EDITORIALS
Music is medicine for the heart
I David Todres
MD. Chief, Pediatric Ethics Unit, Massachusetts General Hospital (MGH), Boston, MA, USA. Former Chief, Pediatric Intensive Care Unit, MGH, Boston, MA, USA. Professor of Pediatrics, Harvard Medical School, Boston, MA, USA
Music as medicine for the mind and body is an ancient concept. Apollo, the Greek god of mythology, was the giver of medicine and music. While there has been for centuries an appreciation of the benefits of music for those who are ill, it is only in recent years that this benefit has been more scientifically studied. Music has been shown to affect physical, emotional, cognitive and social needs of individuals of all ages.
Music has been of beneficial effect on patients' experience of pain,1 allaying preoperative anxiety in children,2 acting on the autonomic nervous system by reducing heart rate, blood pressure and pain postoperatively,3 and having a positive effect after acute myocardial infarction.4 Music reduces anxiety and pain following open-heart surgery in adults.5 In a study of pain following abdominal surgery, the introduction of both relaxation and music was effective in reducing the degree of pain.6 Music's effect in blunting pain works through the gate-control theory of pain by acting as a competing stimulus that distracts the patient and directs the patient's attention away from the pain, thus modulating noxious stimuli. Imaging studies of the brain have shown activity in the auditory pathway, auditory cortex and limbic system in response to music. Music has been shown to lower increased stress levels and, with certain types of music, such as meditative or slow classical, to produce a reduction in neurohormonal markers of stress. Music has been found to lessen confusion and delirium in elders undergoing elective knee and hip surgery.7 Music is also helpful in reducing patients' mood distress when undergoing high dose therapy with autologous stem cell transplantation.8
Recently, Bernardi et al.9 studied the cardiovascular, cerebrovascular and respiratory changes induced by different types of music in musicians and nonmusicians. In this study, slow (tempo) or meditative music produced a relaxing effect with a reduction in heart rate, blood pressure, and ventilation, with raga music producing the greatest decrease in heart rate. On the other hand, increasing the speed (tempo) of the music can produce an arousal effect, which would increase breathing rate, blood pressure and heart rate due to sympathetic activation. Auditory inputs, such as prayer or yoga mantra carried out with rhythmic repetition, can modify cardiorespiratory function. In the case of music, it is the ability of music tempo to affect the heart rate or circadian rhythms and entrain breathing frequency proportionate to the tempo of the music. In the study by Bernardi et al., it is of interest to note that a pause provided after a musical piece was played led to the greatest evidence of relaxation and cardiovascular benefit.
The study by Hatem et al.10 in this issue of the Jornal de Pediatria on the therapeutic effects of music in children following cardiac surgery is an important contribution to an appreciation of the potential benefits of music in controlling pain and anxiety and moderating vital signs. In the study, the authors were able to demonstrate significant changes in reduction of pain, heart rate and respiratory rate. While postoperative pain is routinely managed with pharmacological agents, the addition of non-pharmacological agents is important because of its potential for reducing drug doses and side effects. Postoperative pain can exacerbate the child's stress and contribute to a difficult postoperative course. Helping to control the pain and anxiety, often interrelated, can provide a more optimal postoperative course. The authors of the study recognize that the results are potentially affected by the sample size and the non-randomization by age group. Also, an observer, as opposed to the child's participation, performed the analysis of the pain scale, which may affect the validity of this assessment. The effect of other factors, such as cardiovascular sedative drugs, while not altered during the 30-minute experiment, could nevertheless have some impact, depending on the timing of the drugs prior to the study.
In optimizing the benefits of music, we need to recognize that while this modality can be effectively provided in a passive manner, as in the study by Hatem et al., its effects can be enhanced by the participation of a music therapist. Music therapists integrate their technique into the care of cardiac patients, assisting them with coping with the stress of the illness. This integration considers the age, sex and cultural background of the patient, amongst other variables.11 In studies comparing passive listening to the participation of a music therapist, the latter has always been found to be more advantageous. In the study by Hatem et al., a single piece of music (Spring, from Vivaldi's Four Seasons) was played. With music therapy, the individual's previous musical experience is considered to optimize the choice and tempo of music. In this study, too, the children in the control group had headphones attached without music. Headphones may help by masking the intense disrupting sounds common in the intensive care unit and contribute to reduction in stress. However, the validity of this control without music is open to question.
Hatem et al. have contributed to our understanding of the importance of the introduction of music to the intensive care unit in optimizing patient care by providing pain relief, allaying stress, and reducing sympathetic activity. We need to recognize that music is an important and humane addition to the care of children post-cardiac surgery.
On a personal note, for the past few years, we have had a harpist in our pediatric intensive care unit at Massachusetts General Hospital helping to calm not only the patients, but also the families, who often have responded very positively. In addition, the nursing and physician staffs have told me how much the harpist's playing has helped to calm them too!
References
1. Nilsson U, Rawal N, Enqvist B, Unosson M. Analgesia following music and therapeutic suggestions in the PACU in ambulatory surgery: a randomized controlled trial. Acta Anaesthesiol Scand. 2003;47:278-83.
2. Kain ZN, Caldwell-Andrews AA, Krivutza DM, Weiberg ME, Gaal D, Wang SM, et al. Interactive music therapy as a treatment for preoperative anxiety in children: a randomized controlled trial. Anesth Analg. 2004;98:1260-6.
3. Ikonomidou E, Rehnstrom A, Naesh O. Effect of music on vital signs and postoperative pain. AORN J. 2004;80:269-78.
4. White JM. Effects of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. Am J Crit Care. 1999;8:220-30.
5. Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduced anxiety and pain during chair rest after open-heart surgery. Pain. 2004;112:197-203.
6. Good M, Anderson GC, Ahn S, Cong X, Stanton-Hicks M. Relaxation and music reduce pain following intestinal surgery. Res Nurs Health. 2005;28:240-51.
7. McCaffrey R, Locsin R. The effect of music listening on acute confusion and delirium in elders undergoing elective hip and knee surgery. Int J Older People Nurs. 2004;13:91-6.
8. Cassileth BR, Vickers AJ, Magill LA. Music therapy for mood disturbance during hospitalization for autologous stem cell transplantation: a randomized controlled trial. Cancer. 2003;98:2723-9.
9. Bernardi L, Porta C, Sleight P. Cardiovascular, cerebrovascular, and respiratory changes induced by different type of music in musicians and non-musicians: the importance of silence. Heart. 2006;92:445-52.
10. Hatem TP, Lira PI, Mattos SS. The therapeutic effects of music in children following cardiac surgery. J Pediatr (Rio J). 2006;82:186-92.
11. Hanser SB, Mandel SE. The effects of music therapy in cardiac healthcare. Cardiol Rev. 2005;13:18-23.
5. Voss JA, Good M, Yates B, Baun MM, Thompson A, Hertzog M. Sedative music reduced anxiety and pain during chair rest after open-heart surgery. Pain. 2004;112:197-203.
Publication Dates
-
Publication in this collection
10 July 2006 -
Date of issue
June 2006
