Effect of Music on Pain and Stress Levels in Terminally Ill

Abstract

Music is known to impact upon its listeners` mental state in many ways including relaxation, arousing happiness and so on. Research on the importance of music therapy in hospital settings is growing around-the-clock. However, studies on the impact of music therapy on pain and is still limited. Hospitalized patients diagnosed with terminal illnesses often suffer from extreme pain and stress. Their suffering is made worse by the reality of droning death. Pain-relieving drugs (analgesics) are what is prescribed to the patients to reduce the pain, but more often than not, they come with side effects. To study the effects of music on terminally ill patients in hospitals, various multimodal therapies can be adopted as well as different criteria. Furthermore, there are limitations that such a study can face and thus should be taken into consideration.

Introduction

When patients are terminally ill, and perhaps during the dying process in the hospital, pain and stress become difficult and complicated to assess with current medication. Undertreating pain and managing stress frequently have a reciprocal impact, and both may worsen other physical and mental adversities. What is more, the sight of a beloved one in sheer pain or near-death situations might result to emotional suffering for family caregivers consequently leading to lengthened grief and at times even mental disorders (McPherson and Addington-Hall, 2004). Music can affect an individual physically, psychologically, emotionally, and spiritually(Munro & Mount, 1978). Integrating music with medical care might reduce the impact of physical, psychosocial and emotional distress, and spiritual concerns in hospitalized patients. Research on the effects of using music in hospital contexts has shown that it is an efficient and non-pharmacological adjuvant useful in cutting down suffering from pain experienced after the operation (Good et al, 1999). The purpose of this proposal is to study the effect of music on pain and stress on terminally ill patients in the hospital.

Literature review

Music therapy was introduced into the hospital and end-of-life care for the very first time in the mid-1980s. Since then, multimodal music therapies in the hospice field have grown in function and importance, getting more common and in demand with the passing years (Anderson, 2011). A survey by Demmer (2004) demonstrated that music therapies are one of the most popular alternative therapies in three hundred hospitals across the United States (US). As noted by Pawuk and Schumacher (2010), reports indicate that the sum of hospital music therapists has risen from 87 in 2002 to 207 in 2008 in the US. The 2014 AMTA workforce analysis showed that 218 music therapists worked with old people and in-hospital medical care, with 109 workings in hospice/bereavement care (AMTA, 2014). Within Chicago alone, the number of hospitals working with a music therapist on their treatments rose from 3 to 10 over four years from 2002 to 2006 (Pawuk & Schumacher, 2010).

The affordability or music therapy in hospices has also been spotlit (Romo & Gifford, 2007). A study by Hilliard (2007) reveals that music therapy has notable positive effects on terminally ill patients in end-of-life care; with outcomes that show advances in patients` mood, quality of life, ease, lessened pain, and higher feelings of tranquility, hopefulness, and spirituality. The tasks of dying, as depicted by Clements-Cortes (2010), include grief, saying goodbye, construction of a meaningful context to one’s life, and letting go. Getting a sense of completion with worldly issues making sense of what one`s life means, and achieving relationship completion are also important pillars for music therapists to address terminal illness and in end-of-life care. The presence of a Board Certified Music Therapist on an interdisciplinary hospice team can aid to accomplish and meet the milestones above in the dying process (Pawuk & Schumacher, 2010).

Research by Calovini (1993) investigated eleven terminally ill patients to examine how music therapy affected anxiety and stress within one music session. He used questionnaires, blood pressure reading before the session and afterward, pulse rate reading, as well as intense temperatures. The study established that anxiety and stress levels were notably affected during the therapy session. Blood pressure and pulse rates reduced, indicating that music had helped ease the patients` anxiety and stress.

Methodology

1. Research questions

1. What type of music genres are generally preferred by inpatients with terminal illnesses?
2. How much did hospitalized patients with terminal illnesses like music as an intervention for pain and stress?
3. How does pain relate to stress levels?

2. Conceptual framework

The conceptual framework is based upon the mile-range theory of acute pain (Good & Moore, 1996) which recommends an equipoise between analgesia and side effects. The theory suggests patient involvement, multi-modal therapy sessions, and heedful nursing care for relieving pain as well as reducing side effects of pain relief medications. One suggestion is that multifaceted therapies that are both medicine-based and non-medicine based can lessen pain. Non-pharmacological methods such as the use of music, imagery, and massage were suggested as resourceful for acute pain reduction (Good, 2009). This study will stretch the theory further by affirming that music also relieves stress among patients diagnosed with terminal illnesses.

Whenever pain is linked to impending death, it can be referred to as “total pain,” where victims experience various physical noxious stimuli and emotional irritations. The pain and stress can be associated with fear and denial of death (Saunders, 1976).

3. Procedure

Inclusion and exclusion criteria

For a patient to be eligible for participation, he or she must (1) have registered a minimal of one pain score in the last 24 hours; (2) has a constantly planned analgetic schedule for controlling variations in pain; (3) is mental stable and aware of his or her environment well enough to be a participant in the study; (4) they should be above eighteen years old. Two queries will also be used. The first query will as to whether the patient likes to listen to music and the second will enquire whether the patients feel it is suitable to listen to music while hospitalized. Patients who answer “yes” to both questions will qualify to participate. Both men and women will be used as subjects.

Patients will be ineligible to participate if they do not meet the requirements of the inclusion criteria, if they have hearing problems, and if they have visual deficiencies that might render them incapable of filing the VAS scales. The independent variable is music therapy while the dependent variable is stress.

Subjects to be studied are inpatients receiving palliative care after being diagnosed with terminal illnesses. The study intends to use a comparative method. All patients with hearing challenges will be excluded. Instrumental music will be used during the research. Before the study commences, all subjects will be required to give informed consent to be allowed to participate. All patient are participating in the study not be informed of either the independent variable or the dependent variable to prevent the probability of bias.

Random assignment will be used to allocated participants to either of two groups. The subjects will be expected to listen to music during one music therapy session allocated twenty to forty minutes. The length of the sessions was determined in consideration of normal hospital therapy sessions which take thirty minutes. Sessions that will exceed the allocated duration will not be included in the data. A professional therapist will be responsible for taking the patients through the sessions. Therapy methods to be used include playing familiar music, playing recorded music, and music-assisted counseling. The therapist will be made aware of the aim of the study. Fifty participants will be recruited for the study. An independent nurse who is not part of the study team will measure the levels of pain among participants before the commencement of the sessions using a horizontal visual analog scale (VAS).

4. Assumptions

1. Though patients might be receiving round the clock pain-relieving medications, these medications could be deficient.
2. Participants can effectively convey their perceptual experience of pain and stress or anxiety
3. Patients receive antianxiety prescriptions.

Limitations

Since the sample that will be studied is from the same hospital, it might not represent the actual impact of music on pain and stress in hospitalized patients. Thus, the findings will not be generalizable. Also, patients who did not participate as a result of not meeting criteria or lack of interests could have a different view on music therapy. Randomization could also lead to unequal distribution in terms of gender and age groups. Furthermore, getting consent from terminally ill patients might be challenging because of concerns about privacy or other issues.

Conclusion

Music-associated interventions are also expected to be well-appreciated and received because of the soothing nature of music. In light of known theories and research findings, it is expected that the research will confirm that music can reduce pain and stress among hospitalized patients with terminal illnesses. Indeed, this study is expected to reveal how music can improve the quality of life for the terminally ill.

References

• American Music Therapy Association (2014). Workforce Analysis. Retrieved from http://www.musictherapy.org/2014_workforce_study_now_available/
• Anderson, V. A. (2011). Music, death, and dying: A systematic review of hospice and palliative care literature (Order No. 1503465).
• Calovini, BS (1993). The effect of participation in one music therapy session on state anxiety in hospice patients Clements-Cortes, A. (2011). Portraits of music therapy in facilitating relationship completion at the end of life. Music and Medicine, 3, 31-39. doi:10.1177/1943862110388181
• Curtis, SL (1986). The effect of music on pain relief and relaxation of the terminally ill. J Music Ther 1986; XXIII: pp. 10–24.
• Demmer C. (2004). A survey of complementary therapy services provided by hospices. Journal of Palliative Medicine, 23,510-516.
• Good, M. (2009). Pain: A balance between analgesia and side effects. In S. J. Peterson & T. S. Bredow (Eds.), Middle Range Theories (2nd ed., pp. 63-81).
• Good, M., & Moore, S. M. (1996). Clinical practice guidelines as a new source of middle-range theory: focus on acute pain. Nursing Outlook, 44(2), 74-79.
• Hilliard, R. E. (2007). The effects of Orff-based music therapy and social work groups on childhood grief symptoms and behaviors. Journal of Music Therapy, 44, 123-138.
• Pawuk, L., & Schumacher, J. (2010). Introducing music therapy in hospice and palliative care: an overview of one hospice’s experience. Home Healthcare Nurse, 28, 37-44 8p. doi:10.1097/01.NHH.0000366795.71528.ac
• Romo, R., & Gifford, L. (2007). A cost-benefit analysis of music therapy in a home hospice. Nursing Economics, 25, 353-358.
• Saunders, C. M. (1976). The challenge of terminal care. In T. Symington & R. L. Carter (Eds.), Scientific Foundations of Oncology. London: Heinemann.