Running head: music as pain management in pediatrics
Music Therapy as a Form of Pain Management in Pediatric Settings Student Name University of Michigan Flint Student Name—In general, this is an excellent paper. Nicely done, and meets/exceeds the expectations of this 100 level class. However, because you are smart and a good writer, I have given you the kind of nitpicky feedback that editors give me when I submit papers for publication. I hope you’ll take the time to read them over [I spent quite a bit of time on them] because I think they will help you get even better as a writer. Again—great job… and here’s how it can be even better:
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music as pain management in pediatrics
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This paper includes a compilation of research and articles on the effects of music therapy as a form of pain management in various pediatric settings. Within the text there are studies on music therapy use for managing pediatric pain and anxiety in the following areas: medical procedures, cancer patients undergoing lumbar puncture, dressing changes, acute care, intravenous starts, venipunctures, injections, and heel sticks. The effects of pain management in children and the developmental consideration is also a topic of discussion throughout the paper with the way in which it can effect a child and how this compares to the effects of nonmusical therapy. Through this, there will be analysis of past studies done and discussion of what could be done in the future for pediatric settings in terms of music therapy as an alternative pain management technique in all forms of health care available for these patients.
Keywords: music therapy, pain management, pediatric, lumbar puncture, intravenous, venipuncture, heel sticks, isolation
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Music Therapy as a Form of Pain Management in Pediatric Settings Pain management for patients in a hospital setting undergoing various procedures varying in pain levels is a topic which is constantly being researched and explored, especially in the pediatric setting. When children are in pain, it is easy to ask, “What can be done to help manage pain for this child?.” Health professions often look to trying to alleviate the pain, and “most think first of drugs to curb or prevent the perception of pain” (Rusy & Weisman, 2000). However, there is are many alternative approaches which may be used to help with pain management in pediatric hospital patients, including music therapy. Some of the procedures and situations in which music therapy has been used to manage pain are as follows: medical procedures, cancer patients undergoing lumbar puncture, dressing changes, acute care, intravenous starts, venipunctures, injections, and heel stick. Also to be considered is the developmental effect this has on children. In the article Complementary Therapies for Acute Pediatric Pain Management (Rusy & Weisman, 2000), it is stated thatRusy and Weisman (2000) found that “children are highly responsive to pain-controlling strategies that involve their imagination and sense of play.” (p. #) Music provides just that, an outlet for children to experience and play with their imagination. In the following studies, there is a common theme of music being able to allow children to control their pain. The first study “investigates the possible effects of music on procedural pain and indicates the benefits of further study” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan,
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2007). Pain has been found to relate with an increase in activity of the amygdala, and “research into the effect of music on the brain has found that music reduces the activity of the amygdala, which is part of the emotional-affective component of pain” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan, 2007). Within the study there were four hypothesis tested. The first was “pediatric patients will report having less anxiety during medical procedures with music therapy” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan, 2007). The second was “pediatric patients will report experiencing less pain during medical procedures with music therapy” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan, 2007). The third hypothesis stated that “engagement in music therapy will reduce behavioral distress in pediatric patients during a medical procedure” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan, 2007). The last tested was that “pediatric patients who are actively and passively engaged in music therapy will have a heart rate and blood oxygenation level close to their baseline during medical procedures” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan, 2007). It is stated that in the study, these hypotheses were “measured via two methods, as perceived by the patient and as observed behavioral distress” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan, 2007). This study was able to explore how pediatric patients responded to music therapy as a form of distraction and as a physical form of pain management in relieving anxiety within patients. In conclusion of this study, there were three interpretations of the music therapy intervention which are as follows: “it was clear from the interviews and the behavioral distress analysis that music therapy helped to reduce the nine subjects' pain”, “the analysis of the behavioral distress and interview data suggests that music therapy affected these subjects' level of anxiety”, and that
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“music therapy interventions is the use of distraction.” (Whitehead-Pleaux, Zebrowski, Baryza, & Sheridan, 2007). Music in pain therapy for medical procedures to reduce pain and anxiety has also been researched[by zombies] in aim “to conduct a systematic review of the efficacy of music therapy on pain and anxiety in children undergoing clinical procedures” (Klassen, Liang, Tjosvold, Klassen, & Hartling, 2008). In this study, researchers created and proceeded with a “randomized controlled trial” for children who were “aged one month to eighteen years” to be examined (Klassen, Liang, Tjosvold, Klassen, & Hartling, 2008). Within this experiment, “music was used as an intervention” (Klassen, Liang, Tjosvold, Klassen, & Hartling, 2008), and it measured both pain and anxiety. As a result of preforming this trial, researchers were able to show that “music therapy showed a significant reduction in pain and anxiety” (Klassen, Liang, Tjosvold, Klassen, & Hartling, 2008) and that “music is effective in reducing anxiety and pain in children undergoing medical and dental procedures and that it can be considered an adjunctive therapy in clinical situations that produce pain or anxiety” (Klassen, Liang, Tjosvold, Klassen, & Hartling, 2008). Another study done, this time with pediatric oncology patients who were undergoing a lumbar puncture, in which “a needle is inserted between two lumbar bones (vertebrae) to remove a sample of cerebrospinal fluid” (Mayo Clinic Staff, 2014). In the study, researchers looked at “forty children, twenty-five boys and fifteen girls, and randomly assigned them to either the music group of the control group” (Nguyen, Nilsson, Hellstom, & Bengtson, 2010). The measurement tools used by researchers were self-reports, vital signs, and interviews. After analyzing all data presented through this study, it was found that “the music reduced the
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experience of pain during the lumbar puncture procedure” and it was stated by almost all of the children in the music group that “they had felt less pain compared with their previous experience” (Nguyen, Nilsson, Hellstom, & Bengtson, 2010). Studies have also been done to show the effects of music therapy on pediatric patients experiencing acute pain. One study states that it included four hypotheses. The first being “music therapy will reduce anxiety levels in pediatric patients during donor site dressing change” (Whitehead-Pleaux, Baryza, & Sheridan, The Effects of Music Therapy on Pediatric Patients' Pain and Anxiety During Donor Site Dressing Change, 2006). The second was that “music therapy will reduce perceived pain in pediatric patients during donor site dressing changes” (Whitehead-Pleaux, Baryza, & Sheridan, The Effects of Music Therapy on Pediatric Patients' Pain and Anxiety During Donor Site Dressing Change, 2006). The third and fourth being “musical therapy will reduce behavioral distress in pediatric patients during donor site dressing change” and that “during a donor site dressing change, the heart and respiration rates of patients who receive music therapy will have a lesser variance from baseline as compared to patients receiving the verbal support” (Whitehead-Pleaux, Baryza, & Sheridan, The Effects of Music Therapy on Pediatric Patients' Pain and Anxiety During Donor Site Dressing Change, 2006). By the end of the study the author had found that both subjects who were exposed to the music therapy “described how the music relaxed them and helped with the pain”, that their mothers “reported a difference in their child’s experience during the dressing change with the addition of music therapy in comparison to previous donor site dressing changes” and both the subjects and their parents “reported that music positively affected their level of relaxation and
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pain” (Whitehead-Pleaux, Baryza, & Sheridan, The Effects of Music Therapy on Pediatric Patients' Pain and Anxiety During Donor Site Dressing Change, 2006). Music therapy across the board is mainly used as a distraction from the pain a pediatric patient is feeling. A study on pediatric which made the attempt to “evaluate the effects of preferred, pre-recorded, musical and/or story tapes on the pain perception of burn and oncology patients between the ages of four and eighteen during painful procedures relating to treatment” (Malone, 1996). In her study, Malone (1996) found that the result differed between age groups. “Distraction for infants entails a soothing, relaxing quality”, while patients between five and seven years of age “overall behavioral distress was minimal compared to younger patients” (Malone, 1996). Her closing argument states, “With agreement from hospital staff and parents, the addition of live music as a non-invasive technique for pain management during invasive procedures such as IV’s, restarts, venipunctures, injections, and infant heel sticks appears to be beneficial in reducing the behavioral distress of pediatric patients. The addition of music therapy as a non-invasive technique in achieving the goals of pain management during invasive procedures (i.e., minimizing suffering and permitting a successful procedure) appears to be justified with the pediatric population.” (Malone, 1996). When looking at pain management in children, one must also look at developmental considerations. In order to look at the effects, one must first look at what is happening. “There
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are three phases of coping with a painful procedure: the anticipation of the procedure and preparation, the actual procedure, and the aftermath of the procedure� (Gerik, 2005). Gerik (2005) also states that for the procedure of hospitalization, music therapy improved ratings of feelings, and for invasive procedures, distraction and relaxation were found to decrease fear and pain. Music is at the base of both of these procedures, and will help a child cope with the procedure at hand in a positive way and manage their pain. In conclusion, it is not hard to see that music therapy has a positive effect on pain perception in pediatric settings. It offers a distraction to the patient from what is going on around them or what their body is feeling, and even offers calming effects which can be shown biologically. With this being said, it seems as if music therapy should be used in pain management in most, if not all, pediatric settings. It is a cost effective way for practitioners to help pediatric patients manage their pain and cope with what is going on around them. Funding for music therapy programs in the pediatric settings of hospital and other health care facilities is a great investment into pain management for children, and creates an inexpensive way to help children who are going through a painful and traumatic experience in their lives.
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References Gerik, S. M. (2005). Pain Management in Children: Developmental Consideration and Mindbody Therapies. Southern Medical Journal, 295. Klassen, J. A., Liang, Y., Tjosvold, L., Klassen, T. P., & Hartling, L. (2008). Music for Pain and Anxiety in Children Underoging Medical Proceedures: A Systematic Review of Randomized Controlled Trials. National Center for Biotechnology Information, 117-128. Malone, A. B. (1996). The Effects of Live Music on the Distress of Pediatric Patients Receiving Intravenous Starts, Venipunctures, Injections, and Heel Sticks. Journal of Music Therapy, 19-33. Mayo Clinic Staff. (2014, December 6). Lumbar Puncture (spinal tap). Retrieved from mayoclinic.org: http://www.mayoclinic.org/tests-procedures/lumbarpuncture/basics/definition/prc-20012679 Nguyen, T. N., Nilsson, S., Hellstom, A.-L., & Bengtson, A. (2010). Music Therapy to Reduce Pain and Anxiety in Children With Cancer Undergoing Lumbar Puncture: A Randomized Clinical Trial. Journal of Pediatric Oncology Nursing, 146-155. Rusy, L. M., & Weisman, S. J. (2000). Complementary Therapies for Acute Pediatric Pain Management. Pediatric Clinics of North America, 589-599. Whitehead-Pleaux, A. M., Baryza, M. J., & Sheridan, R. L. ( 2006). The Effects of Music Therapy on Pediatric Patients' Pain and Anxiety During Donor Site Dressing Change. Journal of Music Therapy, 136-153.
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Whitehead-Pleaux, A. M., Zebrowski, N., Baryza, M. J., & Sheridan, R. L. (2007). Exploring the Effects of Music Therapy on Pediatric Pain: Phase 1 . Journal of Music Therapy, 217241.