26 February 2005

Music soothes...

Sedative music reduces anxiety and pain during chair rest after open-heart surgery
Jo A. Vossa, et.al
Open-heart surgery patients report anxiety and pain with chair rest despite opioid analgesic use. The effectiveness of non-pharmacological complementary methods (sedative music and scheduled rest) in reducing anxiety and pain during chair rest was tested using a three-group pretest–posttest experimental design with 61 adult postoperative open-heart surgery patients. Patients were randomly assigned to receive 30 min of sedative music (N=19), scheduled rest (N=21), or treatment as usual (N=21) during chair rest. Anxiety, pain sensation, and pain distress were measured with visual analogue scales at chair rest initiation and 30 min later. Repeated measures MANOVA indicated significant group differences in anxiety, pain sensation, and pain distress from pretest to posttest, P<0.001. Univariate repeated measures ANOVA (P?0.001) and post hoc dependent t-tests indicated that in the sedative music and scheduled rest groups, anxiety, pain sensation, and pain distress all decreased significantly, P<0.001–0.015; while in the treatment as usual group, no significant differences occurred. Further, independent t-tests indicated significantly less posttest anxiety, pain sensation, and pain distress in the sedative music group than in the scheduled rest or treatment as usual groups (P<0.001–0.006). Thus, in this randomized control trial, sedative music was more effective than scheduled rest and treatment as usual in decreasing anxiety and pain in open-heart surgery patients during first time chair rest. Patients should be encouraged to use sedative music as an adjuvant to medication during chair rest.

And what counts as sedative music?
Sedative music was operationalized as music without lyrics and with a sustained melodic quality, with a rate of 60–80 beats per minute and a general absence of strong rhythms or percussion (Gaston, 1951 and Good et al., 2000). The volume and pitch were controlled so that the music was heard comfortably. Participants who received sedative music selected a tape from a collection prior to chair rest by listening to a 30-s excerpt of each of the selections. The collection consisted of six types of music—synthesizer, harp, piano, orchestra, slow jazz, and flute. Good (1995) developed the selections on the first five tapes in consultation with a music therapist. The synthesizer tape included new age music, the piano tape included music popular in the United States from the 1940s to the 1980s, the orchestra tape was classical music, the harp tape included both popular and new age music, and the jazz tape was slow modern jazz (Good et al., 2000). A tape featuring American Indian flute music was added to provide a culturally acceptable selection for the American Indian population served at the hospital (DeRuyter, 2000 and Good et al., 2000). The music has been shown to reduce the sensation and distress of postoperative pain up to 31% in abdominal surgical patients (Good et al., 1999) and also to reduce labor pain (Phumdoung and Good, 2003).

The availability of choice has got to be key. Put me in a chair with Enya soothing my ears and I'll have a heart attack.*

*I'm actually somewhat serious about this. Several years ago, I donated platelets three times a month for nearly a year. Donation involves being immobile in a bed for 2 hours, so the center kindly provides you with a movie. Trouble is, they provided it whether I wanted it or not; and its a bit hard to remove headphones with a large IV plugged into each arm. They had a closet full of movies to choose from, very few that I could stomach. The discomfort of watching Men at Work for the nth time was far worse than the needles, saline infusions, or ischemic discomfort.

I can only imagine the music selection available in the ICU. Will they let you bring in your own music? Will it have to pass their scrutiny? What if I find electroclash most soothing?

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