Effect of Music Therapy on Pain After Orthopedic Surgery – A Systematic Review and Meta-Analysis

Lin CL, Hwang SL, Jiang P, & Hsiung NH.  Pain Pract. 2019 Nov 30. doi: 10.1111/papr.12864.

https://www.ncbi.nlm.nih.gov/pubmed/31785131

Take-Home Message

Music interventions may reduce a patient’s perceived pain intensity after orthopedic surgery.

Summary

A patient undergoing an orthopedic surgery may experience significant post-operative pain, which has physical and psychological consequences including depression, anxiety, delayed recovery times, or impeding rehabilitation efforts.  In today’s opioid crisis, there is a need to look for non-pharmacological approaches to pain mitigation, especially given the psychological factors that have been linked to a patient’s perceptions of pain.  Music can improve post-operative patients, but it has not been systematically investigated among patients undergoing an orthopedic surgery.  These authors conducted a systematic review of randomized clinical trials to explore the effects of music interventions (music medicine or music therapy) on pain after orthopedic surgery. The authors identified 9 clinical trials among adult participants. Overall, the authors reported a lack of blinding in most of the included studies, which leaves most of the available research susceptible to biases. The authors also observed a lot of variability among the trials. The music was sometimes live or pre-recorded and performed for 20 to 60 minutes before, during, or after surgery. The authors reported that music reduced pain intensity after orthopedic surgery. However, music interventions failed to affect the length of stay, opioid use, or other physiologic measures. 

Viewpoints    

This study is very interesting because it potentially adds another less conventional treatment to a clinician’s approach to reducing a patient’s pain from orthopedic surgery. The authors found that music interventions like music medicine (listening to music) or music therapy (patients actively engaging with music) can be beneficial. Pain perception is a very complicated process, and pain mitigation approaches should not be one-size-fits-all.  Our ability to individualize music to the patient’s preference is clearly a patient-centered approach.  The authors admitted the evidence is limited by the few number of available research studies and the overall lack of blinding.  It may be informative to look at specific orthopedic surgeries (such as anterior cruciate ligament reconstruction) to see if there is an effect of music interventions on pain rather than looking at all orthopedic surgeries (e.g., knee, back, hip).  It would be interesting to see if the surgery type changed the impact of music interventions on pain. Despite the need for more research, there is little risk to using music interventions to complement other pain management strategies. Hence, it may be worthwhile to recommend music interventions to patients after an orthopedic surgery.

Questions for Discussion

How do you use music as an intervention for pain?  Are there any other non-pharmaceutical approaches that you have found to be effective in reducing a patient’s perception of pain?

Written by: Nicole M. Cattano
Reviewed by: Jeffrey Driban

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