Music for pain relief

 

Abstract

Background

The efficacy of music for the treatment of pain has not been established.

Objectives

To evaluate the effect of music on acute, chronic or cancer pain intensity, pain relief, and analgesic requirements.

Search methods

We searched The Cochrane Library, MEDLINE, EMBASE, PsycINFO, LILACS and the references in retrieved manuscripts. There was no language restriction.

Selection criteria

We included randomized controlled trials (RCTs) that evaluated the effect of music on any type of pain in children or adults. We excluded trials that reported results of concurrent non-pharmacological therapies.

Data collection and analysis

Data was extracted by two independent review authors. We calculated the mean difference in pain intensity levels, percentage of patients with at least 50% pain relief, and opioid requirements. We converted opioid consumption to morphine equivalents. To explore heterogeneity, studies that evaluated adults, children, acute, chronic, malignant, labor, procedural, or experimental pain were evaluated separately, as well as those studies in which patients chose the type of music.

Main results

Fifty-one studies involving 1867 subjects exposed to music and 1796 controls met inclusion criteria.

In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity ( I² = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a zero to ten scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2).

Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13).

Three studies evaluated opioid requirements two hours after surgery: subjects exposed to music required 1.0 mg (18.4%) less morphine (95% CI: -2.0 to -0.2) than unexposed subjects. Five studies assessed requirements 24 hours after surgery: the music group required 5.7 mg (15.4%) less morphine than the unexposed group (95% CI: -8.8 to -2.6). Five studies evaluated requirements during painful procedures: the difference in requirements showed a trend towards favoring the music group (-0.7 mg, 95% CI: -1.8 to 0.4).

Authors' conclusions

Listening to music reduces pain intensity levels and opioid requirements, but the magnitude of these benefits is small and, therefore, its clinical importance unclear.

 

Plain language summary

Music for pain relief

Music should not be considered a first line treatment for pain relief as the magnitude of its benefits is small. Listening to music for treatment of pain offers potential advantages of low cost, ease of provision, and safety. This systematic review included 51 studies involving 3663 subjects. The review authors found that music reduced pain, increased the number of patients who reported at least 50% pain relief, and reduced requirements for morphine-like analgesics. However, as the magnitude of these positive effects is small, the clinical relevance of music for pain relief in clinical practice is unclear

 

摘要

背景

音樂對緩解疼痛的效果

音樂對於治療疼痛的療效尚未確定。

目標

評估音樂在急性、慢性或癌症疼痛的強度，緩解疼痛及止痛藥要求之影響。

搜尋策略

我們搜查了Cochrane資料庫、MEDLINE、 EMBASE 、Psycinfo 、 LILACS 及所取得文稿中的參考文獻。所搜查的資料並沒有限制使用的語言。

選擇標準

我們納入的隨機對照試驗，主要評估音樂對兒童或成人中任何類型的疼痛之影響，並去除掉合併其他非藥物治療的臨床試驗。

資料收集與分析

研究數據分別由2位獨立審查的作者所提取。在疼痛的強度，至少50 ％疼痛緩解的患者之百分比，及鴉片類藥物的需求量等方面，我們計算其平均差。我們將試驗中鴉片類藥物的用量轉換成等效嗎啡的用量。為了探討其中的異質性，我們對於研究成人，兒童，急性，慢性，癌症，分娩，處理步驟，或實驗性疼痛的臨床試驗，與選擇何種類型的音樂，逐一分開探討與評估。

主要結論

51個研究，納入1867位接受音樂治療的實驗對象和符合條件的1796位對照組。在31個評估平均疼痛強度的研究中，存在相當大的變異性，這表明統計的異質性(I2為85.3 ％) 。根據疼痛模型加以分組後，此異質性仍然存在，除了評估急性術後疼痛的實驗組。在這最後一組，接觸音樂的患者其疼痛強度是0.5單位，比未使用的患者，低0到10的規模(95 ％ CI間為−0.9至−0.2)。允許病人各自選擇音樂的研究顯示並沒有由音樂得到益處；疼痛下降強度，為0.2單位(95 ％ CI 為−0.7至0.2)。 4個研究指出有部分病患至少有50 ％的疼痛緩解; 接觸音樂的受測者有70 ％較高的可能性可以得到疼痛緩解(95 ％CI 為1.21至2.37)。NNT = 5 (95 ％ CI 為4至13)。三個研究報告評估，兩個小時的手術後鴉片類藥物的需求：接觸音樂病患所需嗎啡量為1.0毫克(18.4 ％)，比未使用者少(95 ％ CI 為−2.0至−0.2)。5個研究評估手術後24小時嗎啡藥物的需求：音樂組所需的嗎啡量為5.7毫克(15.4 ％)比未使用組少(95 ％ CI為：−8.8至−2.6)。5個研究評估，接受疼痛的醫療處置過程止痛藥物的需求：不同的要求，顯示一種趨勢，有利於音樂組(−0.7毫克， 95 ％ CI 為：−1.8至0.4)。

作者結論

聽音樂可以降低疼痛強度和鴉片類藥物的需求，但是這些好處不大，因此，其臨床的重要性尚不清楚。

翻譯人

本摘要由三軍總醫院黃子權翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

由於其好處小，音樂不應被視為緩解疼痛的第一線治療。以聆聽音樂作為疼痛治療，提供了潛在優勢，包括低成本，容易提供和安全性。這篇系統性的評論，包括51個研究涉及3663實驗對象。文獻回顧作者發現，音樂可以減少疼痛，增加至少有50 ％的疼痛緩解的病人數目與減少嗎啡類止痛劑的需求量。然而，由於這些正面影響的強度小，音樂用於減輕疼痛的關聯性，在臨床運用上目前還不清楚。