Music therapy effects on preoperative anxiety and patient outcomes in surgery

Music Therapy

CHARMS to SOOTHE the SAVAGE BREAST

Music Therapy as a Standard of Healthcare

The human being is born into an environment of sound and stimulation and thereafter shaped and affected by it, most of all, by rhythmical music. Music therapy has been applied since Biblical times informally until its formal recognition after a gathering of significant benefits to physical, mental, and emotional disordered conditions. Today, various and numerous studies evidence its positive, reliable and long-lasting effects on the stress response during and after surgery, on back pain, on hypertension, Alzheimer's disease, Parkinson's, on people in rehab, the elderly, the mentally and terminally ill and on women in labor. Overwhelming evidence prompts that music therapy be incorporated into the standard health care system as a built-in regimen.

Introduction

Music therapy is a technique or mode of complementary medicine, which uses music to alter a patient's physical, emotional, intellectual or social condition (Turner 2001). It has been tried and found to improve the well-being of older patients in nursing home; lower the stress and pain level of women in labor; and benefit students, inmates in rehabilitation center, patients in hospitals, hospice, nursing homes, as well as clients in community centers and the home. The therapeutic effects of music are recorded in history from Biblical times to the present. It has helped most anyone to restore physical, emotional, social or cognitive balance. It also helps relax, reduce stress, improve one's mood or even increase one's immune system. In order to produce these effects, music therapy is handled by skilled therapists (Turner).

For its broad-spectrum benefits and the absence of any harmful side effects, music therapy should form part of standard healthcare.

Literature Review

Allen, G. (2007). Effect of Music Therapy on Stress Response to Day Surgery. British Journal of Surgery: Association of Operating Room Nurses, Inc.

Surgery is a stressful time. The patient becomes anxious. Stress disturbs his metabolic, neuro-hormonal and immune system levels. Cortisol and natural killer lymphocytes increase. A randomized study was conducted to investigate how music therapy reduces stress during day surgery by evaluating changes in plasma levels of cortisol and natural killer lymphocytes. These are known to increase during stress.

Sixty randomly selected patients scheduled to undergo surgery at a university hospital in Italy were studied from January to December 2005. Results showed that the plasma levels of cortisol and natural killer lymphocytes were reduced during surgery in those who listened to music. The conclusion was that perio-operative music therapy decreased stress. Furthermore, the style of music appeared to be of significance in reducing stress. This strongly suggests that music therapy can bring on positive effect on patients about to undergo surgery if they are allowed its style and type. Hence, perio-operative nurses and managers should consider including music therapy as part of their surgical routine.

Reiss, V. (2007). The Soundtrack of Your Life. Natural Health: Weider Publications

Reiss writes that a playlist can be created to unleash the power of music and use its ability to nurture oneself, whatever the mood. Music therapists suggest compiling and organizing CDs for whatever chosen effects. These can be music to relax, music to excite, and music to bring back memories. One can pay attention to his own breathing as he listens to a particular music a few minutes a day.

Christian M.A. (2006). The Positive Power of Music. Jet: Johnson Publishing Company

Music has much positive power. It makes one dance, sing, smile or cry. It cools off, calms and comforts. One of its major uses is as a form of therapy. Health care professionals use it to address physical, emotional, mental and social needs of patients of all ages. One major music therapy setting is the Ireland Cancer Center in Cleveland.

Each person is exposed to music throughout his existence. Even in the womb, an unborn infant is already exposed to the rhythmical heartbeat and liquid sounds. In life, music has a way of verbalizing what is unsaid or badly said. This is done through a melody. It is a special aid to those with speech impediments, like stuttering.

Music has the power to uplift, inspire and communicate what words cannot. Cultures, such as African-American and African, use music in almost all the aspects of their daily life for its strong positive energy. It is part of their work, play, ceremony and worship. Music makes work easier or more enjoyable. Play becomes more pleasurable because of music. It adds meaning and purpose to ceremonies. It adds power to praise in worship. To many, music is one of the powerful things God has given man. It helps make one realize His presence. It reaches a person's mind which does not reach his heart.

McRee, L et al. (2003). Using Massage and Music Therapy to Improve Post-Operative Outcomes. AORN Journal: Association of Operating Room Nurses, Inc.

Anxiety before surgery can negate desired outcomes. Increased anxiety can raise the level of circulating hormones, prostaglandin and free fatty acids. Such increase can also lead to myocardial and other organ ischemia, dysrhythmia, hypercoagulability, malnutrition, fluid and electrolyte imbalance, decreased wound healing and immunocompromise. Anxiety increases oxygen use, cardiac output and blood pressure.

A malnutrition, fluid and electrolyte imbalance, decreased wound healing, and blood pressure. It also requires higher doses of anesthetics and sedatives, a condition that can produce negative effects on recovery. There too are the fear of pain and the fear of pain to contend with. Surgical teams must, therefore, consider interventions, which can decrease anxiety and pain.

Music therapy is the use of music to address certain mental and emotional conditions in order to change them. In the 1800s, music was used to induce sleep, decrease anxiety before surgery and help in administering anesthesia. A pilot study of 30 patients about to undergo orthopedic surgical procedures was conducted to investigate if listening to music reduced their anxiety. The respondent patients said that music facilitated the surgery, covered background noise and kept their minds from the dreaded surgical procedure. Hospital staff members said that the patients were calmer throughout the surgery and the pulse and blood pressure were more stable.

Another group of researchers studied the physiological effects of music therapy on 22 critically ill patient respondents in an intensive care unit. They found that the therapy reduced the heart rate, systolic blood pressure, pain and anxiety. A six-month study was also conducted to determine the effect of music on painful procedures after making the patients listen to music. It showed that those who did needed 30% less pain medication than those who did not listen. Another study examined the perception of music of 25 participants who were administered local, spinal or epidural anesthesia. At an interview 20 hours after surgery, they said that music reduced their anxiety, distracted them and increased their tolerance for pain.

One study looked into the effect of music on pain among patients who had thyroidectomy, parathyroidectomy or modified mastectomy. Those who listened to music could tolerate pain much longer than those who did not listen. Those who listened also perceived their experience as more pleasant than did those who did not listen to music. Still another research was conducted on the effect of music on anxiety of groups of patients undergoing heart surgery. Anxiety levels before and after surgical procedure were recorded and then compared. Members of all groups said they experienced reduced anxiety and improved moods. Their heart rate and blood pressure also significantly deceased. And a study on the effect of music on the anxiety of 42 ambulatory surgery patients 10 minutes before surgery. Findings showed that those who listened to music had significantly lower heart rates than those who did not.

The studies recommended the adoption of music therapy to help decrease the overall stress response of patients. Nurses must acquire an understanding of this non-invasive and cost-effective approach in improving outcomes and patients' experiences.

Natural Health (2003). Tune Out Your Back Pain.Weider Publications: Gale Group recent study revealed that those who suffer from back pain, perform physical therapy, use guided imagery and listen to music will have substantially less back pain than those who only perform physical therapy. Guided imagery consists in focusing on relaxing images. Professor. Guenther Bematzky of the University of Salzburg in Austria said that guided imagery in combination with music calms the nervous system and reduces muscle tension. There is as yet no evidence that music or guided imagery alone will produce the same result. Therapists recommend listening to calming music and performing guided imagery for pain or relaxation about 30 minutes before bedtime.

Ambroziak, P. (2003). Use Music to Improve Health and Performance. American Fitness: Aerobics and Fitness Association of America

Research has discovered the awesome benefits that can be derived from listening to music. Music can energize, soothe, modify one's emotional outlook, increase immunity, decrease pain, hasten recovery, reduce blood pressure, improve one's focus and IQ and help reduce weight. All this goodness is within hearing distance. It involves the ears, the brain, the body itself and the nervous system. Music is sound, which enters the outer ear and passes through the middle ear into the inner ear and the brain by means of electrical energy. In the brain, it can generate motor responses, draw emotions, release hormones and trigger higher-order processes. The brain develops its response as it perceives the sound. If a loud sound creates fright, calm music can soothe.

Records on music therapy date as far back as Aristotle and Plato. Egyptian and Biblical documents also bear out that music was used to lighten illness and sorrow. American and European researchers in 1800 discovered the connection between music and the states of the body and the mind. They measured the connection in terms of cardiac output, rate of breathing, pulse and blood pressure. Numerous studies on the effect of music on health have been conducted since the 80s. Dr. Susan Hallam of the Department of Psychology and Special Education of the Institute of London gathered and evaluated more than 200 scientific studies, reports and books on the health effects of music. Collective research revealed that music has strong therapeutic effects. It can alter behavior, mood and emotional, physiological and cognitive states. It can reduce anxiety, pain, drug dosages by as high as 50%. It promotes well-being, improves symptoms of psychiatric patients, reduces depression and promotes rehabilitation and recovery. It enhances the production of stress-related hormones and painkillers. Her findings showed that music influences physiological arousal according to the type of music. Loud and fast music tends to excite and arouse. Calming music tends to soothe. Physically, the heart rate, blood pressure, rate of breathing, muscular tension, motor responses and skin temperature tend to rise with fast and loud music. These tend to go down in response to slow, soft music.

Dr. Hallam also says that music influences activity levels, mood, concentration, health, well-being and intelligence. It can increase or decrease levels of secretory immunoglobin a, which goes up during immune system activity. It can also induce elation or depression and patients' perception of pain. Music can be used as a self-enhancement tool according to one's purpose or intent. Fast-paced, lively or loud music should be used to rouse oneself in the morning; perk up during the day instead of drinking coffee; and work out with matching music. This type of music helps one work longer, harder and probably with less effort. It can drive out depression, anxiety, negative feelings or thoughts and raise self-confidence. It can also release anger, aggressive or any negative feeling or thought. In contrast, slow and soft music relaxes stress and soothes irritation; stretches the mind and feeling after a workout; allows down eating; and induces sleep.

Those who have discovered the benefits of music to health and well-being have collected music pieces of their preference. One should observe what effects certain music has on himself. A portable CD or tape player and headphones should be used if appropriate music pieces are carried to bring about particular effects.

Vibrant Life (2002). Effect of Music on Blood Pressure. Journal of the American Medical Association: Review and Herald Publishing

Music will not replace change in lifestyle or medications in dealing with hypertension. But findings of a new study showed that it can help in preventing the ailment. This study gathered the responses of 50 male surgeons who tackled difficult mental arithmetic tasks. Despite their high level skills, the tasks often raise their blood pressure and heartbeat. Those who listened to music while performing the tasks experienced the least increase in blood pressure. Those who did not listen experienced the highest number of hypertension occurrences by 23 points and diastolic by 15 points. Moreover, the speed and accuracy of their tasks scored better by listening to music.

Klotter, J. (2001). Music and Alzheimer's. Townsend Letter to Doctors and Patients: The Townsend Letter Group music therapy program reported increased melatonin levels, improved behavior and reduced sleeping problems in the 20 male respondents suffering from Alzheimer's. The respondents had 30 to 40 minutes of music therapy, five days per week for a month. The test used blood samples throughout the investigation. The leader, Dr. Ardash Kumar, and his associates at the University of Miami, School of Medicine in Florida examined the levels of melatonin, norepinephrine, epinephrine, serotonin and prolactin. These brain chemicals affect the mental state of sufferers of Alzheimer's. They found that the blood levels of these chemicals significantly increased at the end of the therapy schedule. Furthermore, melatonin levels remained high for 6 weeks after the cessation of therapy. The researchers estimated that epinephrine and norepinephrine levels would have returned to their original readings. The respondents were also reported to be more active and cooperative and that they slept better.

Dr. Kumar said that the use of music to calm oneself down is very helpful. He advised that favorite and soothing music be listened to during meals, before sleeping and when relaxation is desired or needed. He also believed that music therapy could even be a safer and more effective substitute to many habit-forming psychotropic drugs. Music can help maintain hormonal and emotional balance even when stressed or ill.

Turner, Judith (2001). Music Therapy. Encyclopedia of Alternative Medicine: Gale Encyclopedia of Alternative Medicine

The impressive health benefits of music to World War II veteran patients encouraged studies and the formation of music therapy. Degrees in the new line began to be offered in the late 40s and 50s. The first association of music therapists, the National Association of Music, was organized. It later merged with the American Association of Music in 1998 to form the American Music Therapy Association.

Music can be used as a complementary mode of therapy as well as by healthy individuals to relax, reduce normal stress or improve the mood or as a hefty accompaniment to exercise or movement. Music also helps improve communication, enhance academic abilities and accomplishments, increase attention span and sharpen motor skills. It has been found useful in behavioral therapy and pain management.

Brain function undergoes physical changes in response to music. Breathing can become slower and calm it. The speed of the heartbeat either speeds up or slows down according to the type of music heard and the volume. It relaxes muscle tension and improves motor skills. It has been of particular benefit in rehab clinics as a kind of pacifier. Levels of natural painkillers called endorphins go up and those of stress hormones go down when one listens to music. The decrease of stress hormones points to the ability of music to boost the immune function by raising interleukin-1 levels. This was the finding of a 1993 study at the Michigan State University with respondents who were made to listen to music every 15 minutes.

Mentally, music can sharpen mental capacity or help relax the mind. It can enhance memory and learning, especially in children with learning disabilities. Music can likewise increase concentration. Overall, improved concentration results in greater productivity. A specific example is the "Mozart effect" whereby college students can do math computations better while listening to classical music.

As to its emotional effects, music releases feelings, tones down tension and excitement, or creates a romantic atmosphere. Lullabies are an example for soothing babies to sleep. It has been used as an effective way of expressing emotions indirectly and as such, presents as a very important therapeutic tool to some disorders.

The music therapist determines the goal and specific activities and exercises suited to the specific needs of the patient. It may be to develop communication, cognitive, motor, emotional or social skills. Techniques include singing, listening, instrumental music composition, creative movement, and guided imagery.

Stimulating and playful music can help develop a child's ability to express emotion and rhythmic movement, speech and language skills. It can improve children's self-esteem if they engage in musical activities, which enhance success or accomplishment. Selected music can reduce stress, anxiety and pain, those preparing for surgery in hospitals or recovering from it. Moreover, music has been demonstrated as contributing to rapid wait gain in premature babies, earlier hospital discharge and improved cognitive function.

Those suffering from brain damage due to stroke, traumatic brain injury or other neurologic conditions have benefited significantly by music therapy. Entrainment may explain the benefit. Entrainment is the synchronization of movement with musical rhythm. As a consequence, practice with music as accompaniment can lead to improved motor skill ability and efficiency.

Music has proved to provide enjoyment, relaxation, relief from pain and a chance to socialize and remember delightful past events. The elderly are generally prone to anxiety and depression, especially those residing in nursing homes. It is of specific benefit to those with Alzheimer's disease. Music reduces their agitation and leads them to become more focused and responsive at least for a while. Studies have also shown that older people who play musical instruments were more physically and emotionally adept as they age than those who did not.

Autistic children have been shown to relate better and improve learning with music therapy. Besides autism, substance abuse, schizophrenia, paranoia and personality disorders can be helped by music therapy. Cases showed that the sufferers' orientation with reality improved, coping skills developed, stress decreased and feelings better expressed.

The terminally ill, whether in hospice or not, generally experience fear of death and dying. The relief of pain provided by soothing music can be of specific value to them. This type of music can release endorphins, promote relaxation and verbalize their fears of death and dying. Music helps regulate the fast breathing of an anxious person. It helps ease the mind. Music therapy is a regular feature in organizations, which care for dying patients by relieving their pain.