Effect of music intervention on burn patients’ pain and anxiety during dressing changes
Introduction
Management of pain caused by burns has always been a challenging issue. Burn patients in the acute through rehabilitation phases will experience background pain at rest, procedural pain during dressing changes, and breakthrough pain during rehabilitation [1], [2]. Among these, daily dressing changes are a main source of pain [3]; however, anxiety also has a negative interaction with the pain by increasing its intensity and reducing medication's therapeutic effects [2], [4]. The degree of pain in burn patients resulting from dressing changes is moderate to severe. To alleviate pain and anxiety, medication can be used; however, nurses often overestimate the degree of pain patients endure or fear medication side effects and give a lower dose [5]. Every patient's pain relief needs may not be satisfied; non-pharmacological clinically assistive care approaches are also rare.
ICU patients are often in critically ill or unstable condition; nurses prioritize dealing with their health and abnormal pathology and neglect spiritual or emotional care. However, music intervention has been widely used in the care of various diseases, including examination and postoperative patients. Research on reducing anxiety, pain, and stress, improving behavior problems and hospital quality of life, and reducing physical, emotional, and mental disorder-related symptoms and syndromes have shown a certain degree of positive effects; a considerable effect in stabilizing vital signs has been found [3], [6], [7], [8], [9], [10].
Music has multiple aspects. It can evoke experiences with physical, cognitive, and emotional aspects. Music listening can improve mood, reduce anxiety, and transfer pain and unpleasant feelings [4], [11]. In evidence-based nursing, music listening is an effective nursing intervention to promote comfort and wound healing [12]. Pain has both sensory-discriminative and affective-motivation aspects [11]. Pharmacologic and non-pharmacologic treatment can be combined to achieve clinical pain relief. In the sensory-discriminative aspect, pain due to actual or potential tissue damage elicits an unpleasant feeling along with a negative emotional experience [9].
A group of nerves located in the dorsal horn of the spinal gray matter suppresses pain. When the pain from nerve signals pass receivers transmitted to gray matter in the spinal cord dorsal horn synapses, they act as a gate. They may close or open to allow impulses to upload to the brain, thereby resulting in pain; this is called the gate control theory [6], [9], [13].
Listening to music can provide competitive sensory stimulation input, causing nerve impulses to close the gate to increase the pain threshold and decrease pain signals transmitted to the brain, thereby reducing the pain experience. Distraction or learned behavior applies the gate control theory; music can attract their attention, reduce pain or exhaustion of the reaction, and redistribute the pain and anxiety [14], [15].
In the affective-motivation aspect, musical tones and melodies can cause vibrations to affect the hypothalamus and reticular activating system interaction. This stimulates emotions and affects autonomic nervous system and muscular system function. When accompanied by musical tone adjustment, rhythm can cause physiological changes in blood pressure, heart rate, and respiratory rate [4], [6]. When music stimulates the hypothalamus and the limbic system, the generated imagery stimulates autonomic nervous reactions and the spread of nerve impulses to the midbrain and higher centers stimulates endorphin secretion; this offsets negative emotions, elicits feelings of pleasure, and reduces pain [6], [12], [13], [16].
Smooth flowing music, lyrical melody, simple chords, soft tone, and rhythm tempo of 60–80 beat/min music (equivalent to the normal heart rate and physiological effects of the typical adult) can produce relaxed mood and reactions, thereby inhibiting or offsetting pain and promoting emotional self-regulation [4], [5], [8], [9], [16]. Music has simple, low cost, low risk, non-invasive, and non-pharmacological characteristics easily accepted by the public [1], [5], [17]. Clinically, nurses are the first line of patient contact. Nurses are responsible for dressing changes and pain management. Nurses may use ordered prescription analgesics, but if non-pharmacological interventions, such as providing timely music intervention and creating a friendly, comfortable hospital environment are increased, patients’ pain and anxiety will reduce [18]. This study investigated the impact of music interventions before, during, and after dressing changes on burn patients’ pain and anxiety. We expected to provide patients with non-pharmacological methods to alleviate pain and anxiety.
Section snippets
Sample
This study was a prospective randomized clinical trial. The study samples were collected from Chang Gung Memorial Hospital Burn Center, Taiwan (ROC). The research time was from October 2014 to September 2015. The inclusion criteria were (a) burns within 24 h of hospitalization and age over 18 with an expected stay in the hospital of more than seven days; (b) able to communicate clearly with no hearing impairment; (c) no acute or chronic psychiatric disorders, hallucinations, delirium,
Patient basic demographic and clinical characteristics
The patients’ basic demographic and clinical characteristics are shown in Table 2; the basic demographic information contains gender, age, education, religion, and marital status. Clinical characteristics included the diagnosis, injured area, flushing before hospital, and place of injury. The gender ratio (man/woman) was about 2:1; the average age of the music group was 35.83 (SD: 13.05) and the control group was 38.41 (SD: 15.82) years. The two groups did not differ statistically in
Discussion
Music intervention in patients before, during, and after burn dressing changes significantly decreased pain. Anxiety significantly decreased during and after dressing changes. Morphine usage was not significantly different between the two groups. Najafi et al.’s [1] research on burn patients with three days of continuous background pain found that music therapy effectively reduced it. In this research, pain before dressing changes was similarly significantly reduced, but only after the fourth
Limitations
A double-blind design would be the ideal research method in order to assess intervention effectiveness. In this scenario, a control group would be given a “placebo.” However, for our music intervention, determining an appropriate “placebo” would be difficult. For instance, should control participants listen to a blank CD, a CD playing an irritable voice, or heavy rhythmic music? Many other possibilities could exist. However, when before dressing changes, patients heard music, they knew they
Conflicts of interest
The authors declare no conflicts of interest.
Acknowledgements
Thanks to the support of Chang Gung Memorial Medical Center, Taiwan (ROC), the hospital's burn center healthcare team, and the burn center's physician Jui-Yung Yang for guiding the research. Institutional Review Board Docket No.: 103-3097B, Nursing Research Project Case Number: 3103022GS.
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