Music benefits on postoperative distress and pain in pediatric day care surgery

Patients' Perceptions of Virtual Live Music in the Intensive Care Unit

BACKGROUND

Implementing music in the intensive care unit has increased in popularity because the environment can be stressful and anxiety inducing for many patients. In hospital settings, therapeutic music can be beneficial for patients' well-being and recovery. Although live music typically involves a face-to-face encounter between the musician and patient, the COVID-19 pandemic has prompted a change to virtual live therapeutic music, using technology to present music in real time (eg, with a tablet computer).

OBJECTIVE

To generate novel findings regarding patients' perceptions of virtual live therapeutic music, which has been little studied compared with live or recorded music..

METHODS

Fifty patients in Vanderbilt University Medical Center intensive care units listened to virtual live music played by a volunteer musician via an online video communication platform. Patients' responses to 5 survey questions were transcribed and analyzed qualitatively and quantitatively using data analysis software.

RESULTS

Seven major themes describing the familiarity and significance of music for patients were identified. Forty-seven patients (94%) experienced positive emotions from the music, 46 (92%) indicated that music was a significant part of their lives, 28 (56%) accessed a cherished memory, and 45 (90%) indicated that they would not change anything.

CONCLUSIONS

Therapeutic virtual music was well received and provided tangible benefits to patients. Additional research would provide information on patients' outcomes and differences between live and virtual live music.

The effect of auditory stimuli on the pain and physiological parameters of children on mechanical ventilation during aspiration procedure: A randomized controlled trial

PURPOSE

The study was conducted to determine the effect of mother's voice and music sound on pain and physiological parameters during aspiration procedure in children with mechanical ventilation support in the pediatric intensive care unit.

DESIGN AND METHODS

This study was a randomized controlled type experimental study. According to the power analysis result of the sample of the study, 84 children who were treated in the pediatric intensive care unit of two university hospitals in Istanbul were formed. Introductory Information Form, Ramsey Sedation Scale, Physiological Parameter Form and Face, Legs, Activity, Cry, Consolability (FLACC) Pain Scale were used to collect data.

RESULTS

When the pain results of the children were evaluated, the mean FLACC Pain Scale value of the children in the control group was found to be significantly higher than children in the mother's voice and music voice group (p < 0.05). It was determined that the lowest FLACC Pain Scale value was in the mother's voice group (p < 0.05). When the physical parameter results were evaluated, it was determined that the physiological measurement values of the children in the experimental group were positively affected (p < 0.05), there was a significant difference between the control group (p < 0.05) and the most effective result was in the mother's voice group (p < 0.05).

PRACTICE IMPLICATIONS

Allowing children to listen mother's voice and music during aspiration procedure reduces pain of the children, positively affects their physical parameter values and enhances quality of nursing care. The results of this study create a scientific basis for nursing practices in the clinical settings and contribute to the clinical practices by shedding a light on future evidence-based studies.

Non-pharmacological management of infant and young child procedural pain

BACKGROUND

Despite evidence of the long-term implications of unrelieved pain during infancy, it is evident that infant pain is still under-managed and unmanaged. Inadequately managed pain in infancy, a period of exponential development, can have implications across the lifespan. Therefore, a comprehensive and systematic review of pain management strategies is integral to appropriate infant pain management. This is an update of a previously published review update in the Cochrane Database of Systematic Reviews (2015, Issue 12) of the same title.

OBJECTIVES

To assess the efficacy and adverse events of non-pharmacological interventions for infant and child (aged up to three years) acute pain, excluding kangaroo care, sucrose, breastfeeding/breast milk, and music.

SEARCH METHODS

For this update, we searched CENTRAL, MEDLINE-Ovid platform, EMBASE-OVID platform, PsycINFO-OVID platform, CINAHL-EBSCO platform and trial registration websites (ClinicalTrials.gov; International Clinical Trials Registry Platform) (March 2015 to October 2020). An update search was completed in July 2022, but studies identified at this point were added to 'Awaiting classification' for a future update.  We also searched reference lists and contacted researchers via electronic list-serves.  We incorporated 76 new studies into the review.  SELECTION CRITERIA: Participants included infants from birth to three years in randomised controlled trials (RCTs) or cross-over RCTs that had a no-treatment control comparison. Studies were eligible for inclusion in the analysis if they compared a non-pharmacological pain management strategy to a no-treatment control group (15 different strategies). In addition, we also analysed studies when the unique effect of adding a non-pharmacological pain management strategy onto another pain management strategy could be assessed (i.e. additive effects on a sweet solution, non-nutritive sucking, or swaddling) (three strategies). The eligible control groups for these additive studies were sweet solution only, non-nutritive sucking only, or swaddling only, respectively. Finally, we qualitatively described six interventions that met the eligibility criteria for inclusion in the review, but not in the analysis.  DATA COLLECTION AND ANALYSIS: The outcomes assessed in the review were pain response (reactivity and regulation) and adverse events. The level of certainty in the evidence and risk of bias were based on the Cochrane risk of bias tool and the GRADE approach. We analysed the standardised mean difference (SMD) using the generic inverse variance method to determine effect sizes.  MAIN RESULTS: We included total of 138 studies (11,058 participants), which includes an additional 76 new studies for this update. Of these 138 studies, we analysed 115 (9048 participants) and described 23 (2010 participants) qualitatively. We described qualitatively studies that could not be meta-analysed due to being the only studies in their category or statistical reporting issues. We report the results of the 138 included studies here. An SMD effect size of 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. The thresholds for the I2 interpretation were established as follows: not important (0% to 40%); moderate heterogeneity (30% to 60%); substantial heterogeneity (50% to 90%); considerable heterogeneity (75% to 100%). The most commonly studied acute procedures were heel sticks (63 studies) and needlestick procedures for the purposes of vaccines/vitamins (35 studies). We judged most studies to have high risk of bias (103 out of 138), with the most common methodological concerns relating to blinding of personnel and outcome assessors. Pain responses were examined during two separate pain phases: pain reactivity (within the first 30 seconds after the acutely painful stimulus) and immediate pain regulation (after the first 30 seconds following the acutely painful stimulus). We report below the strategies with the strongest evidence base for each age group. In preterm born neonates, non-nutritive sucking may reduce pain reactivity (SMD -0.57, 95% confidence interval (CI) -1.03 to -0.11, moderate effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.61, 95% CI -0.95 to -0.27, moderate effect; I2 = 81%, considerable heterogeneity), based on very low-certainty evidence. Facilitated tucking may also reduce pain reactivity (SMD -1.01, 95% CI -1.44 to -0.58, large effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.59, 95% CI -0.92 to -0.26, moderate effect; I2 = 87%, considerable heterogeneity); however, this is also based on very low-certainty evidence. While swaddling likely does not reduce pain reactivity in preterm neonates (SMD -0.60, 95% CI -1.23 to 0.04, no effect; I2 = 91%, considerable heterogeneity), it has been shown to possibly improve immediate pain regulation (SMD -1.21, 95% CI -2.05 to -0.38, large effect; I2 = 89%, considerable heterogeneity), based on very low-certainty evidence. In full-term born neonates, non-nutritive sucking may reduce pain reactivity (SMD -1.13, 95% CI -1.57 to -0.68, large effect; I2 = 82%, considerable heterogeneity) and improve immediate pain regulation (SMD -1.49, 95% CI -2.20 to -0.78, large effect; I2 = 92%, considerable heterogeneity), based on very low-certainty evidence.  In full-term born older infants, structured parent involvement was the intervention most studied. Results showed that this intervention has little to no effect in reducing pain reactivity (SMD -0.18, 95% CI -0.40 to 0.03, no effect; I2 = 46%, moderate heterogeneity) or improving immediate pain regulation (SMD -0.09, 95% CI -0.40 to 0.21, no effect; I2 = 74%, substantial heterogeneity), based on low- to moderate-certainty evidence. Of these five interventions most studied, only two studies observed adverse events, specifically vomiting (one preterm neonate) and desaturation (one full-term neonate hospitalised in the NICU) following the non-nutritive sucking intervention. The presence of considerable heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of evidence of very low to low certainty based on GRADE judgements.

AUTHORS' CONCLUSIONS

Overall, non-nutritive sucking, facilitated tucking, and swaddling may reduce pain behaviours in preterm born neonates. Non-nutritive sucking may also reduce pain behaviours in full-term neonates. No interventions based on a substantial body of evidence showed promise in reducing pain behaviours in older infants. Most analyses were based on very low- or low-certainty grades of evidence and none were based on high-certainty evidence. Therefore, the lack of confidence in the evidence would require further research before we could draw a definitive conclusion.

Impact of music therapy and hand massage in the pediatric intensive care unit on pain, fear and stress: Randomized controlled trial

PURPOSE

This study was performed with the aim of assessing the effect of music therapy and hand massage on pain, fear and stress among 12-18 year-old adolescents treated in the pediatric intensive care unit (PICU).

DESIGN

This study was a randomized controlled trial, with single-blind design.

METHODS

The adolescents were divided into groups with 33 receiving hand massage, 33 receiving music therapy and 33 in the control group. Collection of data used the Wong-Baker FACES (WB-FACES) Pain Rating Scale, Children's Fear Scale (CFS) and blood cortisol levels.

FINDINGS

In the study, adolescents in the music therapy group had lower mean points for WB-FACES before, during and after the procedure by a significant level compared to the control group (p < 0.05). Additionally, the CFS mean points before and during the procedure were lowest in the music therapy group, while the music therapy and massage groups were determined to have lower points by a significant level after the procedure compared to the control group (p < 0.05). However, when the mean cortisol levels of adolescents before the procedure and on the 1st and 2nd day after the procedure were compared, there was no significant difference between the groups (p > 0.05).

CONCLUSIONS

It was determined that hand massage and music therapy were more effective than standard care at reducing pain and fear levels during blood drawing among 12-18-year-old adolescents in the PICU.

PRACTICE IMPLICATIONS

Nurses may use music therapy and hand massage to manage fear and pain related to blood drawing in the PICU.

The use of music for children and adolescents living with rare diseases in the healthcare setting: a scoping review study protocol

Background: Interest in the application of music in the health, social care and community contexts is growing worldwide. There is an emerging body of literature about the positive effects of music on the well-being and social relationships of children and adult populations. Music has also been found to promote social interaction, communication skills, and social-emotional behaviours of children with medically complex care needs. Despite significant advancements in the area, to the authors' knowledge, this is the first scoping review to investigate the evidence for using music therapy and music-based interventions for children living with rare diseases in the healthcare setting. Therefore, the purpose of this study is to conduct a scoping review of the literature to map out the existing studies about the use of music therapy and music-based interventions with children who have rare diseases in the healthcare setting. This review will also identify gaps in current knowledge and use of these interventions. Method: This study follows the Joanna Briggs Institute's methodology for scoping reviews, utilising Arksey and O'Malley's six-stage scoping review framework: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; 5) collating, summarising and reporting results; and 6) consulting with relevant stakeholders step. A comprehensive search will be conducted in CINAHL Complete; MEDLINE Complete; Psychology and Behavioral Sciences Collection; and PubMed Central databases. A search strategy with selected inclusion and exclusion criteria will be used to reveal a wide range of evidence. This study will include quantitative, qualitative and mixed research methods studies published in English from 2010 to 2020.

How Do Music Activities Affect Health and Well-Being? A Scoping Review of Studies Examining Psychosocial Mechanisms

Background: This scoping review analyzed research about how music activities may affect participants' health and well-being. Primary outcomes were measures of health (including symptoms and health behaviors) and well-being. Secondary measures included a range of psychosocial processes such as arousal, mood, social connection, physical activation or relaxation, cognitive functions, and identity. Diverse music activities were considered: receptive and intentional music listening; sharing music; instrument playing; group singing; lyrics and rapping; movement and dance; and songwriting, composition, and improvisation.

Methods: Nine databases were searched with terms related to the eight music activities and the psychosocial variables of interest. Sixty-three papers met selection criteria, representing 6,975 participants of all ages, nationalities, and contexts.

Results: Receptive and intentional music listening were found to reduce pain through changes in physiological arousal in some studies but not others. Shared music listening (e.g., concerts or radio programs) enhanced social connections and mood in older adults and in hospital patients. Music listening and carer singing decreased agitation and improved posture, movement, and well-being of people with dementia. Group singing supported cognitive health and well-being of older adults and those with mental health problems, lung disease, stroke, and dementia through its effects on cognitive functions, mood, and social connections. Playing a musical instrument was associated with improved cognitive health and well-being in school students, older adults, and people with mild brain injuries via effects on motor, cognitive and social processes. Dance and movement with music programs were associated with improved health and well-being in people with dementia, women with postnatal depression, and sedentary women with obesity through various cognitive, physical, and social processes. Rapping, songwriting, and composition helped the well-being of marginalized people through effects on social and cultural inclusion and connection, self-esteem and empowerment.

Discussion: Music activities offer a rich and underutilized resource for health and well-being to participants of diverse ages, backgrounds, and settings. The review provides preliminary evidence that particular music activities may be recommended for specific psychosocial purposes and for specific health conditions.

The use of music for children and adolescents living with rare diseases in the healthcare setting: a scoping review study protocol

Background: Interest in the application of music in the health, social care and community contexts is growing worldwide. There is an emerging body of literature about the positive effects of music on the well-being and social relationships of children and adult populations. Music has also been found to promote social interaction, communication skills, and social-emotional behaviours of children with medically complex care needs. Despite significant advancements in the area, to the authors' knowledge, this is the first scoping review to investigate the evidence for using music therapy and music-based interventions for children living with rare diseases in the healthcare setting. Therefore, the purpose of this study is to conduct a scoping review of the literature to map out the existing studies about the use of music therapy and music-based interventions with children who have rare diseases in the healthcare setting. This review will also identify gaps in current knowledge and use of these interventions. Method: This study follows the Joanna Briggs Institute's methodology for scoping reviews, utilising Arksey and O'Malley's six-stage scoping review framework: 1) identifying the research question; 2) identifying relevant studies; 3) study selection; 4) charting the data; 5) collating, summarising and reporting results; and 6) consulting with relevant stakeholders step. A comprehensive search will be conducted in CINAHL Complete; MEDLINE Complete; Psychology and Behavioral Sciences Collection; and PubMed Central databases. A search strategy with selected inclusion and exclusion criteria will be used to reveal a wide range of evidence. This study will include quantitative, qualitative and mixed research methods studies published in English from 2010 to 2020.

Distraction by a cognitive task has a higher impact on electrophysiological measures compared with conditioned pain modulation

Background

Conditioned pain modulation (CPM) evaluates the effect of a painful conditioning stimulus (CS) on a painful test stimulus (TS). Using painful cutaneous electrical stimulation (PCES) as TS and painful cold water as CS, the pain relief was paralleled by a decrease in evoked potentials (PCES-EPs). We now aimed to compare the effect of CPM with cognitive distraction on PCES-induced pain and PCES-EP amplitudes.

Methods

PCES was performed using surface electrodes inducing a painful sensation of 60 (NRS 0–100) on one hand. In a crossover design healthy subjects (included: n = 38, analyzed: n = 23) immersed the contralateral hand into 10 °C cold water (CS) for CPM evaluation and performed the 1-back task for cognitive distraction. Before and during the CS and 1-back task, respectively, subjects rated the pain intensity of PCES and simultaneously cortical evoked potentials were recorded.

Results

Both CPM and cognitive distraction significantly reduced PCES-EP amplitudes (CPM: 27.6 ± 12.0 μV to 20.2 ± 9.5 μV, cognitive distraction: 30.3 ± 14.2 µV to 13.6 ± 5.2 μV, p < 0.001) and PCES-induced pain (on a 0–100 numerical rating scale: CPM: 58 ± 4 to 41.1 ± 12.3, cognitive distraction: 58.3 ± 4.4 to 38.0 ± 13.0, p < 0.001), though the changes in pain intensity and PCES-amplitude did not correlate. The changes of the PCES-EP amplitudes during cognitive distraction were more pronounced than during CPM (p = 0.001).

Conclusions

CPM and cognitive distraction reduced the PCES-induced pain to a similar extent. The more pronounced decrease of PCES-EP amplitudes after distraction by a cognitive task implies that both conditions might not represent the general pain modulatory capacity of individuals, but may underlie different neuronal mechanisms with the final common pathway of perceived pain reduction.

Effects of music therapy as an adjunct to chest physiotherapy in children with cystic fibrosis: A randomized controlled trial

Airway clearance therapy (ACT) is considered an important approach to improve airway clearance in children with cystic fibrosis (CF). Daily ACT administration requires substantial commitments of time and energy that complicate ACT and reduce its benefits. It is crucial to establish ACT as a positive routine. Music therapy (MT) is an aspect of integrative strategies to ameliorate the psycho-emotional consequences of chronic diseases, and a MT intervention could help children with CF between the ages of 2 and 17 develop a positive response. The aim of this randomized controlled trial was to evaluate the effects of specifically composed and recorded instrumental music as an adjunct to ACT. We compared the use of specifically composed music (Treated Group, TG), music that the patient liked (Placebo Group, PG), and no music (Control Group, CG) during the usual ACT routine in children with CF aged from 2 to 17. The primary outcomes, i.e., enjoyment and perception of time, were evaluated via validated questionnaires. The secondary outcome, i.e., efficiency, was evaluated in terms of avoided healthcare resources. Enjoyment increased after the use of the specifically composed music (children +0.9 units/parents +1.7 units; p<0.05) compared to enjoyment with no music (0 units) and familiar music (+0.5 units). Perception of time was 11.1 min (±3.9) less than the actual time in the TG (p<0.05), 3.9 min (±4.2) more than the actual time in the PG and unchanged in the CG. The potential cost saving related to respiratory exacerbations was €6,704.87, while the cost increased to €33,524.35 in the CG and to €13,409.74 in the PG. In conclusion, the specifically composed, played and compiled instrumental recorded music is an effective adjunct to ACT to establish a positive response and is an efficient option in terms of avoided costs.

Trial registered as ISRCTN11161411. ISRCTN registry (www.isrctn.com).

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.

The Effect of Different Audio Distraction Methods on Children's Postoperative Pain and Anxiety

PURPOSE

The aim of the study was to determine the effect of different auditory methods of attention distraction on postoperative pain and anxiety in children.

DESIGN

The study was conducted as a pretest-posttest experimental study to determine the effect of classical music, Turkish music, and audiobook on the reduction of postoperative pain and anxiety in children.

METHODS

The patient population of the study comprised children who had undergone a surgical operation in the pediatric surgery clinics. A total of 90 children were included in the sample of the study. The data were collected using the Visual Analog Scale, the Wong-Baker Faces Pain Scale, and the State-Trait Anxiety Inventory for children, in addition to the sociodemographic data form of the child and the parent.

FINDINGS

Classical music, Turkish music, and audiobook methods played an effective role in decreasing postoperative pain and the anxiety state in children. Classical music listening was the most effective method in reducing the pain in children in the postoperative period in the three groups in the study.

CONCLUSIONS

We demonstrated that different auditory attention distraction methods had a decreasing effect on postoperative pain and anxiety in children.

Effect of music therapy on cortisol as a stress biomarker in children undergoing IV-line insertion

OBJECTIVE

An IV-line insertion can often provoke stress that can lead to an increase in cortisol levels. Complementary medication such as music therapy is needed to overcome the increase in cortisol levels. We conducted this study to determine the effect of music therapy on salivary cortisol levels in children with leukaemia undergoing IV-line insertion.

METHOD

This was a pre-experimental study with a pre- and post-test design. We analysed the salivary cortisol levels in 30 children with leukaemia undergoing IV-Line insertion from January until February 2018. Music was played using earphones after the completion of the IV-line insertion procedure. The salivary cortisol levels were analysed by an enzyme-linked immunosorbent assay (ELISA) test. Changes in cortisol levels were considered clinically significant if the differences were ≥0.05 ng/ml. The Wilcoxon test was used to test the effect of music therapy on cortisol levels and a p-value of <0.05 was considered statistically significant.

RESULT

Levels of cortisol before and after the music therapy had a median (min-max) of 4.14 (0.25-9.89) and 3.47 (0.16-15.31), respectively. The median difference of cortisol levels was 0.67 ng/ml. This change of ≥0.05 ng/ml indicates the clinical effect of music therapy on cortisol levels. Though the music therapy did not significantly affect salivary cortisol levels (p = 0.99), this study revealed the clinical effect of music therapy in reducing cortisol levels.

CONCLUSIONS

This study did not indicate a statistically significant effect of music therapy on cortisol levels of children with leukaemia during an IV-line insertion. However, the study findings reflect the clinical effect of music therapy in reducing cortisol levels.

The biological impact of listening to music in clinical and nonclinical settings: A systematic review

This systematic review explored the evidence base on the impact of listening to music on biological response in both clinical and nonclinical settings. Human studies exploring the effects of listening to recorded music on biological markers were included. Studies had to involve a non-music control condition. Keyword searches were carried out of five major databases (Cochrane/Wiley, PsycINFO, PubMed, Sage, and Science Direct) and bias was assessed using the Cochrane Risk of Bias Tool for Randomized Studies (RoB 2.0). Forty-four studies assessing the biological impact of music listening were identified: 27 in clinical settings and 17 in nonclinical settings. Eighty-two percent had examined the effects of short-term listening interventions, while the remainder had looked at longitudinal interventions. Thirteen of 33 biomarkers tested were reported to change in response to listening to music. The most commonly analyzed biomarker was the stress hormone cortisol, with half of clinical studies demonstrating a stress-reducing effect of music listening. Blood glucose was also found repeatedly to reduce in response to music listening. Many of the other biomarkers analyzed are also part of biological stress pathways, which suggests that the primary way by which music listening affects us biologically is via modulations of stress response. Effects were shown irrespective of genre, self-selection of the music, or duration of listening, although a majority did use classical music. The evidence base for understanding biological responses to music is still developing, but there is support for the application of listening to music, especially within clinical settings for stress reduction.

Ambulatory pediatric surgery

Ambulatory pediatric surgery has become increasingly common in recent years, with greater numbers of procedures being performed on an outpatient basis. This practice has clear benefits for hospitals and healthcare providers, but patients and families also often prefer outpatient surgery for a variety of reasons. However, maximizing the potential opportunities requires critical attention to patient and procedure selection, as well as anesthetic choice. A subset of outpatient procedures can be performed as single visit procedures, further simplifying the process for families and providers.

[Music, pulse, heart and sport]

Music, with its various elements, such as rhythm, sound and melody had the unique ability even in prehistoric, ancient and medieval times to have a special fascination for humans. Nowadays, it is impossible to eliminate music from our daily lives. We are accompanied by music in shopping arcades, on the radio, during sport or leisure time activities and in wellness therapy. Ritualized drumming was used in the medical sense to drive away evil spirits or to undergo holy enlightenment. Today we experience the varied effects of music on all sensory organs and we utilize its impact on cardiovascular and neurological rehabilitation, during invasive cardiovascular procedures or during physical activities, such as training or work. The results of recent studies showed positive effects of music on heart rate and in therapeutic treatment (e. g. music therapy). This article pursues the impact of music on the body and the heart and takes sports medical aspects from the past and the present into consideration; however, not all forms of music and not all types of musical activity are equally suitable and are dependent on the type of intervention, the sports activity or form of movement and also on the underlying disease. This article discusses the influence of music on the body, pulse, on the heart and soul in the past and the present day.

Psychological interventions in managing postoperative pain in children: a systematic review

Pediatric surgeries are common and painful for children. Postoperative pain is commonly managed with analgesics; however, pain is often still problematic. Despite evidence for psychological interventions for procedural pain, there is currently no evidence synthesis for psychological interventions in managing postoperative pain in children. The purpose of this review was to assess the efficacy of psychological interventions for postoperative pain in youth. Psychological interventions included Preparation/education, distraction/imagery, and mixed. Four databases (PsycINFO, PubMed, EMBASE, and Certified Index to Nursing and Allied Health Literature) were searched to July 2015 for published articles and dissertations. We screened 1401 citations and included 20 studies of youth aged 2 to 18 years undergoing surgery. Two reviewers independently screened articles, extracted data, and assessed risk of bias. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were calculated using RevMan 5.3. Fourteen studies (1096 participants) were included in meta-analyses. Primary outcome was pain intensity (0-10 metric). Results indicated that psychological interventions as a whole were effective in reducing children's self-reported pain in the short term (SMD = -0.47, 95% CI = -0.76 to -0.18). Subgroup analysis indicated that distraction/imagery interventions were effective in reducing self-reported pain in the short term (24 hours, SMD = -0.63, 95% CI = -1.04 to -0.23), whereas preparation/education interventions were not effective (SMD = -0.27, 95% CI = -0.61 to 0.08). Data on the effects of interventions on longer term pain outcomes were limited. Psychological interventions may be effective in reducing short-term postoperative pain intensity in children, as well as longer term pain and other outcomes (eg, adverse events) require further study.

Differences in Pediatric Pain Management by Unit Types

PURPOSE

The purpose of this study was to determine differences in pediatric pain management by unit type in hospitals across the United States. The aims were to (a) compare unit-type rates of assessment, intervention, and reassessment (AIR), and (b) describe differences in assessment tools and intervention use by unit type.

DESIGN

The study used a cross-sectional design. A secondary analysis of 2013 data from the National Database of Nursing Quality Indicators (NDNQI®) pain AIR cycle indicator was conducted. The sample included 984 pediatric units in 390 hospitals.

METHODS

Data were gathered via retrospective chart review on the pain assessment tool used, presence of pain, interventions, and reassessment. Descriptive statistics and the Kruskal-Wallis one-way analysis of variance test were conducted. Post-hoc analyses included the Wilcoxon-rank sum test with Bonferroni correction.

FINDINGS

Across all units the mean unit-level percentage of patients assessed for pain was 99.6%. Of those patients assessed, surgical units had the highest average unit-level percentage of patients with pain, while Level 4 neonatal intensive care units (NICUs) had the lowest. The most commonly used assessment tool among all units was the Faces, Legs, Activity, Crying, and Consolability (FLACC) Scale. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and Neonatal Infant Pain Scale (NIPS) specifically developed for infants were more commonly used across NICU unit types. The mean unit-level percentage of patients with pain receiving an intervention was 89.4%, and reassessment was 83.6%. Overall, pharmacologic methods were the most common pain intervention, while music was the least common.

CONCLUSIONS

Assessments were performed routinely, yet interventions and reassessments were not. Pain AIR cycle completion varied by unit type. Pain was also widely present across many unit types, and pharmacologic methods were most frequently used.

CLINICAL RELEVANCE

Frontline nurses are instrumental to pain management and have the ability to improve patient care and outcomes by effectively managing pain. A comprehensive understanding of it provides valuable insight into improving our practice to produce the best outcomes for pediatric patients.