Supplementing Relaxation and Music for Pain After Surgery

Music and Pain

The use of music in relation to relaxation and pain control is universal in application. Many cultures use music, tones, chanting, drums, or other forms of biofeedback to treat patients in acute pain, women in labor, recovery, and now, most recently, in pre- and post-operative care. In fact, the therapeutic value of music has been recognized as vital and powerful since Ancient Times; archaeological evidence shows flutes carved from bone in pictures of physicians healing patients, Greek physicians used music and vibration to heal, aid in digestion and induce sleep; the Early Egyptians used musical incantations to help with the healing process; and certainly, numerous native tribes use singing and chanting as part of their healing rituals (Nilsson, 2008).

Further, most postoperative patients have pain, despite the use of analgesia. Nurses are constantly trying to be more effective in delivering pain medication. One study showed that patients who were randomized showed increased pain decrease when music was applied. However, ethically there were patients who did not receive music therapy and, therefore, may have experienced more pain than the group receiving music therapy (Good, et.al., 2010). Additionally, and in relation to the previous article, one of the growing fields of modern medicine is the field of organ transplantation -- steadily increasing over the last few years to almost 35,000 per annum. Kidney transplantation is a particularly robust field, and a deficiency of organs makes the field quite competitive. There are a number of peculiarities regarding transplant -- finding the right organ, complications during recovery, and rejection of the organ. Research suggests that these difficulties often contribute to a stressful psychological state for the post-transplant patient; and certainly contribute to excess anxiety in pre-translplant waiting (Torpy, et.al., 2011).

Because there are so many brain-mind connections, researchers realize that the psychological discomforta in organ transplant patients are often associated with greater pain and reports of physical symptoms brought on by stress, worry and anxiety. Patients who are prone to depression or metal anxiety are particularly prone to more anxiety regarding transplantation. There is a strong correlation, too, to physiological disfunction (immune dysregulation, etc.) because of stress. Traditional coping strategies, however, have focused on more emotional issues than physical. However, research now shows us that the use of music therapy with and without a specific approach has a positive effect on these stress levels. In fact, active music engagement leads to a significant decrease in pain, which results in less stress and negative affect, which also reduces any dysfunction of the immune system (Ghetti, 2011).

However, in numerous studies surveyed, there must be both a control and an experimental group to validate results. Controlled experiments are those in which groups are separated into control and experimental. Neither group knows what they are receiving, so they may or may not be receiving a sugar pill or something else. The control group is essential for comparisons -- what happens in the control group often determines how the experimental data is interpreted (Scientific Control Group, 2008). Thus, any research on pain alleviation using music must make an ethical decision to purposefully exclude certain individuals from the pain relieving properties in order to validate the double blind study.

The field of Biological Ethics, for example, is part of the overall view of the appropriate manner humans should be used within the paradigm of experimental research. Because of these, and other, issues surrounding the field of Biological Ethics, a number of codes were enacted specifically to deal with the issues surrounding the moral and ethical rubric of utilizing humans for experimentation purposes: The Nuremburg Code (a set of directives establishing basic principles when dealing with human subjects); The National Research Act of 1974 (U.S. mandated legislation protecting human subjects); the HHS Policy for Projection of Human subjects (1981, HHS and FDA regulations); and the National Commission for the Protection of Human Subjects -- Also known as the Belmont Report (1979) is the cornerstone document for the protection of human research and includes beneficence, justice, and respect for persons as guiding principles (Goodwin, 2010).

However, it is not always necessary to withhold pain control from patients because there is enough data available regarding pre- and post-operative anxiety and pain issues, that one can use a literature basis to buttress initial arguments. One study, for instance, used patient's elf-reported ratings to evaluate their relaxation, anxiety, pain level, and nausea before and after music therapy sessions. This study was entirely ethical in its approach to the patients -- all were given the same opportunities to use music therapy, and then to rate its efficacy. Using a protocol of music, there was a clear reduction in pain perception, relaxation, and a quicker healing rate than national averages. Although some of this data is qualitative in measure, it was designed to be as includive as possible and used to help make decisions in evidence-based practice using an ethical approach to the patient's overall state of mind and health (Madson and Silverman, 2010).