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Relaxation and music therapy for postoperative pain

Clinical bottom line:

There is insufficient high quality evidence to show whether relaxation and music therapy is effective in the treatment of postoperative pain.


Relaxation techniques and music therapy are sometimes used to help manage discomfort and to balance analgesia and adverse effects in patients who have undergone surgical procedures.

Systematic review:

Good M. Effects of relaxation and music on postoperative pain: a review. Journal of Advanced Nursing 1996;24:903-914.

Date review completed: 1995

Number of trials included: 21

Number of alternative therapy interventions: 14

Number of patients: Unclear

Control group: Not stated

Main outcomes: Effect on reported sensory/affective/univariate pain; opioid intake; pre-test and post-test equivalence of groups.

Medline (1982-1995), the Cumulative Index of Nursing and Allied Health Literature (1982-1995) and PsychLit (1971-1995) were searched for published studies which assessed the effects of relaxation and music on acute postoperative pain. The Journal of Music Therapy and textbooks were hand searched. Effectiveness data were extracted. Studies were segregated according to their study design (e.g. randomised, nonrandomised, uncontrolled studies). Data were extracted using a predefined instrument. A descriptive analysis was conducted.

Inclusion criteria were: published study; assessment of relaxation techniques and/or music therapy for the treatment of acute postoperative pain; adult patients.

Findings

Twenty-one studies were included: 19 were controlled trials (11 were randomised, eight were not) and two were uncontrolled. Several therapies were assessed including jaw relaxation on pain during activity, Benson’s technique, rhythmic breathing, and the effects of different types of music. Most studies assessed about 15 patients per treatment group and all allowed use of opioids every 2-4 hours. No details of patient characteristics were provided. Relaxation or music therapy was reported to have worked in 6/11 randomised controlled trials, 7/8 nonrandomised controlled trials, and both uncontrolled studies. The reviewer concluded that relaxation/music therapy was effective in reducing affective and observed pain, but less effective at reducing sensory pain or opioid consumption.

Adverse effects

Adverse effects were not mentioned.

This review is likely to be misleading. The component trials were of poor quality and validity because of major methodological flaws. Some studies were not randomised and none were blind leaving them open to major sources of bias. The studies lacked the ability to demonstrate a difference between treatments because they did not assess the baseline pain intensity of patients before administration of treatment. The studies were small, suggesting the results were more likely to be due to chance effects rather than true effects of the treatment. In most studies patients were not monitored to check that they were carrying out the relaxation procedures or whether they were doing them properly.

Further reading

SM Koger et al. Is music therapy an effective intervention for dementia? A meta-analytic review of the literature. Journal of Music Therapy 1999 XXXVI: 2-15.

Related topics

No evidence for music therapy for dementia

Identifier AT041 — 1887 RELAXATION AND MUSIC THERAPY FOR POSTOPERATIVE PAIN. Jul-2000