A Brief Music App to Address Pain in the Emergency Department: Prospective Study

Abstract

Background Emergency physicians face the challenge of relieving acute pain daily. While opioids are a potent treatment for pain, the opioid epidemic has ignited a search for nonopioid analgesic alternatives that may decrease the dose or duration of opioid exposure. While behavioral therapies and complementary medicine are effective, they are difficult to deploy in the emergency department. Music is a potential adjunctive therapy that has demonstrated effectiveness in managing pain. Objective Our objective was to understand the feasibility and potential for an effect of a novel music app to address acute pain and anxiety in patients admitted to an emergency department observation unit. Methods This prospective cohort study enrolled patients admitted to an emergency department observation unit with pain who had received orders for opioids. We gathered baseline pain and psychosocial characteristics including anxiety, sleep disturbance, and pain catastrophizing using validated questionnaires. Participants received a smartphone-based music intervention and listened to the music in either a supervised (research assistant–delivered music session 3 times during their stay) or unsupervised manner (music used ad lib by participant). The app collected premusic and postmusic pain and anxiety scores, and participants provided qualitative feedback regarding acceptability of operating the music intervention. Results We enrolled 81 participants and randomly assigned 38 to an unsupervised and 43 to a supervised group. Mean pain in both groups was 6.1 (1.8) out of a possible score of 10. A total of 43 (53%) reported previous use of music apps at home. We observed an overall modest but significant decrease in pain (mean difference –0.81, 95% CI –0.45 to –1.16) and anxiety (mean difference –0.72, 95% CI –0.33 to –1.12) after music sessions. Reduction of pain and anxiety varied substantially among participants. Individuals with higher baseline pain, catastrophizing (about pain), or anxiety reported greater relief. Changes in pain were correlated to changes in anxiety (Pearson ρ=0.3, P=.02) but did not vary between supervised and unsupervised groups. Upon conclusion of the study, 46/62 (74%) reported they liked the music intervention, 57/62 (92%) reported the app was easy to use, and 49/62 (79%) reported they would be willing to use the music intervention at home. Conclusions A smartphone-based music intervention decreased pain and anxiety among patients in an emergency department observation unit, with no difference between supervised and unsupervised use. Individuals reporting the greatest reduction in pain after music sessions included those scoring highest on baseline assessment of catastrophic thinking, suggesting there may be specific patient populations that may benefit more from using music as an analgesic adjunct in the emergency department. Qualitative feedback suggested that this intervention was feasible and acceptable by emergency department patients.

Musicoterapia y telehealth: Una revisión sistemática

“…En los estudios analizados participaron un total de 385 adultos con diversas patologías: demencia, enfermedad de Parkinson, oncología, lesiones medulares, dolor crónico, problemas emocionales, como ansiedad o depresión, y trastorno por estrés postraumático (TEPT). Solo tres de los diez estudios pudieron acceder a una muestra amplia y representativa de participantes (Chai et al, 2020;Hansen, 2015;Hides et al, 2019). Los estudios podían agruparse en tres grandes bloques:…”

“…1. Estudios enfocados a tratamientos de enfermedades y problemas de salud con causa física, como el dolor crónico y las lesiones medulares (Casellas et al, 2021;Chai et al, 2020;Folsom et al, 2021;Hansen, 2015;Tamplin et al, 2020). 2.…”

“…Este estudio ofrece una revisión de la literatura sobre musicoterapia empleando la teleasistencia para diferentes problemas de salud. Tras el análisis sistemático de los estudios encontrados, se han revisado diez estudios que muestran logros en: mejora del dolor crónico; reducción de la ansiedad y la angustia; control de la respiración y la voz (Chai et al, 2020;Hansen, 2015;Stegemöller et al, 2020;Tamplin et al, 2020); regulación emocional (Hides et al, 2019;Lightstone et al, 2015); mejora del estado de ánimo, relajación y motivación autopercibida (Casellas et al, 2021;Dassa et al, 2020;Martin et al, 2013); disminución de la ansiedad y mayor conexión social (Folsom et al, 2021). En cuatro estudios se han utilizado nuevas tecnologías en la preparación de músicas personalizadas automatizadas (Chai et al, 2020;Martin et al, 2013), usando aplicaciones como Music eScape y comprobado si ayuda a los jóvenes a identificar y gestionar emociones mediante la escucha de música (Hides et al, 2019).…”

“…En una intervención grupal de musicoterapia con un modelo de medicina integradora, Folson et al (2021) consiguen reducir la ansiedad y mejorar habilidades de afrontamiento y apoyo social en pacientes hospitalizados y ambulatorios. Una escucha musical para reducir el dolor crónico obtuvo una reducción significativa en las puntuaciones de dolor crónico y la ansiedad en la mayoría de los participantes (Chai et al, 2020). Con pacientes quirúrgicos, Hansen (2015) no obtuvo mejoras significativas pre-post intervención en ansiedad tras la escucha musical, pero aumentó significativamente el sentimiento de autoeficacia.…”

Effects of punctate skin grafting combined with or without irrigation on skin graft survival, redness and swelling score and pain in treatment of large-area residual burn wounds

“…relieve sensory nerves and accelerate wound healing of patients. 18 Redness, swelling and edema are also symptoms of patients with large area burns. 19 After burned, central coagulation zone, middle stasis zone and peripheral hyperemia zone well appear on the injured surface.…”