the VMT program (M = 4.93, standard deviation = 1.98). Qualitative findings suggest that VMT resulted in better self-management of pain, enhanced psychological well-being, and stronger social and spiritual connections.

Conclusions: Recruitment into the 12-week program was challenging, but quantitative and qualitative findings suggest significant benefits of VMT for chronic pain management.

Melody Extraction and Encoding Method for Generating Healthcare Music Automatically

The strong relationship between music and health has helped prove that soft and peaceful classical music can significantly reduce people’s stress; however, it is difficult to identify and collect examples of such music to build a library. Therefore, a system is required that can automatically generate similar classical music selections from a small amount of input music. Melody is the main element that reflects the rhythms and emotions of musical works; therefore, most automatic music generation research is based on melody. Given that melody varies frequently within musical bars, the latter are used as the basic units of composition. As such, there is a requirement for melody extraction techniques and bar-based encoding methods for automatic generation of bar-based music using melodies. This paper proposes a method that handles melody track extraction and bar encoding. First, the melody track is extracted using a pitch-based term frequency–inverse document frequency (TFIDF) algorithm and a feature-based filter. Subsequently, four specific features of the notes within a bar are encoded into a fixed-size matrix during bar encoding. We conduct experiments to determine the accuracy of track extraction based on verification data obtained with the TFIDF algorithm and the filter; an accuracy of 94.7% was calculated based on whether the extracted track was a melody track. The estimated value demonstrates that the proposed method can accurately extract melody tracks. This paper discusses methods for automatically extracting melody tracks from MIDI files and encoding based on bars. The possibility of generating music through deep learning neural networks is facilitated by the methods we examine within this work. To help the neural networks generate higher quality music, which is good for human health, the data preprocessing methods contained herein should be improved in future works.

Effects of music interventions on stress-related outcomes: a systematic review and two meta-analyses

Music interventions are used for stress reduction in a variety of settings because of the positive effects of music listening on both physiological arousal (e.g., heart rate, blood pressure, and hormonal levels) and psychological stress experiences (e.g., restlessness, anxiety, and nervousness). To summarize the growing body of empirical research, two multilevel meta-analyses of 104 RCTs, containing 327 effect sizes and 9,617 participants, were performed to assess the strength of the effects of music interventions on both physiological and psychological stress-related outcomes, and to test the potential moderators of the intervention effects. Results showed that music interventions had an overall significant effect on stress reduction in both physiological (d = .380) and psychological (d = .545) outcomes. Further, moderator analyses showed that the type of outcome assessment moderated the effects of music interventions on stress-related outcomes. Larger effects were found on heart rate (d = .456), compared to blood pressure (d = .343) and hormone levels (d = .349). Implications for stress-reducing music interventions are discussed.

Symptom burden in heart failure: assessment, impact on outcomes, and management

Evidence-based management has improved long-term survival in patients with heart failure (HF). However, an unintended consequence of increased longevity is that patients with HF are exposed to a greater symptom burden over time. In addition to classic symptoms such as dyspnea and edema, patients with HF frequently suffer additional symptoms such as pain, depression, gastrointestinal distress, and fatigue. In addition to obvious effects on quality of life, untreated symptoms increase clinical events including emergency department visits, hospitalizations, and long-term mortality in a dose-dependent fashion. Symptom management in patients with HF consists of two key components: comprehensive symptom assessment and sufficient knowledge of available approaches to alleviate the symptoms. Successful treatment addresses not just the physical but also the emotional, social, and spiritual aspects of suffering. Despite a lack of formal experience during cardiovascular training, symptom management in HF can be learned and implemented effectively by cardiology providers. Co-management with palliative medicine specialists can add significant value across the spectrum and throughout the course of HF.

Feeling the sound - short-term effect of a vibroacoustic music intervention on well-being and subjectively assessed warmth distribution in cancer patients-A randomized controlled trial

OBJECTIVES

So far, the effects of vibroacoustic music therapy in cancer patients are unknown. However, used in anthroposophic medicine, it could be an approach to enhance well-being. The goal of this study was to evaluate the immediate effects of a sound-bed music intervention with respect to the subjective well-being as well as body warmth and pain.

PATIENTS AND METHODS

We treated 48 cancer patients with 10 min of sound-bed intervention in a cross-over design. Primary outcome was the total sum of the Basler Mood Questionnaire (BMQ), secondary outcomes were subscales of the BMQ and questions addressing body warmth and pain. The EORTC-QLQ C30 was used as baseline assessment for quality of life (QOL).

RESULTS

Patients had lower QOL values than the EORTC reference samples (p < .001, d = 0.90). The primary outcome increased after music (p < .001, d = 0.47), no changes were seen in the control condition (p = .73, d = 0.04), the time by condition interaction was significant (p < .05).

SECONDARY OUTCOMES

Increase after music for the BMQ subscales inner balance (p < .001, d = 0.73), vitality (p < .001, d = 0.51) and vigilance (p < .001, d = 0.37) as well as for the additional questions satisfaction (p < .001, d = 0.43), current mood (p < .001, d = 0.43), body warmth (p < .05, d = 0.44) and warmth distribution (p < .01, d = 0.49). No significant changes were seen in pain levels and social extroversion.

CONCLUSION

Sound-bed intervention improved momentary well-being and caused self-perceived physiological changes associated with relaxation beyond the benefits of simple resting time (control condition). Thus, it might be a promising approach to improve well-being in cancer patients.

Physiologic effects of voice stimuli in conscious and unconscious palliative patients-a pilot study

BACKGROUND

Sounds and acoustic stimuli can have an effect on human beings. In medical care, sounds are often used as parts of therapies, e. g., in different types of music therapies. Also, human speech greatly affects the mental status. Although calming sounds and music are widely established in the medical field, clear evidence for the effect of sounds in palliative care is scare, and data about effects of the human voice in general are still missing. Thus, the aim of this study was to evaluate the effects of different voice stimuli on palliative patients.

METHODS

Two different voice stimuli (one calm, the other turbulent) were presented in a randomized sequence, and physiological parameters (blood pressure, heart frequency, oxygen saturation, respiratory rate) were recorded.

RESULTS

Twenty patients (14 conscious and 6 unconscious) participated in this study. There was a decrease of heart frequency as well as an increase of oxygen saturation in the group of conscious patients, whereas no significant change of blood pressure or respiratory rate were detected in either group, conscious and unconscious patients.

CONCLUSIONS

Although our dataset is heterogeneous, it can be concluded that voice stimuli can influence conscious patients. However, in this setting, no effect on unconscious patients was demonstrated. More clinical research on this topic with larger groups and a broader spectrum of parameters is needed.

Does Music Matter? A Look at the Issues and the Evidence

Does music matter? Judging from the ever-diminishing support for music education in public funding, the message is that it is just a frill to be cast aside for more pressing needs. The pleasure of listening to music is worthy in itself and reason enough for support, but what happens when people are more deeply engaged, such as when they learn to read music and play an instrument? Can more material rewards follow for cognition, language, and emotion, and for social and physical well-being? This essay presents an overview of issues and evidence from a broad range of disciplines and age groups.

Not Cure But Heal: Music and Medicine

Do you know that our soul is composed of harmony? Leonardo Da Vinci Despite evidence for music-specific mechanisms at the level of pitch-pattern representations, the most fascinating aspect of music is its transmodality. Recent psychological and neuroscientific evidence suggest that music is unique in the coupling of perception, cognition, action and emotion. This potentially explains why music has been since time immemorial almost inextricably linked to healing processes and should continue to be.

The Effect of Music Listening on Pain, Heart Rate Variability, and Range of Motion in Older Adults After Total Knee Replacement

The purpose of this study was to investigate the effects that listening and not listening to music had on pain relief, heart rate variability (HRV), and knee range of motion in total knee replacement (TKR) patients who underwent continuous passive motion (CPM) rehabilitation. We adopted a single-group quasi-experimental design. A sample of 49 TKR patients listened to music for 25 min during one session of CPM and no music during another session of CPM the same day for a total of 2 days. Results indicated that during CPM, patients exhibited a significant decrease in the pain level ( p < .05), an increase in the CPM knee flexion angle ( p < .05), a decrease in the low-frequency/high-frequency ratio (LF/HF) and normalized LF (nLF) of the HRV ( p < .01), and an increase in the normalized HF (nHF) and standard deviation of all normal-to-normal intervals (SDNN; p < .01) when listening to music compared with no music. This study demonstrated that listening to music can effectively decrease pain during CPM rehabilitation and improve the joint range of motion in patients who underwent TKR surgery.

Effect of Music on Outpatient Urological Procedures: A Systematic Review and Meta-Analysis from the European Association of Urology Section of Uro-Technology

PURPOSE

Music is a practical, inexpensive and harmless analgesic and anxiolytic. An increasing number of original studies have been performed to investigate its potential application in urology. Our aim was to identify the effect of music on outpatient based urological procedures.

MATERIALS AND METHODS

We systematically reviewed the effect of using music during all reported outpatient urology procedures, including transrectal ultrasound guided prostate biopsy, shock wave lithotripsy, urodynamic studies, percutaneous nephrostomy tube placement and cystoscopy. Data were included on all randomized trials from 1980 to 2017 and no language restrictions were applied.

RESULTS

Included in analysis were 16 randomized studies in which 972 of 1,950 patients (49.8%) were exposed to music during an outpatient procedure. The procedures included transrectal ultrasound guided prostate biopsy in 4 studies in a total of 286 patients, shock wave lithotripsy in 6 studies in a total of 1,023, cystoscopy in 3 studies in a total of 331, urodynamics in 2 studies in a total of 210 and percutaneous nephrostomy in 1 study in a total of 100. All studies incorporated a visual analog score to measure pain. Anxiety was measured by STAI (State-Trait Anxiety Inventory) in 13 studies and by a visual analog scale in 2. While 14 of the 16 studies showed a reduction in self-reported pain, a reduction in anxiety was seen in 14. When using music, overall procedural satisfaction was better in 9 studies and patient willingness to repeat the procedure was also higher in 7. Our meta-analysis revealed a significant reduction in visual analog scale and STAI findings across all studies (p <0.001).

CONCLUSIONS

Our systematic review demonstrated a beneficial effect of music on urological outpatient procedures. Music seemed to decrease anxiety and pain. It might serve as a useful adjunct to increase procedural satisfaction and patient willingness to undergo the procedure again.