Music soothes patients' pain, but could distract surgeons

Surgery patients who listen to music before, during or after their procedures show reduced pain scores, anxiety and need for pain relievers, a new review suggests.

What's less clear is whether doctors and nurses are distracted by music during surgery.

Researchers from the United Kingdom pooled together the results of 72 randomized trials involving nearly 7,000 surgical patients who either listened to music or received standard care, massage or relaxation.

The findings were published in Wednesday's online issue of The Lancet.

"If you can imagine a way of measuring pain from nought to 10 on a centimetre scale where nought is no pain at all and 10 is the worst pain imaginable, the music we found reduced peoples' pain by about two on that scale," said lead author Dr. Catherine Meads from Brunel University in Uxbridge. 

It's a clinically meaningful effect, which reduced the amount of painkillers needed, eased anxiety and increased patient satisfaction, compared with controls, Meads said. But the effect wasn't strong enough to replace an anesthetic.

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Meads speculated that the songs might help patients before the operation if they were feeling anxious or afterward for reducing pain.

"When you've just come around from an operation, quite often you don't feel very well at all, and you're in quite a lot of pain and you don't have any energy to do very much like reading or watching television," said Meads.

Listening to music might be an easy way to get through the first few hours after surgery, she said, because it soothes pain and stress. Meads said she listened to Pink Floyd's Dark Side of the Moon when she had a hip operation.

While the choice of music, timing and duration varied in the studies analyzed, these factors made little difference to pain and the other outcomes measured. Music even worked when patients were under general anesthetic, the researchers found.

Even though music is non-invasive, safe and inexpensive, it isn't routinely used around the time of surgery, perhaps because of ignorance or skepticism about its effectiveness, a previous Dutch study suggested.

Distraction factor

Last week, another U.K. research team published "an exploratory study" in the Journal of Advanced Nursing suggesting that when music is played in the operating theatre itself, surgeons were distracted because they repeated their requests more frequently when the tunes were on than when it wasn't played.

The nursing study was based on an analysis of video recordings from 20 operations over six months at two operating theatres in the U.K.

"In the operations we observed, dance music and drum and bass were often played fairly loudly, whilst patients were anesthetized," Sharon-Marie Weldon from the cancer and surgery department at Imperial College London and her team said.

"If music can become distracting even during one operation, it is one too many and awareness has to be raised among clinical managers but also the general public who are cared for under these circumstances."

To find out more, Meads's colleagues plan to explore what facilitates and blocks the use of music during caesarian sections. They aim to look at how nurses, midwives, doctors and patients enjoy it or not. Patients will use a music playlist on a device of their choice, which will be played through a pillow with built-in speakers.

Dr. Khalid Syed is an an orthopedic surgeon with Toronto's University Health Network who specializes in the hip, knee, foot and ankle. Syed has also studied the use of patient-specific music played to them through ear buds in the operating room.

"One of things we found was patient satisfaction was significantly improved compared to people who were not listening to music or had white noise," Syed said. He said research shows there tends to be lower heart rates and better blood pressure control during the operation when patients listen to music. 

 Dr. Paul Glasziou from Bond University in Queensland, Australia, wrote a journal commentary published with the study.

The effect on pain relievers partly allays concern that music is simply a placebo effect, Glasziou said.

Since musical tastes vary, one option would be to ask patients to bring their own music in the patient information sheets they receive before surgery or offer a choice of standard options, such as in-flight systems.

No side-effects were reported in the trials reviewed.

There was no funding for Meads's review.