Staff at the Malcolm Randall VAMC (MRVAMC) outpatient pain clinic in Gainesville, Florida, found that procedures to reduce a patient’s pain could initially cause pain and anxiety. Typical nursing care plans involved measures to reduce anxiety in patients undergoing interventional procedures expected to produce pain, including identifying and reinforcing coping strategies, providing reassurance and comfort, and giving patients clear explanations slowly and calmly. The MRVAMC nursing staff therefore also advocated to add music therapy to the existing plan.
Background
As part of a quality improvement (QI) project, the authors conducted a literature search to find scientific evidence for the use of music therapy. Multiple medical databases were analyzed to find studies that included total time, dose of sedative medications, pain scores, patient experience, and willingness to repeat the same procedure in the future with use of music vs no music.1 The literature review revealed that music therapy demonstrated effectiveness in decreasing anxiety and pain, supporting relaxation, reducing sedation medication during procedures, and improving patient satisfaction.
As a result of the literature search the authors conducted a prospective, randomized controlled study to investigate music therapy as an adjunct intervention during painful procedures.
Radiofrequency Lesioning
One of the more common (and most painful) procedures performed at MRVAMC is radiofrequency lesioning (RFL).The procedure uses electrical pulses to block nerves for pain relief. Using fluoroscopy, the physician inserts a needle adjacent to the nerve that innervates the facet joint. The sensory and motor nerves are stimulated, causing a tingling or buzzing sensation and tapping. Once the tip of the needle is placed in the correct location, electrical pulses (small radiofrequency currents) are passed through the needle. A lesion is formed that temporarily interrupts the pain messages that the nerve sends to the brain. The procedure can take between30 and 60 minutes, which is longer than most pain clinic procedures.
Radiofrequency lesioning controls pain caused by degenerative disc disease, facet arthropathy, sacroiliac joints, stellate ganglions, and other nerve conditions. Due to the length of the RFL procedure, patients may experience pain and anxiety (as well as other complications, such as vasovagal responses).
The clinic staff anticipated that there would be 20 RFL procedures scheduled per week and selected it as the study procedure for 3 reasons: procedure length, high level of pain, and frequency performed.
After receiving approval from the University of Florida Institutional Review Board and VA Research and Development, the MRVAMC pain clinic initiated the study from September 2013 to April 2014. The purpose of the study was to measure the effects of music on patient’s self-reported anxiety and pain levels before and after nonsedating lumbar RFL.
Methods
Study Design
Veterans aged between 21 and 88 years who were scheduled to return for lumbar RFL and who did not require sedation were invited to participate. Sixty participants consented. The music group had 21 men and 2 women. The no-music group had 19 men and 2 women. Table 1 summarizes descriptive data. Table 2 describes the results of the comparison analysis. Patients were randomly assigned to either the music intervention group or no-music g
The study tools included the global anxiety VAS (GA-VAS) for pain and anxiety and a yes/no self-reported question, “Did music help?” for participants in the music group. Evaluation of the GA-VAS demonstrated reliability and validity and were patient friendly.2,3 Pain was recorded using a Likert scale of 0 for no pain and 10 for severe pain. Anxiety was recorded using a Likert scale of 0 for no anxiety and 4 for extreme anxiety.
Study subjects were recruited from patients who were on a maintenance lumbar RFL schedule, did not require sedation, and were willing to participate. If sedation was required, the patient was excluded from the study. Returning patients scheduled for RFL were informed about the music study and asked whether they were interested in participating. If they agreed, the study was explained in full, and informed consent was obtained prior to the day of their scheduled procedure. After obtaining informed consent, participants were asked to choose a music genre from 3 options: easy listening, jazz, or classical. Participants received a sealed envelope identifying their group (30 envelopes were created for each group) to be opened by the procedure nurse on the day of the procedure.4,5
Sixty participants consented to participate in the study. Of these 60 patients, 44 were studied. The 16 patients who did not participate had either a change in procedure or did not show for the appointment.