Music Therapy Reduces Pain In Palliative Care: Evidence-based Practice

Ask: PICO Questions

Chronic pain is a major concern irrespective of the age of the individuals. However, mainly the older adults are the major victims of chronic pain. Though pain management is targeted as the main priority, it continues to be addressed inadequately. The use of pharmacological medications for the management of pain is associated with numerous side-effects and hence the importance of non-pharmacological strategies for the management of chronic pain is gaining prominence. The professional nurses are in a unique position for facilitating the acquisitions and subsequent utilization of the non-pharmacological strategies for pain management (Duke et al., 2013). According to Gelinas et al. (2013) there is lack of proper evidence-based practices in the domain of non-pharmacological management of pain. However, evidence-based practice is an importance aspect of nursing interventions (Craig & Smyth, 2012). The concept of evidence-based practice is guided by 5 steps and this includes ask, access, appraise, apply and access. Ask deals with formulation of the clinical question, access helps to track down the best possible evidence, appraise consists of validity of the evidences and consideration of its usefulness. Apply deals with integration of results within the clinical expertise of the nursing professionals and final assessment deals with evaluation of the effectiveness of the process (Melnyk & Fineout-overholt, 2015). The following paper aims to highlight the best-suited evidence-based practice for non-pharmacological interventions for chronic pain management.

According to Nicholas et al. (2013) community dwelling adults who are aged over 65 years reports of having chronic pain in relation to accomplish daily living activities. The pain arises either from arthritis or due to previous dispositions of some chronic diseases. The adults in the post-operative care or in palliative care also suffer from chronic pain. Increase in the level of chronic pain hampers the quality of life of the adults. For effective management of pain, non-pharmacological interventions care increasingly accepted due to side effects associated with the pharmacological interventions. However, there is little evidence of the widespread application and utility of non-pharmacological interventions for the management of chronic pain among the older adults (Nicholas et al, 2013).

Thus, the main clinical question of this study is to what is the effect of music in comparison to analgesic, as non-pharmacological intervention for the effective management of pain among the adults in the post-operative care and palliative care unit?

Gutgsell et al. (2013) conducted the study in order to study the role of single music therapy session in pain management of palliative care patients. Gutgsell et al. (2013) studied 200 in-patients of the University Hospitals Case Medical Care who are enrolled between 2009 to 2011. The patients were randomly assigned to two different groups. One groups received medical and nursing care along with the scheduled use of analgesic while the other group received the standard music therapy (30 minutes). The pre and posttest results were used to assess the level of pain with the use of numeric rating scale and this was considered as primary outcome. The secondary outcome of study includes functional pain scale, consolability scale and activity of legs and expression in face. The intervention mainly included music-therapy guided autogenic relaxation and live music. The analysis of the results highlighted significant greater decrease in the numeric rating scale pain score among the music therapy groups however no significant change was noticed in the secondary outcomes however, the mean change in functional group is significantly greater. Gutgsell et al. (2013) stated that therapist-guided autogenic relaxation and live music is effective in decreasing the pain among the palliative care patients. As per the CASP checklist, the main strengths of the study is the trial access the clearly focused issue with clearly discussed population studies (palliative care), interventions given (music therapy) and the comparator used (use of analgesic) and the outcomes considered (decrease in pain score). The randomization was also done in a proper manner as the selected group of patients were randomly disseminated into two groups. The main limitations of the study are the study personnel were not blinded to the treatment outcomes and this might lead to biased results. Moreover, the results might not be applicable to local population as selected population was palliative care adults. 

Access: Research of the research articles

The aim of the study conducted by Özer et al. (2013) was to investigate the effect of listening to music of personal choice on decreasing the intensity of pain and other physiological parameters among post open-heart surgery patients. Özer et al. (2013) mainly used quasi-experimental study over 87 patients who under-went open heart surgery. 44 patients were assigned in the music group (20-minite of music) and 43 patients were groups as placebo and aged between 18 to 78 years. The level of pain was measured through Numeric Pain Score (NRS) and the parameters for the physiological assessment include oxygen saturation, heart rate and blood pressure. The analysis of the results highlighted no difference in the physiological parameter however, the NRS showed significant decrease among the patients assigned under the music groups. Thus Özer et al. (2013) concluded that music is safe and cost-effective method for reduction in chronic pain. According to the critical appraisal checklist of quasi-experimental study of Jonna Briggs Institute, the main strength of the article is, the people under one group received the same treatment. Moreover, multiple measurements of the outcome was done through pre and post exposure. The outcome was reliable as the author gave a detailed list of the pain score along with the parameters of the physiological outcome. The main limitation of the study is, participants included in both the group do not have similar parameters. The age group selected was 18 and 78, the level of pain among the older adults and much higher than the young adults were and this might lead to discrepancy in results.

Thus, the main evidence-based non-pharmacologic intervention that was selected for the effective management of chronic pain is use of music of the choice of the patients for about 30 minutes per day for getting music-therapy guided autogenic relaxation. The implementation of the evidence-based information can be done under the presence of a nursing professional and a music therapist. At first, the patient will be asked to pay attention to breathing for about one minute. Then the therapist will ask the patient for autogenic muscle relaxation by paying attention to the scalp muscles and allowing them to release and move down slowly with similar focus on specific muscles. This muscle relaxation will end with the feet while music playing in the background (Özer et al., 2013). According to Smith et al. (2018), music of choice helps in mental relaxation, which help to decrease painful secretion, and relaxation of the muscles further help to decrease the painful stimuli.

The process of evaluation of the reduction in the pain score will be measured with the help of NRS. Along with this, improved on the well-being will also be monitored through analyzing the increase in the level of quality sleep at night and improvement in mobility. The potential barrier in implementation of the music therapy is the patient rejection. However, proper education of the patients in the domain of importance of the psychosocial needs and perceived benefits of the music therapy will be helpful in overcoming the strong patient objection (Chen, 2017).

References

Chen, Y. C. (2017). Barriers to Music Therapy Participation for Cancer Patients during Hospitalization (Doctoral dissertation, Ohio University).

Craig, J.V., & Smyth, R.L. (Eds.). (2012). The evidence-based practice manual for nurses (3rd ed.). Oxford: Churchill Livingstone Elsevier.

Duke, G., Haas, B. K., Yarbrough, S., & Northam, S. (2013). Pain management knowledge and attitudes of baccalaureate nursing students and faculty. Pain Management Nursing, 14(1), 11-19.

Gelinas, C., Arbour, C., Michaud, C., Robar, L., & Côté, J. (2013). Patients and ICU nurses’ perspectives of non?pharmacological interventions for pain management. Nursing in critical care, 18(6), 307-318.

Gutgsell, K. J., Schluchter, M., Margevicius, S., DeGolia, P. A., McLaughlin, B., Harris, M., … & Wiencek, C. (2013). Music therapy reduces pain in palliative care patients: a randomized controlled trial. Journal of Pain and Symptom Management, 45(5), 822-831.

Melnyk, B. M., & Fineout-overholt, E. (2015). Evidence-based practice in nursing and health care: A guide to best practice (3rd ed.).  Philadelphia: Wolters Kluwer.

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of internal medicine, 151(4), 264-269.

Nicholas, M. K., Asghari, A., Blyth, F. M., Wood, B. M., Murray, R., McCabe, R., … & Overton, S. (2013). Self-management intervention for chronic pain in older adults: a randomised controlled trial. PAIN®, 154(6), 824-835.

Smith, C. A., Levett, K. M., Collins, C. T., Armour, M., Dahlen, H. G., & Suganuma, M. (2018). Relaxation techniques for pain management in labour. Cochrane Database of Systematic Reviews, (3).

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