Music as therapy.Abstract: Music is widely used to enhance well-being, reduce stress, and distract patients from unpleasant symptoms. Although there are wide variations in individual preferences, music appears to exert direct physiologic effects through the autonomic nervous system autonomic nervous system: see nervous system.
autonomic nervous system
Part of the nervous system that is not under conscious control and that regulates the internal organs. It includes the sympathetic, parasympathetic, and enteric nervous systems. . It also has indirect effects by modifying caregiver behavior. Music effectively reduces anxiety and improves mood for medical and surgical patients, for patients in intensive care units and patients undergoing procedures, and for children as well as adults. Music is a low-cost intervention that often reduces surgical, procedural, acute, and chronic pain. Music also improves the quality of life for patients receiving palliative care palliative care (paˑ·lē·ā·tiv kerˑ),
n an approach to health care that is concerned primarily with attending to physical and emotional comfort rather , enhancing a sense of comfort and relaxation. Providing music to caregivers may be a cost-effective and enjoyable strategy to improve empathy, compassion, and relationship-centered care relationship-centered care,
n health care that honors and focuses on relationships including those between the practitioner and self, practitioner and patient, practitioner and practitioner, and practitioner and community. while not increasing errors or interfering with technical aspects of care.
Key Words: allied health, anxiety, complementary therapy, music, pain, relaxation, stress
Music has been used since ancient times to enhance well-being and reduce pain and suffering. This article will review the medically relevant effects of music, focusing on pain, anxiety, and mood. We will not discuss the use of music to enhance cognitive development (ie, the "Mozart effect") or for patients with severe developmental delays, dementia, psychiatric disorders, neurologic disorders, sensory handicaps, or in institutional settings such as correctional facilities or schools, though a great deal of work has been done in these areas.
Cases and Questions
One of the new physicians on staff in your newborn nursery suggests that you start playing recordings of classical music for the infants. The day shift nurses usually listen to a soft rock music station on the radio, and are reluctant to change. The evening and night shift nurses have not played any music. Is there any evidence that music affects newborn infants? If so, what kind of music might be best?
Increasing numbers of patients in gastrointestinal clinics bring their own CD or MP3 players to clinic visits to help them relax during colonoscopy. What is the evidence that music reduces anxiety, improves mood, or eases the stress associated with procedures? Do all people respond the same way to the same kinds of music, or should everyone just listen to whatever they like (eg, pop and grunge grunge - /gruhnj/ 1. That which is grungy, or that which makes it so.
2. [Cambridge] Code which is inaccessible due to changes in other parts of the program. The preferred term in North America is dead code. rock for teenagers, classical music or jazz for adults)?
Some of the nurses in the preoperative pre·op·er·a·tive
Preceding a surgical operation.
preceding an operation.
the preparation of a patient before operation. and postoperative areas provide headphones and play New Age music for their patients. Is there any evidence that music helps reduce pain or enhances wound healing wound healing Physiology The repair of a wound Steps Inflammation, repair and closure, remodeling, final healing; repair of incisions may be either simple–'clean' wounds with little loss of tissue heal by 'primary intention', or 'dirty' wounds heal by in the perioperative perioperative /peri·op·er·a·tive/ (-op´er-ah-tiv) pertaining to the period extending from the time of hospitalization for surgery to the time of discharge.
A harpist volunteers at the local hospice. What role does music have in end-of-life care?
One surgeon prefers to listen to country western while another likes classical. How does listening to music affect clinician or caregiver performance?
Illness, injuries, and hospitalization are stressful. Hospitalized patients are susceptible to environmental stressors such as cold temperatures, noise, and bright lights, in addition to the pain, discomfort, and anxiety associated with their medical conditions and treatments. Stress may interfere with sleep, appetite, digestion, growth, behavior, and wound healing. Stress may also adversely affect the cardiovascular, neuroendocrine neuroendocrine /neu·ro·en·do·crine/ (-en´do-krin) pertaining to neural and endocrine influence, and particularly to the interaction between the nervous and endocrine systems.
adj. , and immune systems, which, in turn, may impair recovery, increase risk for adverse effects, and delay hospital discharge. (1,2) Recently, the use of structured stimuli has been encouraged to reduce stress, using techniques such as regular cycling of light and dark, massage, and music therapy. (3-5)
Environmental sounds that exist without controls for volume, duration, or cause/effect relations are perceived as noise. The most well-known adverse effects of exposure to excessive noise are related to hearing damage; noise also contributes to fatigue, hyperalerting, insomnia, and decreased appetite. In mice, exposure to noise leads to physiologic stress, manifested as significantly increased airway reactivity and increased allergic reactions. (6) Among infants hospitalized in the neonatal intensive care unit Noun 1. neonatal intensive care unit - an intensive care unit designed with special equipment to care for premature or seriously ill newborn
ICU, intensive care unit - a hospital unit staffed and equipped to provide intensive care , excessive noise is correlated with decreases in oxygen saturation oxygen saturation sO2 The O2 concentration of blood expressed as a ratio of its total O2-carrying capacity; the OS is a measure of the utilization of O2 transport capacity; sO2 and increases in heart rate and sleep disturbances. (7)
Music is an intentional auditory stimulus with organized elements including melody, rhythm, harmony, timbre timbre
Quality of sound that distinguishes one instrument, voice, or other sound source from another. Timbre largely results from a characteristic combination of overtones produced by different instruments. , form, and style. Repetitive listening allows the listener to identify and predict sounds. (5) Thus, repeated exposure may enhance clinical effects. However, excessive repetition may lead to boredom and irritation.
Music is ubiquitous in all human cultures and is listened to by persons of all ages, races, and ethnic backgrounds. One measure of the popularity of a topic is the number of Internet sites devoted to that topic. Using this metric, music (at 131 million sites) follows sex (at 185 million sites) in terms of the most popular listings on the Google Internet search engine (search October 22, 2003). (8) Not surprisingly, different kinds of music appeal to persons of different ages and ethnic backgrounds, and the same person may desire different kinds of music under different circumstances. For example, nursery rhymes may be soothing for toddlers, but hearing the "Sesame Street" or "Barney" song several times daily can be irritating for adolescents or parents. High-tempo contemporary music is often used to increase athletic performance, whereas baroque music may be preferred for relaxing after a stressful examination, and jazz may be preferred for socializing. Recently, specific types of music have been marketed to enhance pediatric pediatric /pe·di·at·ric/ (pe?de-at´rik) pertaining to the health of children.
Of or relating to pediatrics. development (eg, the Mozart effect), to address cognitive problems, and to enhance effectiveness of other complementary therapies such as Reiki Reiki Definition
Reiki is a form of therapy that uses simple hands-on, no-touch, and visualization techniques, with the goal of improving the flow of life energy in a person. and massage. Although these strategies remain somewhat controversial, music has long been used as a complementary healing therapy to soothe patients afflicted with pain, anxiety, and a variety of illnesses and injuries.
Music therapy is recognized as an established allied health profession that uses music to facilitate therapeutic processes. (9) Music therapists are typically musicians who have undergone specific training in using music and the therapist's self to accomplish therapeutic aims: the restoration, maintenance, and improvement of mental and physical health. Music therapists work in a variety of settings as part of the health care team. The American Musical Therapy Association has more than 2,500 members working in hospitals, clinics, schools, day care centers, hospices, rehabilitation centers, correctional facilities, and private practice settings. However, even in the absence of a professional music therapist, many patients and clinicians listen to or play music to manage stress, anxiety, and pain in clinical settings.
Music may have different effects, based on listener characteristics: age, culture, medical conditions that affect hearing, musical aptitude, and experience. Other factors affecting music influence include elements of the music (tempo, pitch, harmony, melody, rhythm), means of delivery (headphones, speaker, open air, live versus recorded), setting (group or alone), and active versus passive participation. (10)
What Does Music Do for Patients?
Music and music therapy may benefit patients directly: physiologically, psychologically, and socioemotionally. Music may also affect patients indirectly through its effects on caregiver attitudes and behaviors. With regard to direct physiologic effects, in animals, music changes neuronal activity with entrainment entrainment /en·train·ment/ (en-tran´ment)
1. a technique for identifying the slowest pacing necessary to terminate an arrhythmia, particularly atrial flutter.
2. to musical rhythms in the lateral temporal lobe temporal lobe
The lowest of the major subdivisions of the cortical mantle of the brain, containing the sensory center for hearing and forming the rear two thirds of the ventral surface of the cerebral hemisphere. and in cortical areas devoted to movement. Steady rhythms entrain entrain /en·train/ (en-tran´) to modulate the cardiac rhythm by gaining control of the rate of the pacemaker with an external stimulus. respiratory patterns. Listening to classical music increases heart rate variability Heart rate variability (HRV) is a measure of variations in the heart rate. It is usually calculated by analysing the time series of beat-to-beat intervals from ECG or arterial pressure tracings. , a measure of cardiac autonomic balance (in which increased levels reflect less stress and greater resilience), whereas listening to noise or rock music decreases heart rate variability (reflecting greater stress). (11,12) In students engaged in stressful tasks, lower salivary sal·i·var·y
1. Of, relating to, or producing saliva.
2. Of or relating to a salivary gland.
pertaining to the saliva. cortisol cortisol (kôr`tĭsôl') or hydrocortisone, steroid hormone that in humans is the major circulating hormone of the cortex, or outer layer, of the adrenal gland. levels are noted in those listening to music compared with control subjects, whose cortisol levels increased. (13) Music affects mu opiate receptor opiate receptor
Any of various cell membrane receptors that can bind with morphine and other opiates; concentrations of such receptors are especially high in regions of the brain having pain-related functions. expression, morphine-6 glucuronide, and interleukin-6 levels in healthy volunteers. (14) Its effects may be mediated by nitric oxide nitric oxide or nitrogen monoxide, a colorless gas formed by the combustion of nitrogen and oxygen as given by the reaction: energy + N2 + O2 → 2NO; m.p. −163.6°C;; b.p. −151.8°C;. , but the precise mechanisms remain speculative. (15)
Types of Music
Although there are wide individual and cultural variations in types of music preferred, certain kinds of music appear to have consistent physiologic effects. (16) In one study, for example, adults and teenagers listened to four different types of music: classical, grunge rock, new age, and designer (designed to enhance a sense of well-being). At baseline and immediately, after listening to each kind of music, respondents completed a survey of personal feelings. Classical music decreased tension but had little effect on other feelings. Listening to grunge rock led to significant increases in hostility, fatigue, sadness, and tension and significant decreases in relaxation, mental clarity, vigor, and a sense of compassion. With new age music, there was a significant increase in relaxation and reductions in hostility, mental clarity, vigor, and tension. After listening to designer music, subjects reported significantly more relaxation, mental clarity, vigor, and compassion and significantly decreased hostility, sadness, fatigue, and tension. Teenagers had negative psychological and emotional responses to grunge rock music, even when they usually liked listening to it outside the study setting.
Music for Premature Infants
Among premature infants, lullabies and classical music appear to increase weight gain, decrease episodes of oxygen desaturation desaturation /de·sat·u·ra·tion/ (de-sach?ah-ra´shun) the process of converting a saturated compound to one that is unsaturated, such as the introduction of a double bond between carbon atoms of a fatty acid. , decrease distressed behaviors, and increase nonnutritive sucking nonnutritive sucking,
n a behavior of infants and toddlers that includes sucking on objects (fingers, pacifiers, etc.) out of habit or for psychologic comfort. , all of which may decrease length of hospital stay. (5,17-20) In premature infants, exposure to harp music resulted in significantly lower salivary cortisol levels and lower respiratory rates. While listening to music, infants become quiet and appear to fall asleep; these decreases in activity may reduce caloric caloric /ca·lo·ric/ (kah-lor´ik) pertaining to heat or to calories.
1. Of or relating to calories.
2. Of or relating to heat. expenditure, enhance weight gain, and hasten hospital discharge. (21) The effects of country western, pop, jazz, and other types of music on premature infants have not been systematically compared with the effects of lullabies and classical music, nor has live music been compared directly with recorded music in this setting.
Music and Mood in Medical and Surgical Patients
Providing music on a hospital ward and in perioperative or waiting areas can create a positive milieu for patients, families, and staff. (22-24) Creating such an environment can have significant effects on patients' moods in terms of anxiety, depression, and perceived stress. Furthermore, positive physiologic changes such as increased levels of salivary immunoglobulin A immunoglobulin A
n. Abbr. IgA
The class of antibodies produced predominantly against ingested antigens, found in body secretions such as saliva, sweat, and tears, and functioning to prevent attachment of viruses and bacteria to epithelial and decreased serum cortisol levels often accompany changes in anxiety and stress levels. (25) A review article of 29 randomized ran·dom·ize
tr.v. ran·dom·ized, ran·dom·iz·ing, ran·dom·iz·es
To make random in arrangement, especially in order to control the variables in an experiment. , controlled trials (RCTs) of music therapy revealed that music helps reduce anxiety in hospitalized patients. (26)
For example, music can improve mood and reduce anxiety in surgical patients. In a study of effects of listening to music on preoperative anxiety in men undergoing prostate surgery, participants in a music intervention had significantly reduced anxiety and blood pressure. (27) Patients about to undergo surgery with spinal anesthesia spinal anesthesia
1. Anesthesia produced by injection of a local anesthetic solution into the spinal subarachnoid space.
2. Loss of sensation produced by disease of the spinal cord. who listened to music required less sedative sedative, any of a variety of drugs that relieve anxiety. Most sedatives act as mild depressants of the nervous system, lessening general nervous activity or reducing the irritability or activity of a specific organ. to achieve a similar degree of relaxation compared with a control group. (28) In a study of 20 women awaiting breast biopsy Breast Biopsy Definition
A breast biopsy is removal of breast tissue for examination by a pathologist. This can be accomplished surgically, or by withdrawing tissue through a needle. , the group that received 20 minutes of music had less anxiety than usual care patients, after controlling for baseline anxiety. (29) Similarly, a study of a music intervention during the postoperative period after coronary bypass surgery Coronary bypass surgery
A surgical procedure which places a shunt to allow blood to travel from the aorta to a branch of the coronary artery at a point past an obstruction.
Mentioned in: Cardiac Catheterization, Thallium Heart Scan showed a significant improvement in mood. (30) However, in a study of children undergoing surgery, those who listened to music before surgery had similar reduction in anxiety compared with patients receiving usual care and more anxiety than patients who received midazolam. (31) Taken together, these studies generally demonstrate beneficial effects of music therapy on psychologic outcomes in surgery patients; no adverse outcomes or side effects Side effects
Effects of a proposed project on other parts of the firm. have been reported.
Music also benefits mood in oncology patients. In a sample of stem cell stem cell
In living organisms, an undifferentiated cell that can produce other cells that eventually make up specialized tissues and organs. There are two major types of stem cells, embryonic and adult. transplant patients, those receiving music therapy reported substantially lower psychologic distress than a control group, both immediately after the music therapy session and during the course of the inpatient stay. (32) Among cancer patients undergoing radiotherapy, those patients whose anxiety level was higher at the start were most likely to benefit from the music intervention. (33) Music therapy can also improve mood in pediatric oncology patients. (34,35) A study of patients at a cancer help center compared effects of passively listening to music versus active involvement in improvisation in a group setting. Both of these music groups showed a decreased tension level and shared comments about how music affected their mood: "relaxed and uplifted," "soothing and relaxing," "calmed my nerves," and "felt calm and happy." (36)
In other clinical settings including intensive care units (ICU ICU intensive care unit.
intensive care unit
see intensive care unit.
ICU ), music has been shown to reduce patients' anxiety and depression. (26,37-39) One study of patients on mechanical ventilators in the ICU demonstrated that music therapy was more effective at decreasing anxiety than an uninterrupted rest period. (40) Another RCT RCT Randomized Controlled Trial
RCT Regimental Combat Team (infantry regiment with their own artillery, engineers, medical and tanks)
RCT Rollercoaster Tycoon
RCT Randomized Clinical Trial
RCT Rhondda Cynon Taff of alert patients on mechanical ventilators randomly assigned to a 30-minute patient-selected music condition or a rest period showed significant between-group differences on anxiety level, heart rate, and respiration rate respiration rate
Frequency of breathing, expressed as the number of breaths per minute. as well as a greater reduction in anxiety in the music group. (39)
Music also reduces anxiety associated with unpleasant or uncomfortable procedures such as bronchoscopy Bronchoscopy Definition
Bronchoscopy is a procedure in which a cylindrical fiberoptic scope is inserted into the airways. This scope contains a viewing device that allows the visual examination of the lower airways. , colposcopy Colposcopy Definition
Colposcopy is a procedure that allows a physician to take a closer look at a woman's cervix and vagina using a special instrument called a colposcope. It is used to check for precancerous or abnormal areas. , and colonoscopy (41-43); providing recorded music can be as or more effective in reducing patients' anxiety than preoperative teaching, counseling, or relaxation training relaxation training,
n method that teaches specific techniques for producing the relaxation response. See also relaxation response.
n , while costing far less. (44,45) For example, an RCT of 198 patients having colonoscopy or endoscopy endoscopy
Examination of the body's interior through an instrument inserted into a natural opening or an incision, usually as an outpatient procedure. Endoscopes include the upper gastrointestinal endoscope (for the esophagus, stomach, and duodenum), the colonoscope (for the demonstrated that listening to 15 minutes of self-selected music before the procedure significantly reduced anxiety compared with a control group. (42) Another RCT conducted with patients undergoing flexible sigmoidoscopy showed a significant decrease in anxiety for the music group compared with usual care, controlling for baseline anxiety levels. (46) Among patients having day procedures (cytoscopy, cauterization cauterization /cau·ter·iza·tion/ (kaw?ter-i-za´shun) destruction of tissue with a cautery.
destruction of tissue with a cautery. , endoscopy), those who listened to music while awaiting the procedure reported lower anxiety than a control group. (47)
However, other studies of music therapy in patients undergoing procedures have yielded more equivocal findings. In an RCT of 20 patients awaiting cardiac catheterization Cardiac Catheterization Definition
Cardiac catheterization (also called heart catheterization) is a diagnostic procedure which does a comprehensive examination of how the heart and its blood vessels function. , those randomly assigned to listen to 20 minutes of preselected music had significantly lower anxiety than a control group and also showed a significant reduction in anxiety level, blood pressure, and heart rate. (48) Similarly, nearly 70% of patients enrolled in an RCT of music therapy for cardiac catheterization reported that music made them feel less tense, more relaxed, and safer. (49) However, in another RCT of 45 patients undergoing cardiac catheterization, music therapy did not significantly reduce anxiety, improve mood, or reduce patient uncertainty. (50) Similarly, in an RCT of 60 patients undergoing flexible fiberoptic bronchoscopy fiberoptic bronchoscopy See Bronchoscopy, Bronchial brushings, Bronchial washings. , no significant between-group differences between music therapy and control groups were demonstrated. (51) Likewise, an RCT of 58 cancer patients having unpleasant medical procedures (tissue biopsy, port placement/removal) randomly assigned to music therapy or simple distraction conditions found no significant effects for a music intervention compared with simple distraction. (52)
In summary, there is good evidence for use of music therapy with surgery patients and cancer patients but mixed evidence for use of music therapy with patients having medical procedures. Perhaps factors that affect the effectiveness of music therapy in patients awaiting or undergoing uncomfortable procedures include individual differences such as music preferences, initial anxiety level, and level of interest in being distracted from the procedure. Music therapy may offer benefit to some patients undergoing these procedures by helping to divert their attention from potentially unpleasant experiences; however, it may be important to tailor the intervention to patient desires and preferences.
Effects on Pain
Many studies of the effects of music therapy on pain relief have had methodologic problems, such as small sample size, lack of random assignment, and lack of control for patient anesthesia. (53,54) These issues notwithstanding, overall music is a low-cost intervention that is appealing to patients and often helps reduce pain. (53,54)
Playing music for patients during or after surgery helps reduce pain and use of morphine and other sedatives, anxiolytics, and analgesics Analgesics Definition
Analgesics are medicines that relieve pain.
Analgesics are those drugs that mainly provide pain relief. . (55,56) A series of 17 vascular and thoracic surgery Thoracic Surgery Definition
Thoracic surgery is the repair of organs located in the thorax, or chest. The thoracic cavity lies between the neck and the diaphragm, and contains the heart and lungs (cardiopulmonary system), the esophagus, trachea, pleura, patients who listened to live harp music showed substantially decreased pain levels after the music session. (23) In a study of 311 gynecologic gynecologic /gy·ne·co·log·ic/ (gi?ne-) (jin?e-kah-loj´ik) pertaining to the female reproductive tract or to gynecology. surgery patients, compared with usual care, patients who received music, relaxation, or their combination used substantially less patient-controlled pain medications. (57) A similar study of 500 abdominal surgery patients demonstrated that patients receiving music therapy, relaxation, or a combination reported significantly lower pain levels than a control group. (58) An RCT of 150 patients undergoing inguinal hernia inguinal hernia
A hernia into the inguinal canal.
inguinal hernia Surgery The prolapse of a loop of intestine into a patent inguinal canal or varicose vein varicose vein, superficial vessel that is abnormally lengthened, twisted, or dilated, seen most often on the legs and thighs. Varicose veins develop spontaneously, and are usually attributed to a hereditary weakness of the vein; the valves in the vein that keep the surgery examined differences in pain relief, depending on whether music was played during or after surgery; there were significant short-term pain reductions in both music groups compared with a control group, regardless of whether music was played during or after surgery. (56)
Music has proven effective in reducing pain associated with a variety of procedures, including burn debridement Debridement Definition
Debridement is the process of removing nonliving tissue from pressure ulcers, burns, and other wounds.
Debridement speeds the healing of pressure ulcers, burns, and other wounds. , laceration repair Laceration Repair Definition
A laceration is a wound caused by a sharp object producing edges that may be jagged, dirty, or bleeding. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, muscle, or , lumbar punctures, insertion of intravenous lines, immunizations, and dental procedures. (59-65) Several RCTs of music therapy for patients undergoing colonoscopy or flexible sigmoidoscopy have found that compared with patients in control groups, those who listened to music reported significantly lower pain levels, less physician-administered sedation, and shorter examination times. (46,66-68)
Music can effectively decrease patients' perceptions of and responses to pain during labor and in very young premature infants as well as other populations of patients with chronic pain. (69,70) Women in labor who listened to soft music reported substantially less distress related to pain and perceived music as helpful to them. (71) Older adults who listened to music 20 minutes daily for 2 weeks reported decreased chronic osteoarthritis osteoarthritis
or osteoarthrosis or degenerative joint disease
Most common joint disorder, afflicting over 80% of those who reach age 70. It does not involve excessive inflammation and may have no symptoms, especially at first. pain compared with a control group whose pain level remained constant. (72) The majority of cancer patients have at least moderate pain relief from music, and music is often offered as an adjunctive therapy adjunctive therapy Medtalk A therapeutic maneuver(s) with an ancillary role in treating a disease by ↓ M&M, but not part of the immediate therapy required to stabilize the Pt. Cf Adjuvant therapy. in progressive cancer centers. (73,74) A recent pilot study evaluated the impact of music therapy on self-reported pain and nausea as well as the time to engraftment engraftment /en·graft·ment/ (en-graft´ment) incorporation of grafted tissue into the body of the host.
The process of transplanted stem cells reproducing new cells. among patients undergoing a bone marrow transplant bone marrow transplant: see bone marrow. ; in this very ill population, cancer patients who received music therapy with relaxation imagery reported less pain and nausea and objectively had more rapid engraftment of their transplant. (75)
Music in End-of-life Care
Music therapy can improve the quality of life for dying patients. (76,77) Music therapy can foster supportive interactions between patients and loved ones and help patients connect with and express emotions in a less threatening manner than verbal expression. In working with persons who are dying, music may provide a means of transcending patient experiences of physical symptoms and declines. (22)
Descriptive and qualitative research Qualitative research
Traditional analysis of firm-specific prospects for future earnings. It may be based on data collected by the analysts, there is no formal quantitative framework used to generate projections. provides some data on benefits of music therapy in end-of-life care. Regarding their experience in a palliative care music therapy program, 57% of surveyed patients reported that participation in the program helped them to feel more relaxed or improved their affect. (78) Staff members reported that music seemed most effective in the areas of patient satisfaction, stress reduction, anxiety reduction, and patient receptivity. (78) In a palliative care music therapy program where patients wrote songs, lyrical themes that emerged included messages to others (positive feelings and gratitude), self-reflections, compliments (to staff, other patients, family, friends), memories, reflections on significant others, expression of loss and difficulty related to illness, imagery, and prayers. (10)
In a study of single-session music interventions for terminally ill Terminally Ill
When a person is not expected to live more than 12 months.
Any gifts given out by the afflicted person at this time may be considered as a dispersion of the estate rather than a gift. patients, significant pre- to post-session changes were found for pain control, physical comfort, and feelings of relaxation. (79) In a study of effects of music therapy on home hospice patients, patients were randomly assigned to receive music therapy versus routine hospice care alone (77); patients in the music therapy group reported higher quality of life, and their quality of life increased with greater numbers of music therapy sessions.
Effects on Clinicians/Caregivers
Music may also affect patients indirectly through its effects on the perceived environment and on caregivers. For example, one study suggested that self-selected music enhanced speed and accuracy of surgeons' performance on a stressful nonsurgical task compared with those who did not listen to music or listened to music selected by the experimenters. (80) Another study of long-term care long-term care (LTC),
n the provision of medical, social, and personal care services on a recurring or continuing basis to persons with chronic physical or mental disorders. workers found that participation in group music therapy sessions yielded less burnout Burnout
Depletion of a tax shelter's benefits. In the context of mortgage backed securities it refers to the percentage of the pool that has prepaid their mortgage. and improved mood. (81) A third study suggested that parents preferred providing chest percussion for their children with cystic fibrosis cystic fibrosis (sĭs`tĭk fībrō`sĭs), inherited disorder of the exocrine glands (see gland), affecting children and young people; median survival is 25 years in females and 30 years in males. if music was played during the treatment. (82) In a survey of staff in a neonatal ICU, staff members thought that music could be helpful to patients and would not increase work-related errors but that having a live musician might interfere with work flow; staff in this setting strongly preferred classical or instrumental music to other types of music and preferred recorded to live music. (83) Medical schools are beginning to include music in courses on medical humanism to promote desirable physician characteristics such as caring, empathy, respect for human dignity, compassion, and fostering relationships. (84)
Risks and Costs
Music is quite safe, as long as common sense precautions are used to avoid excessive volume. With the advent of small boom boxes and personal CD and MP3 players, music is an inexpensive service to provide, even on an individual basis. To minimize the risk of spreading infectious diseases, patients may be advised to bring their own headphones (often available at discount stores).
Music plays a central role in all human cultures. It has direct and indirect effects on physiology and clinical symptoms. Carefully selected music can reduce stress, enhance a sense of comfort and relaxation, offer distraction from pain, and enhance clinical performance. Additional research is needed to better define its optimal role in comprehensive, cost-effective patient care. With such research ongoing, music therapy appears to be safe and likely helpful to a broad spectrum of patients in diverse clinical situations.
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Criticism is prejudice made plausible. --Henry Louis Mencken
Accepted December 13, 2004
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RELATED ARTICLE: Key Points
* Music is widely used to promote a sense of well-being and to distract patients from pain and other unpleasant symptoms, thoughts, and feelings, while being convenient and readily available.
* Music helps to improve mood and decrease anxiety, as well as decrease the pain associated with surgery, medical procedures, and chronic conditions; it also helps ease the dying process.
* Music may help premature babies to gain weight more quickly.
* Music may enhance care-giving behavior.
Kathi J. Kemper, MD, MPH, and Suzanne C. Danhauer, PHD
From the Department of Pediatrics and the Department of Internal Medicine, Section of Hematology and Oncology, Wake Forest University School of Medicine Wake Forest University School of Medicine, along with North Carolina Baptist Hospital and Wake Forest University Physicians, is part of the Wake Forest University Baptist Medical Center system. . Winston-Salem, NC.
Supported in part by National Institutes of Health National Center for Complementary and Alternative Medicine National Center for Complementary and Alternative Medicine,
n.pr established in 1998 as a Center of the National Institutes of Health. Supports and conducts research on complementary and alternative med-icine and informs healthcare pro-fessionals about grant R25 AT00538.
The authors have no commercial or proprietary interest in any aspect of music therapy.
Reprint requests to Dr. Kathi J. Kemper, Wake Forest University Health Sciences, Department of Pediatrics, Medical Center Blvd., Winston-Salem, NC 27157. Email: email@example.com