HEALTH SCIENCE JOURNAL

Volume 6, Issue 3 (July September 2012)

_REVIEW_

Does music reduce postoperative pain? A review

Electra Economidou1 , Amalia Klimi2, Victoria G. Vivilaki3, Katerina Lykeridou4
1. RM, PGDip, MSc Independent Midwife
2. RM, MSc Midwife, Elena Venizelou Maternity Hospital, Athens
3. RM, PgCert, MMedSc, PhDc, Lecturer, Department of Midwifery, Technological Educational Institution
of Athens
4. RM, RN, MSc, PhD, Professor of Midwifery, Department of Midwifery, Technological Educational
Institution of Athens
ABSTRACT
Background: Music therapy supports the use of music in medicine suggesting that music can reduce
postoperative pain.
Aim: The aim of the present study was to examine the evidence related to this hypothesis.
Methods: A systematic literature search was performed to identify all studies looking at musics impact on
postoperative pain. Searches on Medline, Embase, Cinahl and Cochran Library identified four trials.
Results: 886 patients, undergoing elective surgery under general anaesthesia participate in all four studies.
Although the intervention was applied differently three of the studies showed that music had reduced
postoperative pain, as measured with visual analogue scale (VAS).
Conclusion: Music appears to be an effective non-invasive, non-pharmacological and relatively cheap
intervention for postoperative pain management.
Key words: Music therapy, pain relief, post operative pain, non-pharmacological methods.
CORRESPONDING AUTHOR

Electra Economidou
Papaflessa 21b
N. Psihiko
15451 Athens
Greece
Tel: 6945194901
Email: electraecon@gmail.com

INTRODUCTION
ain is a known consequence of

fact, pain in the immediate postoperative

surgery, an unpleasant sensory and

period is one of the major concerns of

emotional experience associated with

health

potential or actual tissue damage or

patients who had a surgery. Despite the

described in terms of such damage.1 In

availability of analgesic medication, pain

professionals

looking

after

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remains a common problem, which can

thought to form the soul, put social life

interfere with appetite and sleep, and

in order and heal man holistically, rather

can

than simply entertain him. Though the

contribute

to

complications,

prolonging hospitalization.2

origin of music itself is unknown, the

Patients undergoing an operation often

fact that every civilization developed a

experience a loss of control as well as

different music history, identifiable in

fear of the unknown, fear of pain,

traditional music, indicates the strong

uncertainty and anxiety, emotions that

impact

may intensify the perception of pain.3

humans.

Furthermore physical and psychological

But it was not until the 20th century that

stress contributes to perceived surgical

music

pain, prolonging postoperative recovery

systematically, in the context of music

time

enhancing

therapy. By that time music was already

immunosuppression.4 Quite often post

used in hospitals mainly to boost morale,

operatively,

always

as a general aid to convalescence and as

receive sufficient pain relief from opioids

an entertaining diversion.9 Nowadays

and may have undesired side effects.5,6

music therapy is a recognized science of

The

to

systematically applying music to support

managing patients pain in the immediate

and encourage physical, mental, social

postoperative

and

and
patients

most

do

effective
period

not

approach
may

include

music

begun

has

always

to

emotional

be

had

used

well-being.

on

more

Music

is

combination of pharmacological agents

already used in general hospitals to

and non-invasive, non-pharmacological

alleviate patients mood and counteract

interventions.7

depression,

Music

has

for

physical rehabilitation, calm or sedate,

throughout history as a healing force to

often to induce sleep, and lessen muscle

alleviate illness and distress.8 The idea of

tension for the purpose of relaxation,

music as a healing influence, which

including

could affect health and behaviour is at

system.10

least as old as the writings of Aristotle

Since the interest in complementary

and

and

therapies has increased, the idea of using

medicine still formed a unity and disease

music to alleviate pain in conjunction

was viewed as an imbalance in harmony

with analgesia has been examined in the

between

past, often combined with relaxation or

when

used

movement

extensively

Plato,

been

promote

art,

persons

religion,

physical

and

psychical nature. At that time music was

guided

the

imagery

Does music reduce postoperative pain? A review

autonomic

nervous

techniques.

And,

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HEALTH SCIENCE JOURNAL

Volume 6, Issue 3 (July September 2012)

although health professionals frequently

operative pain experienced in the first 24

use music, in theatres for example, its

hours and day 1 after surgery Pain

potentialities are not widely spread. If

should

music can indeed reduce pain, then this

instruments, like Visual Analogue Scale

relatively cheap, non-pharmacological,

(VAS) and the amount of analgesia

easily

required.

applied

intervention,

with

be

measured

by

appropriate

absolutely no side effects, becomes a

The type of research providing the best

useful tool for health professionals. This

evidence to answer this question is

mini-review examines whether music

randomized controlled trials, comparing

reduces post-operative pain.

listening to music with no intervention.

Double blinding is not feasible, as a

Methods

placebo cannot replace music, unless the

The population of interest is adult

intervention

patients

undergoing

elective

operation. If this is not the case, lack of

surgery,

under

anaesthesia,

double blinding will not be considered as

requiring post-operative pain relief, like

weakness of the study design. This mini

Patient Controlled Analgesia (PCA) or

review is also limited to studies available

opioid analgesic. The intervention is

in English. The question was divided in

music, which is considered to be relaxing

facets, which identified the population

and

(post-operative

major

general

calming,

listened

to

through

is

applied

during

patients),

the

the

headphones so that external sounds will

intervention (music) and the outcome

not

(pain). Medline (1966-present), Embase

interfere,

either

intra

or

post-

operatively. Relaxing music is generally

(1980-present)

thought to be instrumental, with slow

searched, using the following search

flowing rhythms that duplicate a pulse

terms in the combinations shown in

rate of 60-80 bpm.11 The variety of

Table

timing and duration of the intervention

music,

between the studies is acknowledged as

analgesia. Wild card ($) was used to

well as the potential for bias and error in

identify all word endings e.g. operative,

interpretation, but as the intervention is

operation. The MeSH terms used were

music, more music comparing to less

exploded to include all subheadings.

music

The Cochran Library was also searched

will

difference.

not
The

make

outcome

significant
is

1:

and

CINAHL

post?opetati$,

music

therapy,

were

post?surg$,
pain

and

postPage | 367

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Quarterly scientific, online publication by Department of Nursing A,

Technological Educational Institute of Athens

to identify any high quality systematic

studied the use of music during the

review on the subject.

immediate postoperative recovery period

in 34 patients and although the study

Findings

design was excellent, the final sample

The search strategy (table 1) found a

size of 10 patients (5 in the treatment

total of 1631 articles. Exclusion criteria

and 5 in the control group) decreased the

included review articles, studies with

power of the study while introduced

qualitative design, studies that did not

great possibility of error in the results

include music in the interventions, and

and therefore was not included in this

studies that used sounds instead of

review.

music and those who used combination

Six randomized controlled trials were

of music with other methods such as

retrieved and examined in further detail.

relaxation.

Titles and abstracts were

examined for relevance to the review

Methodological

question,

studies

accessibility

and

English

quality

of

included

language. A total of 45 articles were

One double-blinded controlled trial15 and

excluded, as 9 were in foreign language,

five

15 not accessible and 19 irrelevant to the

were analyzed using the critical appraisal

subject, either studying guided imagery

checklist

techniques

factors

randomized controlled trials.21 Half of

reducing postoperative pain in general.

the included studies were performed by

Five of them were excluded, Koch et

Nilsson et al.15,16,17 All of them addressed

al.,12 and Shertzer et al.,13 because the

a clearly focused question, though Good

population of the studies was different to

et al.,18 tested music and jaw relaxation

the population of interest: in the first

in separate treatment groups as well as

study subjects had spinal anaesthesia

their

and in the second had day surgery not

approved by local Ethics Committee,

requiring

relief.

subjects informed consent was obtained

Good et al.,14 examined relaxation and

and all provided full inclusion and

music and their combination but the

exclusion criteria. Randomization was

results reported did not mention each of

clearly described in all of the studies,

the intervention group separately and no

mostly done by using a computer to

conclusions could be drawn for the

generate randomization lists. Because of

al.,7

the type of intervention double blinding

music

using

music

post-operative

intervention.

or

pain

Heiser

et

randomized
for

controlled
articles

combination.

Does music reduce postoperative pain? A review

All

trials16-20
describing

studies

were

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HEALTH SCIENCE JOURNAL

Volume 6, Issue 3 (July September 2012)
15

estimated on Visual Analogue Scale

study, when the intervention took place

(VAS), calibrated from 0=no pain to

intra-operatively, while subjects were

10=maximal possible pain, every 3016,

under general anesthesia. Subjects were

every 60 for the first 24 hours and every

treated equally and received the same

3 hours during the 2nd day15 , every 15

type

for

until the discharge from the PACU18 or

anaesthesia induction and maintenance,

at a times agreeable to subjects.19 The

and immediate post-surgical analgesia

assessment

within all trials. Post-operative analgesia

intervention and on discharge in the

was

patient-controlled

study by Laurion and Fetzer.20Opioid

opioids

(either

intake was measured in all but two

ketomidone or morphine) in all trials and

trials18,19 and when not reported was

morphine equivalent was received via

checked

intravenous (IV) or intramuscular (IM)

collection to make sure it did not affect

routes on request.

the results.

The music listened to was soothing

In all studies statistical analysis (Kruskal-

relaxing music. Good et al.,18 offered a

Wallis

choice of different kinds of music:

differences between the groups. There

synthesizer, harp, piano, orchestral or

were no significant differences in the

slow

demographic

was not possible but in Nilssons et al.,

of

premeditation,

provided

analgesia

by

with

jazz,

to

the

drugs

treatment

group.

was

before

done

and

ANOVA)

after

was

data,

during

used

the

to

anaesthetic

the

data

test

and

Nilsson et al.,15,16,17 used soft classical

surgical factors between the groups.

music

Confidence intervals were not provided

reported

to

be

relaxing

and

calming. Masuda et al.,19 used western

in none of the studies.

classical music as well as traditional

Chinese music and Laurion and Fetzer20

Results

piano music. Subjects in the control

Nilsson et al.,16 tested musics effects in

groups listened to either blank tape i.e.

125 patients undergoing varicose vein or

silence

to

inguinal hernia repair surgery (table 2).

Subjects

Patients exposed to music from the time

listened to the music from the time of

of arrival at the PACU and as long as

arrival at the Post Anaesthesia Care Unit

they felt like it had significantly lower

(PACU)15-19 or intra-operatively without

pain

being conscious.16 Pain intensity was

compaired with patients in the control

or

operating

they
theatres

were

exposed

sounds.

intensity

postoperatively,

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Quarterly scientific, online publication by Department of Nursing A,

Technological Educational Institute of Athens

group

(p-value<0.002),

not

the PACU, the patients in both the post-

significant differences in postoperative

and intra operative music groups had a

morphine requirement (p-value<0.382).

significantly lower pain score compared

Postoperative

well-

with the control group, (p-value < 0.01)

being, fatigue, urinary problems and

and the requirement of morphine was

headache,

were

also

examined;

no

significantly less in the postoperative

difference

was

found

between

the

music group compared with the control

anxiety,

but

nausea,

groups.

group (p-value < 0.05).

After intra-operative exposure to music,

Good et al.,18 noted that 233 patients

Nilsson et al.,15 found that 30 out of 58

after major abdominal surgery in the

patients undergoing elective abdominal

treatment

hysterectomy had significantly less pain

significantly less pain than the control

on the first day after surgery compared

group (p-value<0.013). Differences in

to the patients in the control group (p-

pain were supported by significantly

value<0.001). It was also noted that the

lower radial pulse rate on day 2 and

treatment group experienced less fatigue

observed respiration rate. Opioid intake

on the day of discharge and patients

was not measured in this study.

were mobilized significantly earlier. No

The effects of music in postoperative

differences were found between the

orthopaedic

groups regarding the total amount of

Masuda et al.,19. Forty four elderly

ketomidone (p-value<0.057), nausea and

patients divided in a group of music

well-being.

listening and a control group. After 20

In another study Nilsson et al.,17 divided

minutes

75 patients undergoing open

hernia

intervention group reported significantly

repair as day care surgery in three

lower VAS levels (p-value< 0.001) up to

groups:

post

79.1% compared with the control group

operative music and silence. In addition

where there was no significant change in

to VAS data, the research team is also

the measures.

measuring

as

Finally Laurion and Fetzer20 in their

cortisol and glucose blood levels. Indeed

study of 84 laparoscopy gynae patients

patients in the intra and post operative

found in music group had significantly

music groups had a significant decrease

less pain on PACU discharge to home

45% in cortisol levels comparing with a

than the patients in the control group.

16% of the control group. After 1 hour in

The researchers in this study had the

intra

operative

stress

music,

markers

such

group

of

pain

were

listening

Does music reduce postoperative pain? A review

experienced

to

studied

music

by

the

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HEALTH SCIENCE JOURNAL

Volume 6, Issue 3 (July September 2012)

intervention group members to listen to

articles or the ones unobtainable in the

the listened to the audiotape of piano

time allowed should also have been

music at least two times a day as well as

accessed for assessment. The Journal of

during surgery and after surgery in the

Music Therapy must have been also hand

PACU. However the data collected an

searched.

hour after surgery between the groups

performed the intervention differently,

did not show a significant difference

either during the operation, afterwards

until

or in intervals, and with variations on

the

discharge

measurements.

The

duration

studies

However the methodological limitations

the

influenced the strength of the study:

Although these variances should not be

there was no ability to control the

overlooked, the fact that music therapy

number of times a subject actually

as a science was developed the last

listened to the interventional audiotapes

century and therefore there is not much

before admission and piano music may

research around, justifies the reasons

be irritating to some individuals, thus,

why the inclusion criteria concerning the

opening the pain gate pathways. There

intervention were flexible. Furthermore,

was no significant difference in the

music as a non pharmacological, side

incidence of nausea or nausea and

effect

vomiting among the groups.

harm patients and less exposure to

free

music

of

included

music

intervention,

could

only

exposure.

would

result

in

not
non

Discussion

significant results, if no difference at all.

The aim of this mini review was to find

The outcome pain was measured at

out

reduce

different

studies

something that may introduce error in

included in the review showed significant

the analysis of the results. The inclusion

difference

post-operative

of Nilssons et al.,16 trial where subjects

patients who listened to relaxing music

had varicose vein and inguinal hernia

and those who did not. Patients in the

surgery, unlike the abdominal surgeries

treatment groups experienced less pain

the rest of the studies examined, may

compared

with

the

control

groups,

introduce error as well, but pain is quite

regardless

of

the

different

ways

objective in its context and reports

intervention was operated. This review

regarding pain intensity after common

whether

postoperative

music
pain.

between

could

The

six

stages

post-operatively,

is limited in a number of ways. Foreign

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Quarterly scientific, online publication by Department of Nursing A,

Technological Educational Institute of Athens

surgical procedures have shown that

pain can be a considerable problem.

22

reduction of tension and sympathetic

modulation.24 When music distracts the

This review has not been focused on

mind, the result is selective attention

what type of music is more beneficial or

mediated by thalamus that alerts the

when is the most appropriate time for

prefrontal cortex to the sound rather to

time exposure. Instead this search tried

the

input25

painful
26

causing

to answer if music has beneficial effect

inhibition.

on postoperative pain in general and

muscular

therefore it is difficult to draw any

thereby, reduce sympathetic stimulation

conclusion regarding the most effective

of the hypothalamus27 which activates

timing for the intervention. In addition,

endogenous

the choice of music and the duration of

nervous system, reducing propagation of

the intervention are topics for further

pain

studies. Recovery after surgery has been

perceptions of the sensory and affective

focused

components of pain.28

on

interventions

pharmacological
minimize

and

music

mental

opiates

impulses

reduce

tension

in

the

and

and

central

modulating

patient

According to these results, taped music

postoperative

should be offered to surgical patients

period. The results of this review suggest

because the technique is inexpensive,

that music have some positive effects on

non-pharmacological and non-invasive

postoperative recovery after surgery and

with beneficial effects. Patients should

support the idea of using music, a non-

be

pharmacological intervention along with

preoperatively to reduce stress as well as

analgesic medication to reduce pain.

postoperatively, for as long as they like,

discomfort

to

Soothing

pain

during

the

encouraged

to

listen

to

music

can

since there are no side effects. Henry29

probably be best explained by the gate

states that the optimal duration for

control theory: the perception of pain is

listening to music is not known but

decreased

via

are

recommends a listening time of 25-90

numerous

and

of

min. The use of headphones would also

The

mechanism

of

this

gates,
diverse

effect

which
points

filtration, abstraction and modulation of

screen

noxious input in the central nervous

generated from staff and equipment,

system. The gates are influenced by

increasing patient satisfaction.7

emotional and cognitive factors through

But what would be the most appropriate

descending

inhibition

systems.23

some

of

the

PACU

noises

The

kind of music to listen to? Some music

effect may occur through distraction,

therapists suggest that classical music is

Does music reduce postoperative pain? A review

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HEALTH SCIENCE JOURNAL

Volume 6, Issue 3 (July September 2012)

the best music for relaxation because of

8

The findings of his review suggest that

its consistent tone and form but there

music reduces postoperative pain, but

are

not the amount of opioid intake after

studies

preferences

showing
play

that
large

musical
role

in

surgery. In view of this fact and having

decreasing anxiety for surgical patients.30

in

In

for

pharmacological, easy, inexpensive, non-

elective surgery could either bring with

invasive intervention, the use of music

them the kind of music that is relaxing

perioperatively is highly recommended

for them, or choose from a small variety

to reduce anxiety, stress and reduce pain

provided by hospitals. This procedure

after surgery.

practice,

patients

scheduled

mind

that

music

is

non-

may sound time-consuming for health

professionals, but could definitely fit in
the time spent to explain the operation

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Advanced

Nursing 2004;46: 179185.

25.Wong HL, Lopez-Nahas V, Molassiotis A.
Effects of Music Therapy on Anxiety in
Ventilator-dependent Patients. Heart &
Lung, 2001;30 :376-87.

Page | 375
E-ISSN: 1791-809X

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Quarterly scientific, online publication by Department of Nursing A,

Technological Educational Institute of Athens

ANNEX
Table 1: search terms and their combination

Population

Intervention

Post?operati$
Postoperative period
(MeSH term)
A

Music
(text word &
MeSH term)

OR

OR

Analgesia
(text word &

OR

Post?serg$
Postoperative care
(MeSH term)

Music therapy
(text word &
MeSH term)

Outcome

Pain
Pain postoperative
(MeSH term)

MeSH term)

Does music reduce postoperative pain? A review

Page | 376

HEALTH SCIENCE JOURNAL

Volume 6, Issue 3 (July September 2012)

Table 2:Details of studies included and results, VAS(1-10), Opioids(mg),

m music group, c control group

Study
Nilsson et al.,

Sample
75

(2005)
Nilsson et al.,

Intra & post

operatively

125

(2003)
Nilsson et al.,

Intervention

No limit since
arrival at PACU

58

Intra-operatively

(2001)
Good et al.,

500

(1999)
Masuda et al.,

44

(2005)
Laurion
(2003)

84

VAS
2.1-2.4m
3.8c

Opioids
1.0-1.8m
2.9c

2.1m

2.6m

2.9 c

3.4c

1.8m

2.22m

2.7c

3.28c

15intervals prior

2.8m

to assessment

3.6c

20 intervals prior

2.2m

NA

NA

to assessment

3.3c

before intra &

2.1m

7.0m

post operation

3.5c

9.8c

Page | 377
E-ISSN: 1791-809X

Health Science Journal All rights reserved

www.hsj.gr