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The Effects of Music on Pain: a Review of Systematic Reviews and Meta-Analysis

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The Effects of Music on Pain: a Review of Systematic Reviews and Meta-Analysis THE EFFECTS OF MUSIC ON PAIN: A REVIEW OF SYSTEMATIC REVIEWS AND META-ANALYSIS A Dissertation Submitted to the Temple University Graduate Board In Partial Fulfillment of the Requirements for the Degree DOCTOR OF PHILOSOPHY by Jin-Hyung Lee May, 2015 Examining Committee Members: Cheryl Dileo, Advisory Chair, Music Therapy Wendy Magee, Music Therapy Joseph Ducette, Educational Psychology Deborah Confredo, Music Education ii © Copyright 2015 By Jin-Hyung Lee All Rights Reserved iii ABSTRACT The purpose of this study was twofold: to critically review existing systematic reviews and meta-analyses on the topic of music and pain; and to systematically review and conduct a meta-analysis of clinical trials investigating the effect of music on pain encompassing a wide range of medical diagnoses, settings, age groups, and types of pain. For the review of systematic reviews, the author conducted a comprehensive search and identified 14 systematic reviews and meta-analyses. These studies were critically analyzed to present a comprehensive overview of findings, to evaluate methodological quality of the reviews, to determine issues or gaps in the literature, and to generate research questions for the following meta-analysis. For the meta-analysis, the author conducted electronic searches of 12 databases and a handsearch of related journals and reference lists of relevant systematic reviews, with partial restrictions on design (i.e., randomized controlled trials); language (i.e., English, German, Korean, and Japanese); year of publication (i.e., 1995 to 2014) and intervention (i.e., music therapy and music medicine). Analyzed studies included 87 music medicine (MM) and 10 music therapy (MT) trials; eighty-nine of the included studies involved adults and eight trials focused on children. In terms of the types of pain, there were 51 trials on acute, 34 on procedural, and 12 on cancer or chronic pain; the trials were conducted in over 20 different medical specialty areas. For the assessment of study quality, I used the risk of bias tool developed by the Cochrane collaboration, and pooled data from the included studies were analyzed using the Revman 5.3 software according to the effects of music on levels of pain intensity, amount of analgesic use, and changes in vital signs. iv The results indicated that music interventions resulted in a significant reduction of 1.13 units on 0-10 scales and a small to moderate pain reducing effect on other scales (SMD = -0.39). Participants in the music group experienced a significantly lower level of emotional distress from pain (MD = -10.8), and required significantly fewer anesthetics (SMD = -0.56), opioids (SMD = -0.24), and non-opioid medications (SMD = -0.54). Moreover, the music group showed statistically significant decreases in heart rate of 4.25 bpm, systolic blood pressure of 3.34 mmHg, diastolic blood pressure of 1.18 mmHg, and respiration rate of 1.46 breaths per minute. Findings from several analyses of moderator variables suggest: MT has a stronger effect in reducing self-rated pain intensity than MM; MT is more effective in reducing chronic/cancer pain than other types of pain, but MM seems to be more effective in managing procedural pain; children benefit more from music interventions than do adults, and more from MT than MM; providing different levels of choices in the selection of music yields different outcomes for MM; having a rationale for selection of music greatly improves the treatment outcome for MM; and an active MT approach is more effective in relieving perceived levels of pain than a passive MT approach. The results from the current meta-analysis demonstrate that music interventions may have beneficial effects on pain, emotional distress from pain, use of anesthetics and pain killers, and vital signs including heart rate, systolic blood pressure, diastolic blood pressure and respiration rate. However, these results need to be interpreted with caution due to highly heterogeneous outcomes among the included studies. Considering all the possible benefits, music interventions may provide an effective complimentary approach for the relief of acute, procedural and cancer/chronic pain in the medical setting. v Dedicated to the most incredible woman I know: My loving mother, Songmi Hong vi ACKNOWLEDGMENTS First, I would like to thank my family: my son Eugene, my wife Juri, my mom Songmi Hong, and my mother-in-law Jeongae Park. I cannot thank you enough for your love and support during my long absence. I could not have done this without your incredible patience and trust in me. I love you all so very much and I cannot wait to be reunited as a family. You have been the source of my energy and the light of my life! To my incredible advisor, Dr. Cheryl Dileo, I am deeply touched and humbled by the support, wisdom and trust you have shown me throughout my education at Temple. There are no words that could describe what I am feeling now. You are my inspiration and role-model! Thank you! To my wonderful dissertation committee: Dr. Wendy Magee, Dr. Joseph Ducette, and Dr. Deborah Confredo. I thank you for your invaluable guidance and support during my dissertation. Not only that, you also influenced me greatly as an educator and researcher during my education at Temple. To my fabulous mentor, Dr. Darlene Brooks, you helped me to complete four out of five PhD projects, which means that you literally held my hand through this program. I cherish every second with you at Temple and appreciate your penetrating insights, ever- evolving feedback and unconditional support. To my ‘papa dragon’ Dr. Kenneth Bruscia, your absence at Temple did not stop me from learning and working closely with you, and I am forever grateful for your incredible insights and mentorship. Please don’t stop kicking my butt to stay ‘reflexive!’ To my loving supporters in Cleveland: Dr. Barbara Guy and Dr. Deforia Lane. I can’t thank you enough for your enormous love and support during the past 15 years. vii Barbara, your genuine interest in helping me to write better and succeed, definitely got me this far. Deforia, your presence itself is incredibly healing and inspiring to many, and it keeps me going as a clinician. I truly miss working with you. To my wonderful violin professor, Dr. Marla Mutschler, your belief in me helped me to overcome my fears and expand my potential. I am forever indebted to you. Professor Barbara Crowe, your guidance helped me to keep my love for music therapy all these years and helped me to seek all possibilities. Dr. Kenneth Aigen, though brief I definitely enjoyed our discussions and your astute insights in music therapy. To Benedikte Scheiby and Marilyn Clark, I cherish all the invaluable experiences you provided which helped me to grow as a person and a clinician. I send much love to my sisters, Myung, Sungkyo and Sunmi for their love and support. I would like to take a moment to thank and remember Sanghun, my beloved brother who passed away, but influenced me to become a better man. I’m grateful for my American family: the Guys in Cleveland, the Fahrenkrugs in Normal, IL, and the Koslowskys in Mesa, AZ for their love and support. Sorry I can’t name everyone here, but I’m thankful for all my friends at Temple who journeyed with me throughout our study. I thank Dr. Yuki Mitsudome for her help with my dissertation. I am grateful to my colleagues in Korea: Dr. In yong Lee, Dr. Hyun ju Chong, Dr. In ryung Song, Dr. Dong min Kim, Dr. Eunmi Kwak, Dr. Soo ji Kim, Dr. Nan bok Lee and all the officers of the NAKMT for their support during my absence from our association. Lastly, I thank the Cochrane Collaboration for their invaluable contribution to the research community and all the researchers who conducted the numerous clinical trials that made my meta-analysis possible. viii TABLE OF CONTENTS Page ABSTRACT ....................................................................................................................... iii DEDICATION .....................................................................................................................v ACKNOWLEDGMENTS ................................................................................................. vi LIST OF TABLES ........................................................................................................... xiv LIST OF FIGURES ......................................................................................................... xvi CHAPTER 1. INTRODUCTION .........................................................................................................1 Understanding Pain and Pain Related Issues ...........................................................1 Definition of Pain .........................................................................................1 Classification of Pain ...................................................................................1 Prevalence of Pain ........................................................................................3 Factors Associated with the Undertreatment of Pain ...................................4 Detrimental Effect of Pain ...........................................................................7 The Need for an Effective Non-pharmacological Pain Management ......................8 Music as a Means of Alleviating Pain and Other Symptoms in Hospitals ..............9 Background ..................................................................................................9 Description of Music Medicine in Practice ...............................................10
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