1. By: Angela Zhushma, RN State University of New York Institute of Technology

2. Over 80% of patient experience moderate to severe pain after having surgical procedures Pain is most severe immediately after the surgery after the effect of anesthetic analgesia ends It’s usually managed by administering IV or oral narcotics Music therapy as a complimentary intervention can act as a distraction, thus helping with pain management Inadequate postoperative pain management may lead to disturbed rest and sleep, delayed wound healing, patient dissatisfaction, prolonged recovery time, and increased healthcare costs * Therefore, it’s important to explore the effect of music on post-operative pain*

3. The objective of the integrative review is to determine if music used as a complimentary therapy in post- operative patients 18 years of age and older results in less pain intensity compared to the use of narcotics alone? P - In post-operative patients 18 years and older I - Music as a complimentary therapy C - Pharmacological measures (use of narcotics) O -Effect pain management (using numerical rating scale (NRS) or the visual analogue scale (VAS))

4. The databases CINAHL and MEDLINE were used with key search term ‘music’ along with ‘post-operative pain’, ‘pain management’, and ‘post surgical’ The review included seven studies, all of which used a control group and music group to compare results Data from all these studies overall supported music as an aid in reducing pain intensity when used in conjunction with pain medication Pain intensity was measured by the numerical rating scale (NRS) or the visual analogue scale (VAS) Several of these studies showed that pain intensity was significantly lower in the music group than the control group on the second post-operative day specifically The literature review suggests that music intervention should be offered to patients after surgery as it has been shown to reduce pain intensity

5. Author (s)Study MethodFindings Allred (2010) Surgery: Total Knee Arthroplasty RCT 56 patients Experimental group n=28 Control group n=28 Results from this study provide evidence that pain is reduced while listening to music just before the 1 st ambulation after a TKA. Overwhelmingly, patients reported that music helped them forget about their pain and improved their mood. Comeaux & Steele- Moses (2013) Surgery: various Quasi-experimental Music group n=19 Control group n=22 At Time One (first 24 hrs. post-op) no significant difference between the music and control group was found in pain management. At Time 2 (2 nd post-op day), a significant increase in pain management was found. Ikonomidou & Rehnstrom (2004) Surgery: Gynecologic laparoscopy RCT Music group n=29 Control group n=26 No significant difference between the music and control group in pain scores was found. However, opioid consumption was significantly lower. Lin et al. (2013) Surgery: Spinal Quasi-experimental Music group n= 30 Control group n=30 Lower pain level throughout the entire observation period was found in the music group compared to the control group. Tse et al. (2005) Surgery: Nasal RCT Music group n= 27 Control group n=30 Use of musical therapy resulted in significantly lower pain scores and analgesic consumption in the first 24 hrs. post nasal surgery. Vaajoke et al (2011) Surgery: abdominal RCT Music group n=83 Control group n=85 In the music group, patients’ pain intensity and pain distress during deep breathing and in shift position were significantly lower on the 2 nd post-operative day compared with the control group. Vaajoke et al. (2013) Surgery: abdominal Quasi-experimental Music group n=83 Control group n=85 On the 2 nd post-op day, pain intensity and distress was significantly lower in the music group compared to the control group.

6. My role in this project was meeting with my clinician and discussing the findings of this research The plan is to collaborate with the staff members who provide pre-operative teaching to those having elective surgery They should encourage patients to bring music they prefer from home I will also recommend that our unit (which is a post- surgical floor) invest in several devices that will play music for patients to use in the hospital Patients would be provided ear buds to use for music therapy

7. Music therapy is an inexpensive intervention and can be easily implemented in the clinical settings Hospitals could purchase CD players and MP3 players for patients to use, which could be wiped down and cleaned in between patient use. Patients can be given their own ear buds to keep Nurses should encourage patients to listen to music after receiving pain medication for at least thirty minutes This will likely improve their pain management and increase their overall satisfaction as studies indicate

8. Allred, K., Byers, J., & Sole, M. (2010). The effect of music on postoperative pain and anxiety. Pain Management Nursing, 11(1), 15-25. Comeaux, T., & Steele-Moses, S. (2013). The effect of complementary music therapy on the patient's postoperative state anxiety, pain control, and environmental noise satisfaction. MEDSURG Nursing, 22(5), 313-318. Ikonomidou, E., Rehnström, A., & Naesh, O. (2004). Effect of music on vital signs and postoperative pain. AORN Journal, 80(2), 269. doi:10.1016/S0001- 2092(06)60564-4. Lin, P., Lin, M., Huang, L., Hsu, H., & Lin, C. (2011). Music therapy for patients receiving spine surgery. Journal Of Clinical Nursing, 20(7/8), 960-968. doi:10.1111/j.13652702.2010.03452.x Pyati, S., & Gan, T. (2007). Perioperative pain management. CNS Drugs, 21(3), 185- 211.

9. Tse, M., Chan, M., & Benzie, I. (2005). The effect of music therapy on postoperative pain, heart rate, systolic blood pressure and analgesic use following nasal surgery. Journal Of Pain & Palliative Care Pharmacotherapy, 19(3), 21-29. Vaajoki, A., Pietilä, A., Kankkunen, P., & Vehviläinen-Julkunen, K. (2011). Effects of listeningto music on pain intensity and pain distress after surgery: an intervention. Journal Of Clinical Nursing, 21(5/6), 708- 717. doi:10.1111/j.1365-2702.2011.03829.x Vaajoki, A., Pietilä, A., Kankkunen, P., & Vehviläinen-Julkunen, K. (2013). Music intervention study in abdominal surgery patients: challenges of an intervention study in clinical practice. International Journal Of Nursing Practice, 19, 206-213. doi:10.1111/ijn.12052.