Authors’ Disclosure Statement: This research was supported independently and internally by the Louis Armstrong Center for Music and Medicine. The authors report no actual or potential conflict of interest in relation to this article. The views expressed in this article are the authors’ and may not represent the official views of Mount Sinai Beth Israel.
Acknowledgments: For invaluable involvement and support during the study the authors would like to thank Peter D. McCann, MD, Daphne Ridley, RN, Marissa Petsakos, Brandee Raimer, Jessica Hyde, MA, MT-BC, Clarissa Lacson, MA, MT-BC, Erin Bolding, MT-BC, Crista Orefice, MA, MT-BC, Brenda Buchanen, MA, MT-BC, Soniya Brar, MA, MT-BC, Thomas Biglin, MA, MT-BC, and Emily Autrey, BM.
The treatment of pain continues to gain in saliency as a component of defining best practice in medical care. Music therapy is an integrative treatment modality that impacts patient outcomes in the treatment of spinal pain. At Mount Sinai Beth Israel, we conducted a mixed-methods study addressing the effects of music therapy interventions on the recovery of patients after spine surgery. The study combined standard medical approaches and integrative music therapy. Sixty patients (35 female, 25 male) ranging in age from 40 to 55 years underwent anterior, posterior, or anterior-posterior spinal fusion and were randomly assigned to either music therapy plus standard care (medical and nursing care with scheduled pharmacologic pain intervention) or standard care only. Measurements for both groups were completed before and after the intervention. Music therapy involved the use of patient-preferred live music that supported tension release/relaxation through incentive-based clinical improvisation, singing, and/or rhythmic drumming or through active visualization supported by live music that encompasses tension resolution. The control and music groups showed significant differences in degree and direction of change in the visual analog scale (VAS) pain ratings from before to after intervention (P = .01). VAS pain levels increased slightly in the control group (to 5.87 from 5.20) but decreased by more than 1 point in the music group (to 5.09 from 6.20). The control and music therapy groups did not differ in the rate of change in scores on Hospital Anxiety and Depression Scale (HADS) Anxiety (P = .62), HADS Depression (P = .85), or Tampa Scale for Kinesiophobia (P = .93). Both groups had slight increases in HADS Anxiety, comparable decreases in HADS Depression, and minimal changes in fear-related movement (Tampa scale).
Music therapists use patient-preferred live music, increasing neurologic cues that enhance movement—a seminal recovery function in postoperative spine patients.
Music therapy is an evidence-based, integrative treatment addressing body, mind, and spirit.
Tension release through music therapy can serve as a critical mechanism for building resilience related to pain management.
Music therapy and music medicine are distinct forms of clinical practice that focus on mind-body integration in the healing process.
Music therapists, board-certified and licensed by the state as recognized healthcare professionals, address pain management, which is an increasing subspecialty in postoperative care.
About 70% of people in the United States experience at least 1 episode of back pain in their lifetime,1 and more than 5 million are temporarily or permanently disabled by spinal disorders.2-4 Some require surgery, which may rectify injury, but pain during recovery is often inevitable, and the road to recovery is not guaranteed to be smooth.5-20
Postoperative spine patients are at major risk for pain management challenges.14,15,18,20 Treatment is primarily pharmacologic and based on the surgical team’s pain management orders. Nursing care consists of monitoring the airway, vital signs, and neurovascular status and having patients rate their pain on a visual analog scale (VAS; 0 = no pain, 10 = worst pain imaginable). Nurses have the challenge of monitoring and continually assessing to make sure patients are achieving the optimal outcomes, particularly during the immediate postoperative period, when pain and anxiety are prominently increased.
Variability in spine surgery outcomes can be explained at least partly on the basis of prognostic psychological factors, including hypochondriasis, hysteria, depression, and poor pain coping strategies (eg, catastrophizing).21 In spine surgery patients, kinesiophobia (fear of moving) is a common component of distress that can impede recuperation.21-23Psychological interventions that assist with the secondary stressors associated with pain and loss during physical recuperation are recommended, with increased attention given to the importance of treating the whole person: body, mind, and spirit.24-29 Conventional pain-alleviating medical interventions can be enhanced with integrative therapies that empower patients to marshal their inner resources during recovery.25-28Music therapy may be particularly suited to this effort, as it is adaptable to the patient’s individual and culturally specific needs.29-33
Rationale for Live Music
Pain is subjective and personal, and warrants an individualized approach to care. There is a body of music medicine research on the use of recorded music in modulating psychological and physiological factors in pain perception.30,32,34-54 This research supports the unique relationship of music to well-being, and the understanding that controlling any of these factors affects the duration, intensity, and quality of that experience.41,43,52
These findings provide incentive for breathing-entrained music therapy interventions, which enhance the relaxation response and release of pain-related tension;32,55-58 empower patients to unlock physical and emotional tension;32,57,58 provide a channel for expression and body movement; and enhance blood flow and/or alleviate pain by activating neurologic areas involved in the experience of pain.59-62Studies have found that physical endurance may be enhanced when movement is rhythmically coordinated with a musical stimulus.63-66 Music may prolong physical endurance by inhibiting psychological feedback associated with physical exertion related to fatigue, which may translate into accelerated recovery periods. When we listen to a rhythmic sound, our brains tend to automatically synchronize, or entrain, to external rhythmic cues that can stimulate increased motor control and coordination.63 Sound can arouse and raise the excitability of spinal motor neurons mediated by auditory-motor neuronal connections on the brain stem and spinal cord level.64-66 Rhythmically organized sounds serve as a neurological function in our capacity to organize predictable timing cues that are apparent in music, and may result in an effective treatment intervention in recovery.63,64
Music Therapy in Recovery From Spine Surgery
In music therapy, music is used within a therapeutic relationship to support or affect change in the patient and the treatment regimen.32,33,56-58 Research on music therapy with patients who are recovering from spine surgery is scant.67-69 Kleiber and Adamek67 studied perceptions of music therapy in 8 adolescents after spinal fusion surgery. In their study, a music therapist provided patients with a postoperative music therapy session focusing on the use of patient-preferred live music for relaxation and expression. Although their qualitative query was based on a therapeutic approach similar to that used in the present study, only 1 session was offered during the recovery period, and follow-up was conducted by survey invitation and telephone. In addition, the number of participants was small, and there was no quantitative measure of pain or other symptoms.
