Review Article
Music as an Adjuvant
From the *School of Nursing,
University of Texas Health Science
Center; †M. D. Anderson Cancer
Center, Houston, Texas.
Address correspondence to Linda C.
Cole, 3939 Allen Rd., Pearland,
TX 77584. E-mail: lindapaws@gmail.
com
Received May 29, 2012;
Revised August 27, 2012;
Accepted August 29, 2012.
1524-9042/$36.00
Ó 2012 by the American Society for
Pain Management Nursing
http://dx.doi.org/10.1016/
j.pmn.2012.08.010
Therapy in Control of
Pain and Symptoms in
Hospitalized Adults: A
Systematic Review
Linda C. Cole, MSN, RN, CCNS,*
---
and Geri LoBiondo-Wood, PhD, RN, FAAN†
- ABSTRACT:
The objective of this review is to evaluate the evidence regarding the
use of music as an adjuvant therapy for pain control in hospitalized
adults. The search terms music, music therapy, pain, adults, inpatient,
and hospitalized were used to search the Cochrane Library, Cinahl,
Medline, Natural Standard, and Scopus databases from January 2005 to
March 2011. (A systematic review conducted by the Cochrane Collab-
oration has extensively covered the time frame from 1966 to 2004.)
Seventeen randomized controlled trials met criteria for review and
inclusion. Seven of the research studies were conducted with surgical
patients, three with medical patients, one with medical-surgical
patients, four with intensive care patients, and two with pregnant
patients. The combined findings of these studies provide support for
the use of music as an adjuvant approach to pain control in hospital-
ized adults. The use of music is safe, inexpensive, and an independent
nursing function that can be easily incorporated into the routine care
of patients.
Ó 2012 by the American Society for Pain Management Nursing
Pain has been defined as ‘‘an unpleasant sensory and emotional experience asso-
ciated with actual or potential tissue damage, or described in terms of such dam-
age’’ (International Association for the Study of Pain, 1994, p. 209–214). The
American Society for Pain Management Nursing (ASPMN) further classifies
pain into acute (0–7 days in duration such as procedural pain), acute exacerba-
tion of a recurring painful condition (occurs over any duration of time, e.g., mi-
graine headache), chronic pain (persistent pain that lasts longer than the
expected time of healing, such as low back pain), and cancer pain (caused by
potentially life-threatening conditions) (ASPMN, n.d.). Pain is subjective, and it
is subjectively experienced.
Pain is often treated with opioid analgesics. Opioids may cause adverse side
effects, such as nausea, vomiting, constipation, and confusion, as well as inade-
quate pain control. The 2007 National Health Interview Survey included a com-
prehensive survey of complementary and alternative medicine (CAM) usage by
Pain Management Nursing, Vol -, No - (--), 2012: pp 1-20
2 Cole and LoBiondo-Wood
Americans. The survey reported that
38% of adults
use some form of CAM. Additionally, that survey noted
that
44% of American adults with pain or neurologic
conditions used CAM modalities during the previous
year (National Center for Complementary and
Alternative Medicine, n.d.). If adding a CAM modality
to the usual pharmacologic care provided for pain con-
trol in hospitalized patients can improve overall pa-
tient outcomes, an opportunity for nurses arises to
advocate for the use of this adjuvant approach. The
purpose of the present paper is to review the use of
music as an adjuvant therapy for pain control in adult
hospitalized patients.
METHOD
A Cochrane Collaboration review of studies from 1966
to 2004 on the use of music for pain control was exam-
ined (Cepeda, Carr, Lau, & Alvarez, 2006). Because of
that report, the time frame used for the present review
was 2005 to March 2011. Cochrane, Medline, Cinahl,
Scopus, and Natural Standard databases were searched.
A combination of search terms were used, including:
music, music therapy, pain, adults, inpatients, hospital-
ized, randomized controlled trials, and published in
English.
Sixty trials were identified through the initial elec-
tronic search. After manual review of abstracts, 17 of
these trials met the inclusion criteria of randomized
control trials conducted in an inpatient setting from
2005 to March 2011 and published in English. Two re-
search studies included pregnant women, four studies
were focused on intensive care patients, one involved
medical-surgical patients, three studied medical pa-
tients, and seven of the studies were conducted with
surgical patients.
RESULTS
Pregnant Patients
Ebneshahidi and Mohseni (2008) conducted a random-
ized control trial with women (study group: n ¼ 38;
control group: n ¼ 39) 18–36 years old who underwent
a cesarean section. The sample of 36 in each group was
needed to achieve a power of 80% and p < .05 on the
outcome of pain. The study group received 30 minutes
of self-selected music via headphones that began 15
minutes after arrival in the postanesthesia care unit
and continued for 30 minutes. The control group re-
ceived silence delivered by the same headphone
method. Pain, heart rate, and blood pressure were mea-
sured twice with a 5-minute interval between measure-
ments by a nurse unaware of the group assignment. An
average of the two measurements was used for the
analysis. Total morphine usage during the recovery
room stay and the first postoperative hour was calcu-
lated. Pain scores and morphine use were statistically
lower (p < .05) in the study group. No statistically sig-
nificant differences were found in heart rate or blood
pressure.
In a similar study, Liu, Chang and Chen (2010) en-
rolled primiparous women aged 18–39 years expected
to have a normal vaginal delivery into a study group (n
¼ 30) and a control group (n ¼ 30). The sample size
was estimated to be 26 for each group based on
a power of 80% and p < .05. The study group listened
to 30 minutes of music during the latent (2–4 cm) and
active labor (5–7 cm) phases. Subjective measure-
ments of pain and anxiety were recorded before and
30 minutes after the music intervention by the nurse.
Finger temperature was also used to measure anxiety.
Subjects were also questioned regarding the advan-
tages of the music intervention.
During the latent phase of labor, the study group
had significantly lower pain scores on the visual analog
scale as well as the nurse’s observation of present be-
havioral intensity scale (p < .001). Additionally, anxiety
was significant less in the study group as demonstrated
by self-report and higher finger temperature readings
(p < .001). No difference was noted between the
groups during the active labor. Both adequately pow-
ered studies identified in this area found listening to
music to be a useful adjunct to treatment.
Critical Care Patients
Kshettry, Carole, Henly, Sendelback, and Kummer
(2006) studied patients undergoing either a coronary
artery bypass graft, a valve replacement, or a combina-
tion of both surgeries (experimental group: n ¼ 53;
control group: n ¼ 51). This study had three interven-
tion phases: phase one included preoperative relaxa-
tion skills training with guided imagery and
a 30-minute gentle touch or light massage; the second
phase occurred over the first two postoperative days,
in which the patient listened to self-selected music
for 20 minutes chosen from three types delivered via
a tape player with headphones. Patients used the mu-
sic as desired. The third phase was a second gentle
touch or light massage provided on discharge from
the intensive care unit. Patients were encouraged to
use guided imagery techniques for stress and pain re-
lief. Pain and tension were measured using self-report
and blood pressure and heart rate were also recorded.
Measurements were obtained immediately before and
after the intervention preoperatively, as well as before
and after the intervention on postoperative days 1 and
2. No significant differences were noted in blood pres-
sure or heart rate between the groups after the
 Use of Music in Control of Pain
intervention. However, posttest pain and tension
scores for the study group were significantly lower
on postoperative day 1 (p < .01) and postoperative
day 2 (p < .038) than in the control group.
Chan (2007) enrolled 66 cardiac patients aged
35–75 years (study group: n ¼ 31; control group: n
¼ 35) undergoing application of a C-clamp after a per-
cutaneous coronary intervention from three intensive
care units. A sample size of 35 for each group was re-
quired to achieve 80% power and p < .05. The study
group listened to three types of self-selected, soft,
slow music without lyrics, using an MP3 player with
headphones for 45 minutes during the procedure. Mu-
sic was low pitched with simple and direct musical
rhythm and a tempo of
60 beats per minute. The mu-
sic types were: Chinese classical, religious, and west-
ern classical. The control group had 45 minutes of
uninterrupted rest. Physiologic data of interest, includ-
ing blood pressure, heart rate, respiratory rate, and ox-
ygen saturation, were collected at baseline before the
C-clamp was applied and then at 15, 30, and 45 min-
utes before removal. Pain was measured at baseline
and at 45 minutes (before C-clamp removal). Heart
rate was lower for the music group at 30 minutes
(p < .001) and 45 minutes (p < .001). Respiratory
rate was lower for both time periods (p < .001). Oxy-
gen saturation was also lower for the 30 and 45 minute
time intervals (p < .001). The music group demon-
strated a significant reduction in pain scores (p <
.001) as well as compared with baseline (p ¼ .041),
whereas the control group had a rise in pain scores
compared with baseline (p < .001).
Seventeen critical care patients were enrolled in
a cross-over study to evaluate the effect of music on
pain associated with turning (Cooke, Chaboyer,
Schluter, Foster, Harris, & Teakle, 2010). Subjects
ranged in age from 19 to 87 years. Participants listened
to self-selected music for 15 minutes delivered by head-
phones connected to a compact disc player before and
during the turning process. Music selections were clas-
sical, jazz, country-western, new age, easy-listening,
and music mainly from contemporary artists. During
the control phase, subjects wore headphones con-
nected to a compact disc player but no music was
played. Physical discomfort and anxiety were mea-
sured. No statistical differences were found between
the groups. The researchers noted that 53% of the sub-
jects were receiving a continuous opioid infusion and
35.3% had received an opioid bolus within 1 hour be-
fore the turning procedure; acknowledging the admin-
istration of opioids may have affected the findings.
The use of music to decrease pain, anxiety and
muscle tension in burn patients was studied by Tan,
Yowler, Super, and Fratianne (2010). Twenty-nine
3
patients, aged 8–71 years, who were admitted to
a burn intensive care unit were enrolled, with the sub-
jects serving as their own controls. The calculated sam-
ple size needed for this study was estimated to be 29
based on a power of 80% and p < .05 to demonstrate
at least a 20% reduction in the music group’s pain.
On music days, a music therapist administered
music-based imagery (MBI) before and after dressing
changes and music alternate engagement (MAE) during
the burn debridement process. Self-reports of pain and
anxiety were collected as well as muscle tension,
which was measured by trained observers before and
immediately after the MBI intervention. The same
data points were collected immediately before the
MAE intervention began for debridement, immediately
after debridement, and at the end of the dressing
change. On the control days, the patients followed
the exact same process without the music therapy
protocols.
Pain levels were significantly reduced before
(p < .025), during (p < .05), and after (p < .025) on
the days music was received compared with the con-
trol days. Anxiety levels were significantly less during
dressing changes on the music days versus the control
days (p < .05). Decreases in muscle tension were ob-
served and reached significance during (p < .05) and
after (p < .025) dressing changes.
Medical-Surgical Patients
One intervention study was found in the medical-
surgical population. The study of 53 patients ranging
in age from 22 to 96 years admitted for either a neuro-
medical or a neurosurgical diagnosis (study group: n ¼
24; control group: n ¼ 29) were provided a music in-
tervention for pain (Phipps, Carroll, & Tsiantoulas,
2010). The study group received 30 minutes of self-
selected music provided by compact disc. Headphones
were not used owing to the number of patients with
surgical sites on the head. Blood pressure, heart rate,
respiratory rate, peripheral skin temperature, pain,
and anxiety were measured immediately before and af-
ter the 30-minute music intervention. Baseline data for
the groups were similar for all measures, except the
study group had higher negative anxiety, depression,
fatigue, and confusion levels than the control group.
Significant differences were found after the music
intervention for heart (p ¼ .003) and respiratory (p
¼ .002) rates. No differences were found for blood
pressure, skin temperature, and pain. With the use of
an independent t test, significant differences were
found after the music intervention with reductions in
anxiety (t ¼ 4.1; p ¼ .000), depression (t ¼ 4.3;
p ¼ .000), fatigue (t ¼ 2.2; p ¼ .03), and mood
(t ¼ 4.1; p ¼ .000).
4 Cole and LoBiondo-Wood
Medical Patients
Three studies were identified in which music was ad-
ministered as an adjuvant approach for pain control
in the medical population. Subjects were cardiac pa-
tients in two studies and oncology patients in one
study. In a study of 43 patients aged 35–75 years who
underwent C-clamp application after percutaneous
coronary interventions, subjects were randomized to
a music group (n ¼ 20) and a control group (n ¼ 23)
(Chan, Wong, Chan, Fong, Lai,... Leung, 2006). Using
heart rate as the primary outcome measure, a sample
size of 23 was needed to achieve an 80% power
at p < .05. The actual power calculation was 76% at
p < .05. The study group listened to soft, slow, self-
selected music without lyrics delivered via an MP3
player with headphones from three types of music for
45 minutes during the procedure. Pain, blood pressure,
heart rate, respiratory rate, and oxygen saturation data
were collected at baseline before the C-clamp applica-
tion and at 15, 30, and 45 minutes after application.
Pain scores were significantly lower for the music
group at 45 minutes (p ¼ .003). Additionally, the music
group experienced a significant reduction in pain com-
pared with their baseline measurements (p ¼ .009),
whereas the control groups experienced a significant
increase in pain compared with their baseline scores
(p < .001). Respiratory rate was lower at 30 minutes
(p ¼ .002) and 45 minutes (p ¼ .001) for the music
group compared with the control group. The music
group demonstrated lower reductions in heart rate (p
¼ .001) and oxygen saturation (p ¼ .001) at the 45 min-
ute interval compared with the control group. The mu-
sic group also experienced significant reductions in
systolic blood pressure at 30 minutes (p ¼ .001) and
45 minutes (p ¼ .006) compared with their baseline.
In the other trial involving cardiac patients
(Nilsson, Lindell, Eriksson, & Kellerth, 2009), 238 pa-
tients admitted to a percutaneous coronary interven-
tion unit after coronary angiography or percutaneous
coronary intervention were randomized to either a mu-
sic group (n ¼ 121) or a control group (n ¼ 117). The
music and control group were further stratified based
on gender (female and male intervention groups and
female and male control groups). A sample size calcu-
lation to achieve a power of 80% and p < .001 sug-
gested that 60 subjects were needed for each of the
four groups.
The music groups received music delivered via
a Maysound Music Player with the use of Musicure mu-
sic which uses soft relaxing melodies with 60–80 beats
per minute. The music began when the patient was
placed on the procedure table and continued until
just before the patient was removed from the
procedure table. Data for angina and pain were col-
lected before the procedure. A similar scale was used
to collect data after the procedure for pain from the ar-
terial puncture, discomfort related to puncture pain,
angina during the procedure, discomfort related to an-
gina, discomfort related to lying still, sense of relaxa-
tion, and environmental sound. Accumulated doses
of anxiolytics and analgesics administered during the
procedure were recorded.
When demographic data were compared, the mu-
sic groups were significantly older than the control
groups (p ¼ .04). Gender differences found that the fe-
male groups were significantly older (p ¼ .007), in-
cluded more diabetics (p ¼ .014), and scored higher
on preprocedural anxiety (p ¼ .001) than the male
groups. The male groups had significantly more
smokers (p ¼ .019) and experienced a combination
of both angiography and percutaneous coronary inter-
vention (p ¼ .009). No differences were found be-
tween the groups related to gender, trial end points,
or outcomes of the music intervention.
The third trial studied the use of music as an adju-
vant for pain control in a medical population admitted
with cancer pain to an oncology, palliative care, respi-
ratory, or gastrointestinal unit (Huang, Good, &
Zauszniewski, 2010). The trial included 126 individ-
uals (study group: n ¼ 62; control group: n ¼ 64) rang-
ing in age from 18 to 85 years. After a 4-minute
introductory tape, subjects selected the type of music
they wished from four options. The researcher sched-
uled a time to follow up with the subjects. Data ob-
tained before the intervention included: pain level
with the use of a visual analog scale; 24-hour usual,
least, and worst pain; and opioid analgesic in use at
the time of the intervention to rule out confounding ef-
fects of the medication. The experimental group lis-
tened to 30 minutes of self- selected music via
headphones, and data were obtained after the music
session. The same pre- and posttest process was com-
pleted with the control group, who received 30 min-
utes of bed rest and were informed they would have
a music session later. Most of the patients had opioids
in effect during the 30 minutes of either music or rest.
The music group had significantly less pain than the
control group (p < .001) after the 30-minute music ses-
sion. The results of this study supported the hypothesis
that listening to music can decrease cancer pain.
Surgical Patients
Seven trials were identified that evaluated music’s
effects in the surgical population. Patients who under-
went intestinal surgery were recruited for a three-
armed study which randomized participants to
 Use of Music in Control of Pain
a relaxation technique, a music intervention, a combi-
nation of the two, or a control group (Good, Anderson,
Ahn, Cong, & Stanton-Hicks, 2005). This study enrolled
167 subjects, with 43 in the relaxation group, 49 in the
music group, 37 in the combination of music and relax-
ation group, and 38 in the control group.
Preoperative teaching of a jaw relaxation tech-
nique for the relaxation group was taught using
a tape. The music group received sedative music with
60–80 beats per minute with sustained melodic quality,
controlled volume, no lyrics, and strong rhythm or per-
cussion. The music group selected music from five dif-
ferent types. The combination group received both the
music and the jaw relaxation technique. The control
group listened to 10 minutes of conversation in place
of a teaching tape.
All were taught how to use the pain sensation and
distress scales and worst past pain before measure-
ment. The postoperative intervention consisted of
three phases: a 5-minute preparatory period before am-
bulation with the subject remaining in bed, the ambu-
lation period, and after a 10-minute recovery period in
bed. The treatment group listened to the assigned tape
during all three phases. Data were collected four times
during ambulation. The control subjects did not listen
to a tape and rested quietly for 15 minutes in the recov-
ery period.
Data collected included pain sensation and dis-
tress, milligrams of morphine equivalent, sleep quality,
heart and respiratory rates, and time to recovery. Time
to recovery was measured by the number of days be-
fore return of bowel sounds, removal of nasogastric
tube, start of a clear liquid diet, discontinuation of
patient-controlled analgesia pump, length of stay, and
number of complications in the first 2 postoperative
days. When combined, the treatment groups had sig-
nificantly less pain at the postpreparatory (p ¼ .001),
postrecovery (p ¼ .024), and postrest (p ¼ .005)
time points than the control group on postoperative
day 1. Similar findings were found on postoperative
day 2 at the postpreparatory (p ¼ .011) and postrest
(p ¼ .001) time points. The results did not support
the hypothesis that the combination of the two inter-
ventions would result in less pain than the individual
intervention. Also, no significant differences were
found between the relaxation group and the music
group in pain control.
The second trial was conducted with 124 adults
(study group: n ¼ 62; control group: n ¼ 62) who un-
derwent elective hip or knee surgery to evaluate music
use in a geriatric surgical population ranging in age
from 59 to 82 years (McCaffrey & Locsin, 2006). The
study group received music played for 1 hour a mini-
mum of four times per day with the use of a compact
5
disc player. Nursing staff were encouraged to turn
the music on whenever they entered the room. Family
members and the patient were instructed how to use
the player so that music could be played anytime the
patient desired.
Confusion, pain, and analgesic medication usage
were measured after the patient-controlled analgesia
pump was discontinued on postoperative day 1. Ambu-
lation readiness was determined by a physical therapist
on the operative day based on the patient’s cognitive
status, pain, and willingness to participate in therapy.
Distance ambulated was measured in the feet that
the patient walked as recorded by the physical thera-
pists. Postdischarge telephone calls were made to ob-
tain patient satisfaction with the hospital experience.
The study group had a reduction in pain on post-
operative days 1 to 3 (p ¼ .001 for each day). The study
group also used less analgesic medication after surgery
than the control group (p ¼ .001). Signs and symptoms
of acute confusion were less in the study group
(p ¼ .001). Readiness to ambulate as well as distance
ambulated were higher in the study group (p ¼ .001
for each). Finally, the study group demonstrated signif-
icantly higher satisfaction with their hospital experi-
ence (p ¼ .000).
Eighty-six patients (study group: n ¼ 50; control
group: n ¼ 36) undergoing coronary artery bypass or
valve replacement surgery were recruited from three
hospitals within one system (Sendelbach, Halm,
Doran, Miller, & Gaillard, 2006). Study group patients
selected from four types of taped music delivered via
headphones for 20 minutes twice daily on postopera-
tive days 1 to 3. The control subjects received 20 min-
utes of bed rest only. Pain, anxiety, and physiologic data
were collected immediately before and after each 20-
minute intervention. The study group had significantly
lower anxiety scores (p < .001) and pain scores
(p ¼ .009). No differences were noted in blood pres-
sure, heart rate, and opioid use between the groups.
In a study of 27 patients aged 8–73 years (study
group: n ¼ 14; control group: n ¼ 13) admitted for neu-
rologic surgery, the study patients received 20–30 min-
utes of live music preoperatively followed by 30
minutes of live music provided daily after surgery by
a music therapist (Walworth, Rumana, Nguyen, &
Jarred, 2008). Anxiety, mood, pain, perception of the
hospitalization or procedure, relaxation, and stress
levels were measured by self-report. Postoperative an-
algesics were converted to morphine-equivalent doses
and evaluated. Nausea was measured by counting the
number of days that postoperative antiemetics were re-
quired. Hours were used to measure the length of stay
from the time of admission/surgery to discharge. Four
of the six measures had significant differences for the
6 Cole and LoBiondo-Wood
study group in the pre- and postoperative measures.
The differences indicated improvement in anxiety
(p ¼ .03), perception of hospitalization (p ¼ .03), re-
laxation (p ¼ .001), and stress (p ¼ .001). No differ-
ences were noted for mood, pain scores, antiemetics,
analgesics, and impact on hospital length of stay.
Nilsson (2009) examined the impact of music on
serum cortisol levels (used as a physiologic measure
of stress response), arterial oxygen tension and satura-
tion, mean arterial pressure, heart and respiratory
rates, and pain and anxiety levels in 58 adults (study
group: n ¼ 28; control group: n ¼ 30) on postoperative
day 1 after coronary artery bypass surgery or aortic
valve replacement. Physiologic data and pain and anx-
iety levels were measured. Music was delivered
through a music pillow connected to an MP3 player
for 30 minutes during rest. The music was soft and re-
laxing with different melodies, 60–80 beats per min-
ute, at 50–60 dB. The control group received 30
minutes of rest only. Measures were taken at 12:00
p.m. (pretest), 12:30 p.m. (posttest), and 1:00 p.m.
(second posttest).
After 30 minutes, significant differences were
found in the serum cortisol levels between the groups,
with the music group being lower (p < .02). This dif-
ference was not found at the 1:00 p.m. interval. Signif-
icant declines in respiratory rate and mean arterial
pressure from baseline measures were found in the
music group (p < .005 and p < .002, respectively)
but not in the control group. Both pain levels and anx-
iety levels decreased over time for both groups (music
group: p < .001 for pain and p < .004 for anxiety; con-
trol group: p < .011 for pain and p < .037 for anxiety).
No differences were found between the groups regard-
ing heart and respiratory rates, mean arterial pressure,
arterial oxygen tension and saturation, and pain and
anxiety scores.
The impact of music on pain was examined
with 56 subjects (80% power; p < .05) 46–84 years
old undergoing a total knee arthroplasty. Subjects lis-
tened to 20 minutes of self-selected easy-listening
music delivered by headphones and compact disc
20 minutes before the first postoperative ambulation
and during a 20-minute rest period after the first
postoperative ambulation (Allred, Byers, & Sole,
2010). The control subjects received a 20-minute
rest period without music. Pain, anxiety, and physio-
logic parameters were measured. Subjects were
asked four questions to assess their perception of
the music experience. Opioid use from immediately
before the initiation of the music intervention to 6
hours after the intervention was calculated. Data
were collected 20 minutes before the first physical
therapy session, immediately before the physical
therapy session, immediately after, and 20 minutes
after the physical therapy.
Significant differences were found for pain be-
tween the data collection times: from time 1 to time
2 (p ¼ .000) and from time 2 to time 3 (p ¼ .000).
No differences were found between the two groups
in pain scores. As with pain, significant differences
were found for anxiety between the data collection
times: from time 1 to time 2 (p ¼ .035) and from
time 2 to time 3 (p ¼ .014). No differences in pain
and anxiety scores were noted between the groups.
Both groups had significant decreases in mean arterial
pressure between data collection times (p ¼ .000), but
no significant difference was seen between the two
groups. No differences were found for heart rate, respi-
ratory rate, oxygen saturation, and opioid use between
the two groups. When questioned regarding their per-
ception of the music intervention, 84% of the study
group reported that the music helped them forget
about their pain, 92% felt that the music helped their
overall mood, and 88% rated the music as an enjoyable
experience.
Music is often paired with relaxation techniques
and/or patient teaching. This pairing was explored
in a trial in which patients were assigned to either
a patient teaching group, a relaxation and music
group, a combination group where patient teaching
was paired with relaxation and music, or a control
group (Good, Albert, Anderson, Wotman, Cong,
Lane, & Ahn, 2010). The 517 subjects (80% power,
p > .05) were 18–75 years old and admitted for ab-
dominal surgery. There were 82 subjects in the pa-
tient teaching group, 95 in the relaxation and music
group, 86 in the combination group, and 103 in the
control group. Interventions were introduced before
surgery and repeated for 20 minutes on the surgical
day, after transfer to the postsurgical unit, and on
postoperative days 1 and 2. A short introductory au-
diotape (5–10 minutes) was used to introduce sub-
jects to the intervention, and a longer intervention
tape (60 minutes) was used postoperatively. The
teaching tape focused on reporting pain, receiving
medications, preventing pain, managing pain, modify-
ing attitudes, and participating in the pain manage-
ment plan. The relaxation and music tape contained
instructions on a jaw relaxation technique with relax-
ing music in the background. Subjects selected the
music used from six different types without lyrics
and with 60-80 beats per minute. The combination
group’s tape contained 5 minutes of teaching fol-
lowed by 25 minutes of the jaw relaxation technique
and music. Subjects were encouraged to use the inter-
vention at least four times a day on the first 2 days
after surgery.
 Use of Music in Control of Pain
Pain and sensation and distress of pain were
measured. Opioid intake was measured by convert-
ing opioids into milligrams of morphine equivalents
and recorded for the first 24 and 48 hours after
surgery. Poststudy interviews were performed
with the intervention groups to determine their
perceptions of the interventions. Heart and respira-
tory rates were also collected before and after the
20-minute test.
Patient teaching or a combination of patient
teaching and relaxation and music did not have an
immediate effect on pain, and subjects did not have
less pain than those who received relaxation and mu-
sic alone or the control group. The two groups that
received relaxation and music with or without
patient teaching did have significantly less pain than
the patient teaching group or the control group
(p < .001). No differences were noted in opioid
use among the groups. Heart and respiratory rates
were significantly lower in the relaxation and music
group and the combination group than the patient
teaching group or the control group (p ¼ .04).
SUMMARY OF FINDINGS
A summation of the reviewed studies demonstrates
a positive impact of music on pain. Both of the studies
which included pregnant women demonstrated a posi-
tive effect from music on both latent phase labor pain
and postcesarean surgery pain. An additional benefit
noted was a decrease in anxiety among the women
in labor. Opioid use was noted to be less in the women
after cesarean surgery. Of the four studies reviewed in
the critical care population, three found that music in-
terventions reduced pain in this vulnerable patient
group. Additionally positive physiologic responses,
such as reduced heart rate and muscle tension, were
noted in association with the music.
Two of the three studies that included medical pa-
tients noted a reduction in pain scores, as did one of
the two studies which had mixed patient populations
of medical and surgical patients. Most of the studies re-
viewed were conducted in the surgical patient popula-
tion. Two of the seven studies conducted in surgical
patients did not find a significant impact of music on
pain. Although these studies did not demonstrate an
impact on pain, positive outcomes were noted for anx-
iety, relaxation, stress, and perception of hospitaliza-
tion, which can affect an individual’s ability to cope
with existing pain. An added issue in the majority of
the studies is that multiple variables were measured
mainly with the use of valid instruments and powered
adequately to detect difference with well controlled
study conditions, thus ensuring a level of fidelity of
7
the findings. An evidence table of the studies is pro-
vided in Table 1.
RECOMMENDATIONS FOR FURTHER
RESEARCH
The studies reviewed were predominantly conducted
in surgical or procedural inpatients with the use of
a variety of music type and duration. Further study
is needed to determine the feasibility of music as an
adjuvant pain control method in patients with non-
surgical or procedural pain and to assess the opioid-
sparing effect of music use in these groups. These
studies add to the body of knowledge in this area,
but a need remains to identify if a particular type of
music provides better results than another. Finally,
the optimum duration and dose of the music inter-
vention needs to be determined.
APPLICATION TO PRACTICE
The randomized controlled trials reviewed consisted
of 1,937 subjects from five continents and included
multiple patient populations in acute care settings.
Music type ranged from that selected by the re-
searcher to music selected by the subject. Of the
17 studies reviewed, 13 studies found a positive im-
pact on pain by using a music intervention. In addi-
tion to positively affecting pain, music was found to
reduce anxiety, muscle tension, blood pressure, and
heart rate, to name a few effects. Specific details re-
garding impacts on these factors can be found in
Table 2. Based on these findings, use of music as an
adjuvant for pain control in the adult hospitalized pa-
tient is supported. This recommendation is consistent
with those made by Cepeda et al. (2006) in the Co-
chrane review of the literature.
CONCLUSION
Music is a simple and easy intervention that has min-
imal to no side effects. This simple and straightfor-
ward approach can be used in a variety of patient
types in an array of acute care environments. The
use of music has added benefits in that it can posi-
tively impact not only pain but also other variables,
such as anxiety, muscle tension, and mood, that can
be negatively affected by hospitalization. The com-
bined findings of these studies provide support for
the use of music as an adjuvant approach to pain con-
trol in hospitalized adults. The use of music is safe,
inexpensive, and an independent nursing function
that can be easily incorporated into the routine care
of patients.
 8
TABLE 1.
Evidence Table for Music Therapy as an Adjuvant Intervention for Pain
Research Independent Dependent
Questions/ Variables and Variables and Weaknesses,
Citation Country Hypotheses Measures Measures Sample Size Results Strengths Limitations, Bias

Pregnant women
Ebneshahidi Iran Effect of patient- Study group: 30 Pain: VAS. n ¼ 77 (39 control, Pain and postoperative Clear inclusion Study allowed self-
& Mohseni, selected music on minutes self- Total morphine via 38 music) opioid consumption criteria. selection of music.
2008 postoperative pain, selected music. PCA in recovery room significantly lower in Both groups had Pain and anxiety scores
anxiety, opioid use, Control group: silence via and for first study group vs. similar demographics measured only in
and hemodynamic headphones. postoperative hour. control group. regarding age, immediate
measures. After intervention, nurse Anxiety scores, NBP, and anesthesia, and postoperative period.
(blinded to patient HR not statistically surgery. No indication whether
group) measured HR different between effect of music would
and NBP twice with a groups. be sustained further in
5-minute interval. postoperative stay.
Average of

Cole and LoBiondo-Wood

measurements
analyzed.
Liu et al., 2010 Taiwan Impact of music on Study group: 30 Pain: VAS and n ¼ 60 (30 per During latent-phase Clear inclusion and Behavioral tool for pain
pain and anxiety minutes self- behavioral instrument group) labor, study group exclusion criteria. measurement.
during labor. selected music completed by a nurse. had lower pain and Adequate sample. Though 100%
from five music types. Anxiety: VAS and finger anxiety scores and Clear treatment interrater reliability
Measures taken temperature. Study higher finger protocol. was reported,
before and group asked about temperature than subjective rating of
30 minutes after advantages of music. control group. During another’s pain based
music and 24 active labor, no on behavior is not
hours after difference in pain, accepted practice in
delivery. Study anxiety, or finger pain management.
group asked temperature. Possibly a better
about music No differences between measure of impact of
effectiveness. groups in music on pain would
demographic or have been to ask all
obstetrical the women to rate
information. their labor experience.
Thus a comparison
could have been
made between
groups.
Critical care
patients
Chan, 2007 Hong Kong No statistical Study group: 45 BP, HR, RR, and n ¼ 66 (31 music, Music group: significant Clear inclusion and Limited music choices
difference in reduction minutes self- oxygen saturation 35 control) pain reduction at 45 exclusion criteria. (15 musical pieces to
of pain or physiologic selected music collected at baseline minutes; control Both groups had select from). Four
measures between from three types and 15, 30 and 45 group: significant similar demographic subjects withdrew
groups. during procedure. minutes. Control increase in pain at 45 distributions because of limited
group received 45 minutes. Significant regarding age, selections. Thirty-one
 minutes of rest. Pain reduction in all gender, education, subjects had a
scores: UCLA physiologic and health history. C-clamp placed in the
universal pain parameters for music past, which may have
assessment tool. group with skewed results.
significance found Authors did not
between baseline identify percentage of
measures and 30 patients in each group
minutes and baseline who had past
measures and 45 experience.
minutes.
Cooke et al., Australia Music listening for 15 Subjects: 15 minutes Physical discomfort: n ¼ 17 No statistical Several music options Sample size small. Fifty
2010 minutes will decrease self-selected music NRS ranging from differences between provided for subjects. participants needed
the discomfort and from six types 0 ¼ no discomfort to preturn discomfort or Use of a cross-over for power and only
anxiety experienced before and during 10 ¼ worst anxiety scores design permitted the had 17.
by postoperative ICU turning. Control group discomfort. between groups. patients to serve as Discomfort and anxiety
patients during wore earphones with Anxiety: Faces their own controls. levels were low at
turning. silence. anxiety scale. Clear description of baseline, so achieving
Demographics: age, inclusion and statistical significance
gender, previous exclusion criteria. was challenging,
hospitalizations, especially with small

Use of Music in Control of Pain

surgery type, current sample size.
medications. Clinical: Time from general
medications anesthesia and first
frequency and type turn not recorded;
administered residual anesthesia
presence or absence effects may be
of endotracheal tube a factor.
and hours of 53% of subjects received
mechanical continuous analgesia
ventilation. and 35.3% had
analgesia bolus 1 hour
before turning.
60% of the patients
screened ineligible,
thus patients that may
have benefited most
from the intervention
may have been
excluded.
(Continued )

9
 10
TABLE 1.
Continued
Research Independent Dependent
Questions/ Variables and Variables and Weaknesses,
Citation Country Hypotheses Measures Measures Sample Size Results Strengths Limitations, Bias

Kshettry USA Impact of a Preoperative relaxation Pain and tension n ¼ 104 adults BP was slightly Conducted in the critical Did not address validity
et al., relationship-based training with guided measured on a 10- (53 study, 51 lower and HR slightly care environment, and reliability of the
2006 complementary imagery and 30 point scale; SBP, control) $18 higher in control which demonstrated scales used for
therapy program minutes of gentle DBP, and HR years old group. that complementary measurement of pain
massage on the touch or light measured. admitted for By POD 2, average HR therapies can be and tension.
postoperative course massage. POD 1 and Surgical elective or and SBP had applied to a stressful Did not address
of heart surgery 2, study group complications emergent decreased in environment. calibration of
patients. listened to self- abstracted from cardiovascular experimental group Used a combination noninvasive BP
selected music from medical records surgery and were unchanged approach of monitor.
three types for 20 and tallied. in control group. interventions. In the results, general
minutes. Second Pain and tension scores Both groups were similar health ratings
gentle touch or light were similar in both in demographics and reported using the

Cole and LoBiondo-Wood

massage session groups on POD 1, health issues. Duke Health Profile,
conducted on which was considered but tool is not
discharge from ICU. pretest. Posttest pain discussed in the
Measurements before and tension scores on instruments section of
and after preoperative POD 1 and 2 were the article.
massage and guided significantly lower for Use of analgesics
imagery session study group. discussed in results
completion. No differences reported but not identified as
Postoperative in length of stay. a measured variable.
measurements before Analgesia use was higher Researchers permitted
and immediately after in control group. variations to the
music therapy No differences were treatment protocol
completion on day 1 noted in complication and individualized
and music and gentle rates between the two care and extended the
touch or light groups. treatment to POD 3 for
massage on day 2. a subset of patients.
Tan et al., USA Patients will report Music-based imagery Pain and anxiety n ¼ 29 No differences in pain, Patients served as own Measurement tool used
2010 significantly less pain (MBI) and music measured by anxiety, or muscle controls. for pain and anxiety
and anxiety on the alternate engagement trained observers tension scores at Interrater reliability adapted by staff
research days with (MAE) were provided using the Muscle baseline before reported nurses on the burn
music therapy by a music therapist Tension Inventory interventions. Opioids and unit from the Trippett
compared with no during burn Scale. Significant decreases in anxiolytics not Objective Muscle
music control days. debridement. Self-report pain before, during, changed for study— Relaxation Inventory.
of pain and anxiety and after the dressing patients received No information on
also obtained change on the days same medication reliability and validity
using a 0–10 NRS. the patients received standards on days of the adapted tool
music therapy with and without reported.
compared with days music.
without music Nurses collecting data
therapy. never assigned to
Significant changes in a research patient
anxiety during the thus decreasing bias.
 dressing changes with Clear inclusion and
music therapy. exclusion criteria
Significant changes in The researchers tested
muscle tension during for any sequence
and after dressing effects on the no
changes with music music days and none
therapy. were found.
No significant differences
in amount of opioids
and anxiolytics
administered with or
without music.
Medical-surgical patients
Phipps et al., USA Subjects randomly 30-minutes self-selected HR: palpation of radial n ¼ 53 adults Baseline data for Both groups’ similar No attempts to control
2010 assigned to usual care music provided. artery pulse and (29 control, groups similar for BP, demographic data. the subjects’ hospital
plus music counted for 1 24 study) HR, RR, skin Detailed description of environment—
intervention minute. temperature, pain data collection tools interventions could be
(treatment group) will SBP and DBP: perception, and included. interrupted, possibly
have reduction in BP, noninvasive demographics. Inclusion and exclusion affecting intervention.
HR, RR, pain automatic BP cuff. Baseline treatment group data clearly Number of times

Use of Music in Control of Pain

perception, and mood RR: counted for 1 higher negative mood described. intervention
states compared with minute. scores than control. interrupted and if
usual care group. Peripheral skin After intervention, intervention resumed
Music intervention plus temperature: hand- significant reduction after interruption not
usual care (treatment) held infrared in anxiety, depression, reported.
will increase thermographic mood state, HR, and Patients with a variety of
peripheral skin scanner. RR for treatment neurologic conditions
temperature Pain: VAS. Mood group and no were enrolled vs.
compared with usual states: Profile of difference in BP, skin targeting one
care. Mood States. temperature, and pain particular condition.
between groups.
Medical patients
Chan et al., Hong Kong No significant Study group listened to Physiologic n ¼ 43 (20 study, The music group had Clear inclusion and Three subjects withdrew
2006 difference in reduction self-selected music parameters: BP, 23 control) significant pain exclusion criteria. from study because of
of pain and during 45-minute HR, RR, and reduction at 45 Both groups had limited music
physiologic measures procedure. oxygen saturation minutes, and control similar demographic selections. Having
between two groups. collected at group had distributions more selections could
baseline and at a significant increase regarding age, be beneficial for future
15, 30, and 45 in pain at 45 minutes. gender, education, studies. Twenty-five
minutes. Significant reductions and health history. of the subjects had
Pain score: UCLA in all physiologic past C-clamp
Universal Pain parameters for music experience; this may
Scale at baseline group with have skewed the
and at 45 minutes. significance found results because data
between baseline and did not identify the
30 minutes and percentage of
between baseline and patients in each group
45 minutes. who had past
experience.
(Continued )

11
 12
TABLE 1.
Continued
Research Independent Dependent
Questions/ Variables and Variables and Weaknesses,
Citation Country Hypotheses Measures Measures Sample Size Results Strengths Limitations, Bias

Huang et al., Taiwan Those who listen to Study group: 30 Cancer pain: VAS n ¼ 126 (62 study, Music group had Sample size was Most of the subjects had
2010 music will have less minutes of self- 24-hour usual, least, 64 control) significantly less pain adequate based on high school education
cancer pain at selected music. and worst, 0–10 oral than control group. a power analysis and or less, so results may
posttest than those Control group: 30 numerical scale. Demographics were reported in article. not generalize to more
who do not. minutes of bed rest Opioid analgesics in similar between the The study used a specific educated individuals.
and told they effect at the time of groups. type of music with Head and neck cancer
would have a the intervention were Worst pain in the past 24 60–80 beats per was the most frequent
music session later. measured to rule out hours averaged 8.44 minute without lyrics type (41%) of cancer
confounding effects, and least pain and a sustained study. Stage IV cancer
defined as averaged 2.46. melodic quality and was documented in
administration of the Most of the subjects had controlled pitch and 54% of patients, and
medication within the opioids in effect volume. 64% had metastatic

Cole and LoBiondo-Wood

time frame ordered during both the music Control and experimental cancer, so
and assumption made and the rest groups were similar in generalization of the
to be in the body and interventions. demographics except findings to cancer
affecting pain. that the control group patients with less
Experience with music had significantly more severe disease may
was asked of both unemployed not be possible.
groups. individuals. No mention made
Demographic data was whether patients were
collected for both undergoing
groups. chemotherapy or
whether cancer and
cancer pain was the
reason patients were
hospitalized.
Nilsson et al., Sweden Patients will use less Music began when Demographic data n ¼ 238 (121 music, Patients in music group Sample size was Measurements taken
2009 anxiolytics and the patient was collected before the 117 control) were significantly adequate based on after procedure for
analgesics, placed on the procedure. Angina older (67 vs. 64 years). a power analysis and some items, such as
experience less procedure table and anxiety: 10-point Otherwise, two reported in article. pain with arterial
anxiety, angina, and and continued until numeric scale. groups were similar in Clear inclusion and puncture, that should
puncture-related pain, just before the After procedure, demographics, health exclusion criteria. have been measured
and a higher degree of patient was participants were issues, and at the time of the
relaxation and removed from the asked to rate their preprocedural levels event. State-Trait
comfort if they listen table. pain from arterial of pain and anxiety. Anxiety Inventory
to music during puncture, their Differences in should have been
coronary discomfort related characteristics were administered before
angiographic to puncture pain, noted in gender the procedure to
procedures. Evaluate angina during comparisons, with provide a more robust
whether the response procedure, and female group being measure of anxiety.
to music intervention their discomfort older, with more Several scales used the
differs by gender. related to the diabetics, and scoring same 0–10 numeric
angina. higher on scale but anchor
 Patients also rated their preprocedural anxiety words changed,
discomfort due to scores. Male group which could confuse
lying still and their had more smokers subjects, especially in
feeling of relaxation on and more older population such
a similar scale angiographies as this study had.
with 0 ¼ not at all combined with
and 10 ¼ very percutaneous
much. Environmental coronary
sound during the interventions, which
procedure assessed caused procedure to
on a 10-point scale be longer with longer
with 0 ¼ not at all good exposure to music
and 10 ¼ very good. intervention.
Anxiety rated after No differences found
procedure with State- between music and
Trait Anxiety control groups related
Inventory. to anxiolytic and
Accumulated anxiolytic analgesic use, pain
and analgesic doses related to arterial
administered during puncture, discomfort

Use of Music in Control of Pain

procedure recorded. related to puncture
pain, angina,
discomfort related to
angina, discomfort of
lying still, feeling of
relaxation, and
environmental sound.
Surgical patients
Allred et al., USA Does listening to music Study group: 20 Pain: VAS and McGill n ¼ 56 (28 each No statistical difference Valid instruments Validity of four-question
2010 just before and after minutes easy- Pain Questionnaire. group) between groups in used for pain, anxiety, survey used for music
the first ambulation listening music before Anxiety: VAS. pain, anxiety, and physiologic group not assessed.
after total knee joint first ambulation and Physiologic physiologic parameters. Inclusion Control group was
arthroplasty decrease during 20-minute rest parameters: BP, parameters, or opioid and exclusion criteria assured to receive 20-
the perception of pain, period after HR, and oxygen use. Overall pain clearly reported. minute rest period
anxiety, physiologic ambulation. Control saturation. Four- scores were 30% Method for before first
parameters, i.e., HR, group: 20-minute question survey lower in experimental randomization ambulation—authors
BP, RR, and oxygen quiet rest period. assessed music group and anxiety clearly outlined. acknowledge this
saturation, and group perception of scores were 25% could have allowed
amount of opioids listening experience. lower. 84% of music control subjects to be
consumed from the group noted that another experimental
onset of the music helped them to group with the rest
intervention up to 6 forget pain for a while, actually becoming
hours later? 92% noted that the a second intervention.
music helped to Researchers reported
improve general that pain medication
mood, and 88% noted was changed to ‘‘as
that the music was an needed’’ on POD 1
enjoyable experience. with inconsistent
administration by
the nursing staff.
This could have
affected pain
scores.

13
(Continued )
 14
TABLE 1.
Continued
Research Independent Dependent
Questions/ Variables and Variables and Weaknesses,
Citation Country Hypotheses Measures Measures Sample Size Results Strengths Limitations, Bias

Good et al., USA Patients in three Preoperative teaching: Pain: VAS. Pain n ¼ 167 (43 The three treatment Clear inclusion 40% had chronic pain
2005 treatment groups jaw relaxation distress: VAS relaxation, 49 groups taken together criteria. All groups had that had lasted
(relaxation, music, technique. Music sensation of pain music, 37 had significantly less similar demographic more than a month.
and combination) group: self-selected scale. Measures musicþrelaxation, posttest pain than the distributions and 99% had undergone
will have significantly music from five obtained six times 38 control) control group on day 1 health status. previous surgery.
less pain than those in different types. each day. at postpreparatory, Measured impact Both factors may
the control group. Combination group: Opioid use: converted postrecovery, and of music on opioid have decreased the
Patients who receive the music and jaw the amount of opioid postrest use. effect of the
combination of relaxation technique. used to mg morphine measurements. On intervention.
relaxation and music Control group: 10 equivalents. POD 2, treatment Because preoperative
will have significantly minutes conversation. HR and RR: palpation groups had teaching was done
less pain than those All taught use of pain and observation, significantly less pain with all patients, some

Cole and LoBiondo-Wood

who receive single sensation and distress respectively. Sleep: at the postpreparatory changes in patient
treatments (relaxation scales, and worst past self-report. and postrest behavior could be
or music). pain was measured. Recovery: number of measurements. attributed to this.
Patients who receive Postoperative days until bowel Though not statistically
relaxation will have intervention: sounds heard, significant, there were
significantly less pain Testing at ambulation nasogastric tube lower scores at
than those who consisted of three removed, clear liquids postambulation on
receive music. phases—a 5-minute ordered, patient- POD 1 and 2 and at
preparatory period controlled analgesia postrecovery on POD
while still in bed, an stopped, number of 2. The combination-
ambulation period, patients who intervention group did
and a 10-minute developed not experience
recovery period in complications in the significantly less pain
bed. Those in first 2 POD, and when than the single-
treatment groups the patient intervention groups,
listened to their discharged. and the relaxation
assigned tape during group did not
all three phases. Data experience less pain
were collected four than the music group.
times during The treatment and
ambulation. Those in control groups did not
control did not listen differ in sleep,
to a tape and rested recovery variables, or
quietly for 15 minutes complications. 96%
in recovery period. of patients reported
that the interventions
were helpful for pain,
and 64% reported
that their pain was
reduced a moderate
to large amount by the
 interventions; 62% of
intervention patients
reported an increased
sense of being in
control of their pain.
Good et al., USA Primary hypotheses Interventions were Pain sensation and n ¼ 517 (82 patient Patient teaching did not Sample size was The researchers did not
2010 were: Patients who introduced before distress: VAS. Opioid teaching, 95 have immediate adequate based on identify when the
received audiotaped surgery on 5–10- intake: converted music-relaxation, effects on pain. a power analysis and participants were
patient teaching minute audiotapes opioid intake into mg 86 patient Patients who received reported in article. asked their
would have used before surgery morphine equivalent. teaching and relaxation and music Clear inclusion criteria. preoperative belief in
significantly less and 60-minute Poststudy interviews music-relaxation with or without patient All groups had similar the effectiveness of
immediate pain than intervention tapes were conducted for combination, teaching had demographic the intervention. If this
those who did not, used after surgery. music-relaxation, 103 control). significantly less distributions and was done before the
and patients who Interventions started patient teaching, and immediate pain than health status. implementation of the
received taped on day of surgery, and combination groups those who did not use Interrater reliability for the intervention, results
relaxation and music participants with three questions relaxation and music. observed and chart could be skewed
would have encouraged to use asked: how patient There was no evidence of data was assessed either for or against
significantly less tapes as much as used music, how nonimmediate effects with every 10th a particular
immediate pain than possible the first much they liked for any of the participant with intervention. No
those who did not. evening and during music, and whether interventions. There $90% agreement mention of reliability

Use of Music in Control of Pain

Secondary the first 2 days with tape made them was no significant obtained. and validity for the
hypotheses were: reminders provided sleepy. HR and RR: difference in opioid poststudy interview
Patients who received four times a day. counted for 1 minute use among the four questions.
audiotaped patient before and after each groups. The sample was
teaching would have 20-minute test. Of those who received predominantly white
significantly less Demographic variables music, 56% used the (69%) and female
nonimmediate pain and preoperative music to both relax (68%). Perceptions
than those who did belief in effectiveness and to distract regarding pain
not, and patients who of intervention themselves from the interventions may be
received taped obtained by interview pain experienced; different by both race
relaxation and music or chart review. 96% liked their music and gender. 81% had
would have Length of surgery choice a moderate undergone previous
significantly less recorded from chart. amount to a lot, and surgery, which may
nonimmediate pain Incision location and 82% reported that the have skewed the
than those who did direction measured by music made them results either for or
not. observation and sleepy. against based on the
incision length HR and RR were past surgical
measured with tape significantly lower in experience.
measure in cm. the groups that
received music.
(Continued )

15
 16
TABLE 1.
Continued
Research Independent Dependent
Questions/ Variables and Variables and Weaknesses,
Citation Country Hypotheses Measures Measures Sample Size Results Strengths Limitations, Bias

McCaffrey & USA What is the difference in Music was played Pain: 10-point numeric n ¼ 124 (62 each Statistically significant Study demonstrated Used room placement to
Locsin, postoperative pain for 1 hour minimum scale and amount of group) reduction in pain successful use of randomize the
2006 and number of of four times daily. analgesic medication scores and music in older patients subjects into control
episodes of acute required after medication use in who are at higher risk or experimental
confusion and discontinuation of experimental group for complications groups.
distance ambulated patient-controlled on each POD. from opioids. Based confusion
among older adults analgesia pump on Experimental group Clear inclusion and on nursing
undergoing hip or POD 1. Number of experienced exclusion criteria for documentation of
knee surgery between episodes of significantly less subjects. symptoms instead of
those who listen to confusion: nurse- confusion than control delirium scale with
music during the identified signs and group. reported validity and
postoperative period symptoms recorded Experimental group had reliability.

Cole and LoBiondo-Wood

and those who do in nurses’ narrative higher readiness to Based readiness to
not? Is there notes. Readiness to ambulate scores than ambulate on items
a difference in ambulate: patient’s control group. without solid measure
satisfaction with the cognitive status, pain Statistical difference vs. utilization of
postoperative hospital and willingness to found in ambulation, a functional score.
experience after hip or participate in physical with experimental Although the researchers
knee surgery in older therapy. Distance group able to set a minimum
adults who listen to ambulated: feet ambulate farther than amount of time for the
music compared to ambulated as control group. music to be used,
those who do not? recorded in physical Experimental group also there was variation in
therapists’ notes. had a statistically the amount of time
Patient satisfaction: significant higher actually used.
postdischarge patient satisfaction
telephone calls made score than control
2 weeks after surgery. group.
Nilsson, 2009 Sweden Evaluate the effect of bed Music: 30 minutes Arterial oxygen tension n ¼ 58 adults No differences in Study focused more Intervention performed
rest with music on the during rest. and oxygen (28 music, groups in on a biologic marker only once, which
first POD to decrease Control group: 30 saturation: arterial 30 control) demographic for stress response vs. could limit the effect.
stress response in minutes rest. blood gas analyzed points, duration of patient report, making No information provided
patients who had Measures taken with ABL 505 surgery, the results stronger. on opioid use of
undergone cardiac at 12:00 p.m. radiometer. extracorporeal Clear inclusion and patients and when last
surgery. (pretest), 12:00 p.m. Stress response: serum circulation time, and exclusion criteria. administered in
(posttest), and 1:00 cortisol levels by intra- and relation to the
p.m. (second radioimmunoassay postoperative intervention.
posttest). (Coat-a-Count analgesia. Research nurse
Cortisol). Significant reductions in remained in room for
MAP, HR, and RR: GE cortisol levels at both the data collection
Carescape Datex- postintervention hour—the nurse’s
Ohmeda monitor. measurements for presence could have
Pain and anxiety levels: both groups affected patient’s
compared with
 self report using a 10- baseline. Significant self-report of pain
point NRS. difference in cortisol and anxiety.
levels for music and
control groups at 30
minutes, with music
group being much
lower, but no
difference seen at
second posttest
measure.
No differences in
between groups on
MAP, HR, RR, pain,
and anxiety.
Sendelbach USA Does music therapy Study group: 20 minutes Pain: 0–10 NRS. Anxiety: n ¼ 86 (50 study; Both groups were similar Study was conducted Control and experimental
et al., delivered on PODs self-selected music State Personality 36 control) on demographic data. at three separate groups were not
2006 1–3 decrease anxiety, from four types played Inventory. HR: The experimental locations. balanced in number of
pain levels, HR, BP, twice per day on bedside monitor. BP: group had fewer A strong impact on participants.
and amount of PODs 1–3 noninvasive BP bypass/valve anxiety with the use of Study had missing data,
parenteral opioid module of the combination music was noted. so the study design

Use of Music in Control of Pain

equivalents monitoring system or surgeries. Because music can had to be changed.
consumed by patients with a cuff BP unit. Music group had be used as an Data was analyzed
undergoing cardiac significantly lower independent nursing only for POD 1 a.m.
surgery, compared anxiety and pain intervention, this and p.m. sessions and
with those patients scores than control study is helpful in POD 2 a.m. session.
who receive standard group. providing nurses with No information regarding
therapy (rest in bed)? No differences in HR and the evidence needed cardiac medications
BP. No differences in to implement this collected. Because
opioid usage. practice. cardiac medications
are frequently
administered
postoperatively, these
could have affected
HR and BP measures.
Researchers reported
that around-the-clock
analgesia
administration was
implemented during
the study. This could
have had a negative
effect on reduction of
opioid usage with
music.
(Continued )

17
 18
TABLE 1.
Continued
Research Independent Dependent
Questions/ Variables and Variables and Weaknesses,
Citation Country Hypotheses Measures Measures Sample Size Results Strengths Limitations, Bias

Walworth USA Examine the effects of Music therapy: 20–30 Anxiety, mood pain, 27 patients Both groups were Study assessed length Sample size small.
et al., live music therapy on minutes live music perception of (13 control, similar in all measures of stay impact, which Researchers reported
2008 quality of life before surgery, hospitalization or 14 study) before the music would lend itself to that preoperative
indicators, amount of followed by 30 procedure, relaxation, intervention. a financial evaluation sessions were
medications minutes live music and stress: patient Significant differences of the intervention. interrupted by
administered, and provided daily after self-report on VAS. for anxiety, Subjects recorded their provision of care. This
length of stay for surgery. Postoperative hospitalization responses to the could have affected
patients receiving analgesics: perception, scales on paper, thus the effects of the
elective surgical conversion to relaxation, and stress, reducing some of the intervention.
procedures of the morphine-equivalent with the experimental bias that might have Researchers reported
brain. doses. group attaining lower been associated with that music session
Nausea: number of days scores. a verbal response to times varied from 20

Cole and LoBiondo-Wood

antiemetics were No differences found the researcher. to 50 minutes. They
administered after between groups did not indicate if
surgery. regarding mood or there were differences
Length of stay: hours pain levels, antiemetic in variables for those
from the time of or analgesic usage, individuals with longer
admission/surgery to and length of hospital session times vs.
discharge from the stay. those with shorter
hospital. times.

BP ¼ blood pressure; DBP ¼ diastolic blood pressure; HR ¼ heart rate; ICU ¼ intensive care unit; MAP ¼ mean arterial pressure; NBP ¼ noninvasive blood pressure; NRS ¼ numeric rating scale; POD ¼ post-
operative day; SBP ¼ systolic blood pressure; RR ¼ respiratory rate; VAS ¼ visual analog scale.
TABLE 2.
Summary Table for Music Therapy as an Adjuvant Intervention for Pain
Citation Country Population Sample Size Pain Medications BP HR RR Anxiety Other Impacts

Allred et al., 2010 USA Surgical 56 p ¼ .000 No No No No No Perception of hospitalization:

positive
Chan et al., 2006 Hong Kong Medical 43 p ¼ .003 NA p ¼ .001; p < .001 p < .002; NA NA
p ¼ .006 p < .001
Chan, 2007 Hong Kong ICU 66 p < .001 NA NA p < .001 p < .001 NA NA

Use of Music in Control of Pain

Cooke et al., 2010 Australia ICU 17 No NA NA NA NA No NA
Ebneshahidi & Iran Pregnancy 77 p < .05 p < .05 No No NA NA NA
Mohseni, 2008
Good et al., 2005 USA Surgical 167 p ¼ .024 to No NA NA NA NA NA
p ¼ .001
Good et al., 2010 USA Surgical 517 p < .001 No NA p ¼ .04 p ¼ .04 NA NA
Huang et al., 2010 Taiwan Medical 126 p < .001 NA NA NA NA NA NA
Kshettry et al., 2006 USA ICU 104 p < .001 NA No No NA NA Muscle tension: p < .001
Liu et al., 2010 Taiwan Pregnancy 60 p < .001 latent labor NA NA NA NA p < .001 latent labor NA
McCaffrey & USA Surgical 124 p ¼ .001 p ¼ .001
Locsin 2006
Nilsson, 2009 Sweden Surgical 58 p < .001 NA No p < .002 p < .005 p < .004 Cortisol: p < .02
Nilsson et al., 2009 Sweden Medical 238 No No NA NA NA No NA
Phipps et al., 2010 USA Med-Surg. 53 No NA No p ¼ .003 p ¼ .002 p ¼ .000 Depression: p ¼ .000;
Mood: p ¼ .000
Sendelbach USA Surgical 86 p ¼ .009 No No p < .001
et al., 2006
Tan et al., 2010 USA ICU 29 p < .025 to NA NA NA NA NA NA
p < .05
Walworth et al., 2008 USA Surgical 27 No No NA NA NA p ¼ .03 Relaxation: p ¼ .001;
Stress: p ¼ .001;
Perception of hospitalization:
p ¼ .03

Abbreviations as in Table 1.

19
20 Cole and LoBiondo-Wood
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