Medical emergencies: when music helps (Part 2/3)
The benefits of music for patients have been widely studied, so isn't it time for a more hollistic and global evaluation on the medical and therapeutic applications?
Music and emergency medicine
About the author: Prof. Nicolas Peschanski works as an Emergency Medicine consultant at the Centre Hospitalier Universitaire de Rennes, France. Translated from the original French version
In Part 1 of this series, we saw how AC/DC riffs seem to have a place in the operating theatre. But what about in our entire emergency departments?
During one of those rare quiet moments in the emergency room, the stretchers being surprisingly empty, I started a literature review. As soon as the computer was switched on, the playlist that usually accompanies my movements flooded into the department. I immediately wanted to mute the sound, but the colleagues present, at first surprised, asked me to leave the music on.
White coats and music have a long history. It is everywhere and there is not a hospital or a team that does not have a hidden musician, a music lover or an artist at heart. Above all, whether we play it, listen to it or talk about it, music is a strong link between us.
It's mostly on night ward shifts that I talk about music - all kinds of music, from opera to country to Bollywood to metal. I'm not a musician, and even less a classical pianist like a good part of my family, but I avidly scrutinize the career of my half-brother, a jazz-pop pianist who also flirts with garage-trash-new beat hip-hop , or that of Arnaud Thorette, a close friend who is a renowned violinist and violist. So I enjoy shifting rapidly from a jazz radio station to a hard rock playlist without transition. This is enough to fuel conversations with my colleagues and medical students.
At night, if the patients stop coming in, a member of the team sometimes starts the MP3 playlist that is lying around on a computer in the ward. These moments of conviviality turn into lively debates about our musical tastes. Sometimes, on the contrary, everyone keeps quiet to listen almost religiously to a song that brings us together when we have just experienced an intense moment as a team.
Music as a non-pharmacological intervention
Music has been used as a therapeutic intervention for centuries. The medical literature is replete with studies that have confirmed the effect of music on pain, anxiety and or other parameters in the clinical context.
There is documented evidence of the physiological impact of music on parasympathetic activity, hormonal regulation of stress and humoral immunity. For example, by decreasing sympathetic and neuroendocrine activity, there is an enhancement of the parasympathetic response that promotes relaxation.
In the medical environment of intensive care units, music has been used for non-pharmacological purposes for several years. A 2013 meta-analysis of music therapy and 'music medicine' (music administered as part of health care by a musician who is not a music therapist) in intensive care showed that music corresponds to a safe and inexpensive non-pharmacological intervention. By helping to reduce the perception of pain and lowering the stress levels associated with often heavy and invasive care, music reduces patient anxiety.1
What about the emergency room?
Over the past two decades, partnerships between musicians, music therapists, clinical physicians and researchers have led to an unprecedented development of therapeutic procedures and interventions, resulting in the publication of numerous rigorous scientific studies.2 While the use of music for therapeutic purposes in the emergency department has been little studied, it is easy to see that it could be an effective non-pharmacological intervention in the emergency department as well, helping to reduce pain and anxiety.
For example, it has been widely demonstrated that, in various patient populations and during multiple more or less invasive procedures, music has a positive effect on pain control, tolerance and perception3-8, as well as on the use of anaesthesia and sedation.9,10
In addition to its effects on anxiety and pain, hundreds of studies have confirmed the therapeutic effect of music on other clinical parameters such as heart rate, blood pressure or lung vital capacity. There is clearly documented evidence of the physiological impact of music, including its effects on parasympathetic activity, plasma stress hormone levels and immunity.
A major meta-analysis by Nilsson et al. in 2008 reviewed 42 studies that measured the effects of music on pain and anxiety (in a perioperative setting but easily transferable to the emergency room). The review found that about half of the studies reported significant positive effects.11 In this context, studies on music in emergency departments have also shown positive results on anxiety and stress12,13, on pain management13-15 and on noise stress reduction.16
From sutures to scans
Music has been shown to reduce the use of painkillers during the suturing of wounds in emergency departments by significantly reducing pain.17 Other studies have shown that music significantly reduces pain and anxiety during dressing changes in burn patients.18,19 In addition, music reduces the anxiety of patients waiting for the results of further tests, which is common in an emergency department.20
While studies have shown that music is an alternative to certain treatments, particularly painkillers, it also significantly reduces the costs of medical procedures such as CT scans.21 Indeed, the use of music during paediatric CT scans reduces or even eliminates the need for sedation and analgesia, or even anaesthesia. It also reduces the need for prolonged post-procedure monitoring and overnight hospital stays.
In addition, it provides a 98% procedure completion rate, a three-hour reduction in peri-procedural paramedical time, and savings of approximately $567 per procedure. Thus, with more than four million scans performed annually on children in the United States, the potential savings from using musicians for this procedure alone would exceed $2.25 billion annually.21
However, even though in emergency and intensive care settings these procedures are performed far more often on adults than on children, it is possible to see an overall benefit from music when these examinations are performed in these settings.
A measure of patient satisfaction
Studies suggest that music can have a positive effect on patient satisfaction in emergency departments. In a meta-analysis based on an evaluation of music in acute medical wards on composite criteria, the authors found favourable effects on the perception and manifestation of pain symptomatology, on anxiety but also on patient satisfaction.
This meta-analysis reports that, in many studies, patients were more satisfied with their care when music therapy was used.22 The authors conclude that the low cost of music allows it to be considered a positive factor. Although few studies focus specifically on patient satisfaction as a measure, more recent work on music includes satisfaction as a qualitative measure of care. These show that music has positive effects and suggest the need for further research in this area.20,23
Live music is ideal!
Few studies have looked at the specific impact of live music. Most interventions use recorded music, including web-based technologies.24 But there is some research specifically on the use of live music as a treatment for pain and anxiety. Unfortunately, little of this research has yet been conducted in emergency departments.25
However, recent work provides a strong case for the use of live music in emergency departments in a randomised controlled trial.26 In this study, original musical compositions further reduced anxiety in emergency department patients. Unfortunately, to date, there are no other randomised studies of this type comparing live music with recorded music in an emergency department.
The majority of this work on music interventions in healthcare settings focuses on individual, patient-specific outcomes. There is relatively little evidence linking music to improvements in the overall care environment, to more global clinical and biological outcomes, to medico-economic impact, or to improvements in the satisfaction of carers who work in highly stressful environments.
If music has its place in the emergency room, it may also play a special role in emergency vehicles. We invite you to continue to Part 3 of this series.
- Mangoulia P, Ouzounidou A. The Role of Music to Promote Relaxation in Intensive Care Unit Patients. Hosp Chronicles 2013;8(2):8-85
- Thaut MH, Gardiner JC, Holmberg D, Horwitz J, Kent L, Andrews G, Donelan B, McIntosh GR. Neurologic music therapy improves executive function and emotional adjustment in traumatic brain injury rehabilitation. Ann N Y Acad Sci. 2009 Jul;1169:406-16.
- Henry LL. Music therapy: a nursing intervention for the control of pain and anxiety in the ICU: a review of the research literature. Dimens Crit Care Nurs. 1995 Nov-Dec;14(6):295-304.
- Whipple B, Glynn NJ. Quantification of the effects of listening to music as a noninvasive method of pain control. Sch Inq Nurs Pract. 1992 Spring;6(1):43-58; discussion 59-62.
- Nilsson U, Rawal N, Unosson M. A comparison of intra-operative or postoperative exposure to music--a controlled trial of the effects on postoperative pain. Anaesthesia. 2003 Jul;58(7):699-703.
- Good M. Effects of relaxation and music on postoperative pain: a review. J Adv Nurs. 1996 Nov;24(5):905-14.
- Good M, Stanton-Hicks M, Grass JA, Anderson GC, Lai HL, Roykulcharoen V, Adler PA. Relaxation and music to reduce postsurgical pain. J Adv Nurs. 2001 Jan;33(2):208-15.
- Mitchell LA, MacDonald RA. An experimental investigation of the effects of preferred and relaxing music listening on pain perception. J Music Ther. 2006 Winter;43(4):295-316.
- Newman A, Boyd C, Meyers D, Bonanno L. Implementation of music as an anesthetic adjunct during monitored anesthesia care. J Perianesth Nurs.2010 Dec;25(6):387-91.
- Lee DW, Chan KW, Poon CM, Ko CW, Chan KH, Sin KS, Sze TS, Chan AC. Relaxation music decreases the dose of patient-controlled sedation during colonoscopy: a prospective randomized controlled trial. Gastrointest Endosc. 2002 Jan;55(1):33-6.
- Nilsson U. The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J. 2008 Apr;87(4):780-807.
- Holm L, Fitzmaurice L. Emergency department waiting room stress: can music or aromatherapy improve anxiety scores? Pediatr Emerg Care. 2008 Dec;24(12):836-8.
- Mandel SE, Davis BA, Secic M. Patient Satisfaction and Benefits of Music Therapy Services to Manage Stress and Pain in the Hospital Emergency Department. J Music Ther. 2019 May 10;56(2):149-173.
- Bauman BH, McManus JG Jr. Pediatric pain management in the emergency department. Emerg Med Clin North Am. 2005 May;23(2):393-414,ix.
- Duroux C, Fainelli M, Dirhoussi Z, Le Joncour A, Bonier C, Zak C, Cornet R, Raynal PA, Yordanov Y, Thiebaud PC. Effect of music on pain and anxiety during wound closure in the emergency department. Acad Emerg Med. 2022 Jan;29(1):105-108.
- Short AE, Ahern N, Holdgate A, Morris J, Sidhu B. Using music to reduce noise stress for patients in the emergency department: a pilot study. Music and Medicine 2010;2(4):201-207.
- Menegazzi JJ, Paris PM, Kersteen CH, Flynn B, Trautman DE. A randomized, controlled trial of the use of music during laceration repair. Ann Emerg Med. 1991 Apr;20(4):348-50.
- Tan X, Yowler CJ, Super DM, Fratianne RB. The efficacy of music therapy protocols for decreasing pain, anxiety, and muscle tension levels during burn dressing changes: a prospective randomized crossover trial. J Burn Care Res. 2010 Jul-Aug;31(4):590-7.
- Son JT, Kim SH. [The effects of self-selected music on anxiety and pain during burn dressing changes]. Taehan Kanho Hakhoe Chi. 2006 Feb;36(1):159-68.
- Chai PR, Schwartz E, Hasdianda MA, Azizoddin DR, Kikut A, Jambaulikar GD, Edwards RR, Boyer EW, Schreiber KL. A Brief Music App to Address Pain in the Emergency Department: Prospective Study. J Med Internet Res. 2020 May 20;22(5):e18537.
- DeLoach Walworth D. Procedural-support music therapy in the healthcare setting: a cost-effectiveness analysis. J Pediatr Nurs. 2005 Aug;20(4):276-84.
- Richards T, Johnson J, Sparks A, Emerson H. The effect of music therapy on patients' perception and manifestation of pain, anxiety, and patient satisfaction. Medsurg Nurs. 2007 Feb;16(1):7-14.
- Dileo, C., Bradt, J. in Medical Music Therapy: Evidence-Based Principles and Practices. In: Söderback, I. (eds) International Handbook of Occupational Therapy Interventions. Springer, New York, NY. 2009.
- Young S, Collins S. A View from the Trenches of Music 2.0. Popular Music and Society 2010 Mar;33(3):339-355.
- Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane Database Syst Rev. 2006 Apr 19;(2):CD004843.
- Weiland TJ, Jelinek GA, Macarow KE, Samartzis P, Brown DM, Grierson EM, Winter C. Original sound compositions reduce anxiety in emergency department patients: a randomised controlled trial. Med J Aust. 2011 Dec 19;195(11-12):694-8.