Music Therapy
Music therapy might be used with standard treatment to decrease post-operative pain and opioid use.
Pharmacologic, Physical, and Cognitive Pain Alleviation for Musculoskeletal Extremity/Pelvis Surgery (2021)
This guideline was produced in collaboration with METRC, with funding provided by the US Department of Defense. Endorsed by: SOMOS, OTA

Rationale

Three moderate studies (Gallagher2018, McCaffrey 2004 and McCaffrey 2006) assessed the impact of use of music therapy after musculoskeletal surgery.  The study by Gallagher also included use of relaxation and imagery strategies, making the impact of music therapy alone difficult to determine.  The authors found no change in opioid or anti-emetic use of length of stay with the use of music therapy but noted decreased pain, anxiety, nausea, and mood up to POD 2 with the intervention. The studies by McCaffrey were designed to assess the impact of music therapy on cognitive function, with pain and function as secondary outcomes.  The authors found that patients in the intervention arm demonstrated greater readiness to ambulate and less pain and opioid use, as well as higher satisfaction.

The Music Therapy recommendation has been downgraded one level because of feasibility issues.

Benefits/Harms of Implementation

The impact of MT on post-operative pain and function requires additional study but may be a useful addition to standard treatment.  No potential harms were noted in either study, but this needs additional research.

Cost Effectiveness/Resource Utilization

Current studies of MT utilize either a board-certified music therapist (Gallagher) or CDs at the patient bedside.  For hospitals not currently employing the former, this could be an added cost.  CDs or other devices with recorded music could be costly, if they need to be replaced frequently.  In-person therapists and biofeedback machines may present substantial cost and time barriers. The delivery of this therapy to outpatients remains to be studied.

Acceptability

Use of music for relaxation is accepted, but its use for pain control and improved function is less so.  Acceptability would need to be evaluated in the setting of multi-patient rooms if the delivery method available did now allow for private sessions. 

Feasibility

The ability to and cost of hiring a music therapist or train current healthcare professionals in this area could limit use of this technique, especially in rural/frontier or smaller hospitals.  Hearing impaired patients may not benefit from pre-recorded relaxation sessions.  MT is currently only studied in inpatients, although the listening only therapy may be available to outpatients as well.

Future Research

Music therapy may be a useful non-pharmacologic adjunct to improve post-operative pain and function.   However, additional research is needed in this area.  The impact of music therapy alone, without the addition of PMR and guided imagery, is needed to determine the relative impact of only music therapy.  The first 2 modalities can be provided by other staff, without needing to have access to a music therapist, making the intervention less costly.  If, however, the most important intervention is music therapy, the relative cost of hiring a therapist or training additional personnel in this technique (and accounting for the time that this would take from their usual duties) compared to usual care and any cost savings in terms of patient pain control and complications would need to be assessed.  Additional research could also assess the impact of virtual or remote applications. Interventions for those deaf or hard of hearing also need to be evaluated.  Sex-based differences in outcome need to be assessed.