Music can help ease pain and anxiety after surgery

Behind the Headlines

Thursday August 13 2015

Most of the studies used relaxing music such as easy listening tunes

Music may help distract people from feeling pain

"Listening to music before, during and after an operation can help reduce pain," BBC News reports. An analysis of data found evidence that people who listened to music had reduced anxiety and were less likely to request pain relief.

Listening to music during a surgical procedure is a very different thing, and it is important to note that this is not routine practice in the NHS. You would not normally expect to be able to choose to have music played to you while unconscious under a general anaesthetic, for example. But for procedures performed while you are awake under local or spinal anaesthesia this could be possible.

Researchers say that following up this work, the Royal London Hospital is conducting an experiment where about 40 women having either a caesarean section or another gynaecological procedure will be given the chance to have their playlist connected to a pillow with in-built speakers.

There are no known negative effects of listening to music, and you would be expected to be free to listen to personal music before a surgical procedure (for example while waiting to be taken to the operating theatre) or when recovering on the ward after. And if you find music helps you relax in these situations, it must be a good thing.

If you are having an operation in the near future you may want to start putting a playlist together. We recommend something soothing – Mozart as opposed to Motörhead.

 

Where did the story come from?

The study was carried out by researchers from Queen Mary University, Barts Health NHS Trust and Brunel University, all in London. Researchers say that this study received no funding from any organisation.

The study was published in the peer-reviewed medical journal The Lancet.

Several UK media sources have covered this story. Overall, media reported the results accurately. However, some of the limitations of the study are not fully explained.

BBC News reported a quote from one of the lead authors of this study, Dr Catherine Meads, who said that listening to Pink Floyd's Dark Side of the Moon album helped soothe her pain three hours after hip surgery in April 2015. She says, "music was a safe, cheap and non-invasive option that should be available to everyone having surgery".

She added: "Currently music is not used routinely during surgery to help patients in their postoperative recovery. The lack of uptake is often down to the scepticism of professionals as to whether it genuinely works, and of course issues of budget and the integration into daily practice."

The Daily Mirror also provides some song suggestions of its own, including Smooth Operator by Sade, Getting Better by The Beatles and The First Cut is the Deepest by Rod Stewart.

 

What kind of research was this?

This was a systematic review and meta-analysis that aimed to assess the effects of music before, during or after surgery in reducing pain and anxiety in postoperative patients.

Researchers say that music was first found to be helpful in patients during operations in 1914 and since then several studies have investigated the effects of music on emotions, pain and sensation.

There are even reports of Florence Nightingale using music to improve her patients' morale.

Systematic reviews gather all published evidence on a particular topic. Meta-analysis is a statistical method that pools the data from many studies to find an overall result. This increases the reliability of the results. It is important to note that this type of research methodology relies on findings from previously published studies, so the reliability of the results depends on the quality of the studies included in the analysis. In this case the differences in study methods and included populations are a potential limitation. 

 

What did the research involve?

Researchers pooled data from 73 randomised controlled trials (RCTs) (total of 6,902 patients) that looked at the effects of music in adult patients undergoing any form of surgical procedure (with or without sedation or anaesthesia). This could be any form of music initiated before, during or after surgery.

Relevant outcomes examined were:

  • postoperative pain
  • need for painkillers (analgesia)
  • anxiety
  • infection rates
  • wound healing
  • costs
  • length of stay
  • satisfaction with care

These studies used comparators such as standard care and other non-drug interventions (e.g. massage, undisturbed rest, or relaxation).

To avoid selection bias two investigators independently checked the eligibility of the studies for inclusion and any differences were resolved through discussions and referral to a senior investigator. The quality of each study was assessed using a standardised checklist. They also conducted sub-group analysis to assess the effects of factors such as timing of music (before, during or after), type of anaesthesia, type of control comparison, and choice of music.

The included studies had a sample size ranging from 20 to 458 participants who had undergone surgical procedures ranging from minor endoscopic (camera) interventions to transplant surgery. In the included studies either the researcher or the patient themselves chose the type of music. Types of music covered by the studies were classical music, instrumental, relaxing, or patient's choice music. Duration of the music varied from a few minutes to repeated episodes for several days.

Pain was generally measured using a Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS). These scales are used to measure subjective characteristics or attitudes that cannot be directly measured (such as pain) – e.g. "on a scale of 1 to 10, with 1 equalling no pain and 10 equalling intolerable pain, how much pain are you in?" These pain scales are mostly self-reported and sometimes observed by others.

 

What were the basic results?

Overall, the review found that music reduced postoperative pain in adults.

Details are as follows:

  • the pooled results of 45 RCTs show that music reduced postoperative pain with standardised mean difference (SMD) on the pain scale -0.77 (95% confidence interval (CI) -0.99 to -0.56)
  • 43 RCT studies found reduction in postoperative anxiety (SMD -0.68, 95% CI -0.95 to -0.41)
  • 34 RCT studies found reduction in postoperative painkiller use (SMD -0.37, 95% CI -0.54 to -0.20)
  • 16 studies found increased patient satisfaction with music (SMD 1.09, 95% CI 0.51 to 1.68)

The sub-group analysis found that no other factors (such as choice and timing of music, type of anaesthesia, pain measure used, etc.) had a significant influence on the effect of music on pain.

 

How did the researchers interpret the results?

Researchers conclude: "Music is a non-invasive, safe, and inexpensive intervention that can be delivered easily and successfully in a hospital setting. We believe that sufficient research has been done to show that music should be available to all patients undergoing operative procedures."

They add: "Timing of music does not make much difference to outcomes so can be adapted to the individual clinical setting and medical team."

 

Conclusion

This systematic study with meta-analysis found that use of music around the time of surgery reduced postoperative pain, anxiety and use of painkillers in an adult population.

This study has several strengths including that it has captured studies published in all languages, which reduces selection bias. It also helps in generalising the results. It has also made careful assessment of the eligibility and quality of the studies to help reduce selection bias.

The review included a large number of studies and the overall participant sample size was large. However, one of the main limitations is that the majority of the individual RCTs had small sample sizes, except for one (458 participants).

The individual trials also varied considerably in their methods, including the study populations, type of surgical procedure and anaesthetic given, and the timing and type of music. A strength of the findings though, is that the researchers conducted sub-group analyses to see if any such factors could have had a significant influence on the effect of music and found none.

Another point worth noting is that the average difference on the pain and anxiety scales between the music and control groups was fairly small (less than 1 point). It is not known how much of a meaningful clinical effect on the person's wellbeing and experience of surgery these would have.

A large and well-conducted RCT in the future could help strengthen the findings of this review, and also better inform whether there are particular circumstances (e.g. type of procedure or anaesthetic) in which music can be beneficial.

Other self-help methods you can use to relieve – or at least distract yourself – from pain include activities such as knitting or sewing, breathing exercises, reading an engaging book, or playing games on your phone or tablet. Read more self-help tips about easing pain.

Analysis by Bazian. Edited by NHS Choices. Follow NHS Choices on Twitter. Join the Healthy Evidence forum.

Analysis by Bazian

Edited by NHS Choices

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