June 23, 1999 Patients facing surgery can expect to have less postoperative pain if they use relaxation and music with their pain medicine. A new study by a CWRU nurse researcher has found that relaxation and music, separately or together, significantly reduce a patient's pain following major abdominal surgery. Tested in addition to the usual pain medication, these self-care methods reduced pain more than medication alone. The research was reported this week in Pain, the journal of the International Association for the Study of Pain.
Marion Good, assistant professor of nursing at the Frances Payne Bolton School of Nursing, studied 500 patients aged 18-70 over a 29-month period in five Cleveland hospitals: the Cleveland Clinic Foundation, University Hospitals of Cleveland, Fairview General Hospital, Mount Sinai Medical Center, and Southwest General Health Center.
She received $709,480 from the National Institute of Nursing Research at the National Institutes of Health to fund the study. Her co-investigators were Michael Stanton-Hicks and Jeffery Grass, physicians in the Department of Anesthesiology at the Cleveland Clinic; and Gene Cranston Anderson, the Edward J. and Louise Mellen Professor at the Bolton School. The authors of the article also include Charles Choi, a physician at Fairview General Hospital; and two of Good's doctoral students, Laree Schoolmeesters and Ali Salman.
Their research has important implications for the 23 million people who undergo surgery and experience postoperative pain annually in the United States. This pain can hamper recovery by heightening the body's response to surgical stress and increasing tissue breakdown, coagulation, and fluid retention. Pain also interferes with appetite and sleep and can lead to complications that prolong hospitalization. Reduction of pain may improve postoperative recovery. Music and relaxation are useful for patients who have had incomplete relief from pain medication, or who may wish to avoid side effects. They may also be helpful to those who are anxious or who find these methods appealing.Relaxation and music are known to decrease anxiety, reduce muscle tension, and distract patients' attention from pain. They are thought to affect the processes that modulate the transmission of pain signals.
Non-pharmacological methods of controlling pain are not new. Breathing, relaxation, and music have been used for many years to ease the pain of childbirth, Good said.
Good and her research team tested relaxation, music, and their combination the first two days following surgery while patients were resting and walking. They measured the patients' pain before and after 15 minutes of bed rest and four times during ambulation to see if the sensation and distress of pain changed.
One group used a jaw relaxation technique, another group listened to music, and a third group received a combination of relaxation and music. The control group received none of these. All study participants received morphine or Demerol by pressing a button connected to their intravenous patient-controlled analgesia (PCA) pumps.
In her study, Good randomly assigned patients with a computerized program that also assured that the groups were similar regarding gender, type of surgery, chronic pain, first surgery, and antidepressant use. The groups were also similar in demographic and surgical factors, and in medication intake at time of treatment.
These were all things that could have confounded the outcome but did not, she said. Good and her research staff met with the patients prior to surgery. The patients receiving music, relaxation, or a combination of the two listened to an introductory tape, and practiced using it during sitting and walking. The researchers coached participants in the use of the assigned technique.
Patients using music selected one of five kinds of soothing music: harp, piano, synthesizer, orchestra, or slow jazz. Then researchers verified that study participants were able to use the music and relaxation properly. After surgery, the relaxation, music, and combination groups used earphones to listen to tapes during ambulation and rest while the control group did not.
The study showed that the three treatment groups had significantly less pain than the control groups at all measurement points during ambulation and rest on postoperative days one and two.
Traditionally, pain has not been adequately relieved following surgery. Patients often forget or are reluctant to press the button on their PCA pumps for fear of dependence or side effects such as drowsiness and nausea. Relaxation and music have no side effects, and the results of this study promise reduced pain and possibly less need for opioid medication.
Acute pain reminds us that we have had surgery and must allow ourselves time to recuperate, Good said. Ambulation, although painful, is important for recuperation, because it can prevent complications. Unrelieved pain may contribute to complications, however. Therefore, pain can and should be controlled, not prolonged. It is harder to reduce pain the longer it goes untreated.
Both medication and self-care methods are needed for relief, Good said. This study showed that during both walking and rest, patients who used relaxation, music, or the combination along with their medication had less pain than those who used medication alone. Good recommends that physicians and nurses encourage patients to use relaxation and music with medication to control postoperative pain.
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