| Musical notes |
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| These simple notes can effect us in great ways |
Music is a powerful tool. It is capable of regulating emotion, able to calm, excite and relax a person, but more importantly it can be utilized in medicine. Music can be used as an alternative to anesthetic and anxiety medication. Music, unlike medication, does not contain any harmful side effects. It is also capable of reducing the levels of stress and anxiety of a patient. How this specifically works, has yet to be determined, though there are several theories that have tried to explain this. Different styles of music would also elicit varying degrees of effectiveness[2]. Classical music is far more effective at reducing stress level than heavy metal. Research has been done to identify how effective music is on pre-surgery, during surgery and post-surgery.
Background
Stress is not something rare. It occurs all the time. It effects people's daily lives, due to the many symptoms that are associated to stress. Some of the symptoms include rapid heart rate, depression, and anxiety[1]. Music has always had an effect on people. Be it exhilarating people before a big event, setting the mood for a romantic night, or calming oneself before an important test. There has been research done to show which type of music elicit certain effects. Classical music has been shown to strongly induce a calming effect, while pieces of heavy metal would induce a more aggressive state[2]. Since music has calming capabilities, it lead researchers to study the effectiveness of music on surgical patients. This field of research is far from new, research has been done on this since the late 1980s. Sandra L.Curtis was one of the researchers in the 1980s looking into music's pain relief capabilities, on the terminally ill. Her paper found that indeed, music is effective on patient's perception of pain[3]. This type of research, set the ground work for subsequent studies, that not only looked at terminally ill patients, but also patients that are going into surgery and patients who are in the process of being discharged.
Musical Effects
Physiological Effects
Music causes several physiological changes to occur in patients. Most physiological effect includes reduction in heart rate, lower diastolic and systolic blood pressure, and a overall decrease in activity of the sympathetic nervous system[4]. Music enters through the auditory system and stimulates the limbic system which causes the physiological changes. The auditory system may hold an important component for this process to occur. Nitric oxide (NO) is important in the development of the auditory system, making it a candidate for how music evoke physiological changes[5]. This theory is based on NO being used a both a neurotransmitter and a hormone, that acts on the sympathetic nervous system and relaxes the body.
Psychological Effects
Along side with the physiological changes that music causes, only one major psychological change occurs. Reduction of anxiety is the major effect that is shown when music is used as a treatment. However other changes have also been documented, such as the reduction in depression in breast cancer patients after radical mastectomy[6]. How these changes occur could be accounted to the distraction capability that music has. By being distracted, people tend to perceive anxiety, stress, and pain in a less intense manner[7].
Music as a Treatment
Pretreatment
Music used prior to surgery, aims to reduce the overall anxiety a patient feels before undergoing something that is unknown to them. This allows for a much safer surgery to be performed. State trait anxiety inventory (STAI), heart rate, and blood pressure are the usually measurements taken to determine how stressed a patient is prior to an operation. Through clinical trails, only STAI shows a significant difference when exposed to music. Blood pressure and heart rate stay the same[8]. On the contrary, other studies were able to produce results that included reduction of blood pressure and heart rate in addition to the anti anxiety effects music displays[9]. These differences in results show that music may not work in a simple cause and effect fashion. Some of the effects may only occur in certain patients or they type of operation that is at hand. This really shows that this field needs to be dived into deeper to obtain a more concise and better understanding. Some clinical trails have also included bio-marker such as cortisol, epinephrine, and norepinephrine into their findings. These bio-markers are up-regulated when under stressful conditions. Musical trails aimed to show that music is capable in reducing these bio-markers levels, however results have shown that the bio-marker levels in those who listen to music prior to an operation are no different from the levels from the control group. [10].
During Treatment
| Anxiety Test |
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| Typical visual analogue scale test anxiety (VASA) source:annals.org/data/Journals/AIM/19936/9FF1.jpeg |
Not only has music been used as a pretreatment, it has also been applied to patients under general or localized anesthesia that are undergoing operations, such as cardiovascular surgery and caesarian section. The aim for this type of music intervention is same as for pretreatment, to reduce stress and anxiety of the patients. Females that undergo cesarean sections have shown to have typical anxiety that most patients exhibit. Visual analogue scale for anxiety (VASA) is used to measure their perceived anxiety. At the time of the operation, an average scale value of 6 is perceived by most pregnant females. During the operation, some females were given the option to listen to music of their choice. Shortly after the operation, another VASA test is done, yielding results that strengthens the music capabilities in reducing anxiety. Females who listen to music average a 2 on the VASA test while the control averaged a 3. Other test were done along side this, but showed no significant results[11]. Music has been shown to be effective when patients are under localized anesthesia, but when under general anesthesia, its effectiveness becomes non-existent. This could be contributed to the patients not being able to consciously listen to the music. Most patients under these conditions do not recall hearing music during the operation[12]. Since music does not seem to have an effect on unconscious patients, it does not mean that music is entirely useless in this regard. Some clinical trails have shown that by listening to music before surgery, the amount of anesthesia required can be reduced[13]. This decreases some of the side effects that come along with anesthesia and this could also help those that cannot tolerate standard levels of anesthetic.
Post-treatment
Post-treatment follows what both pretreatment and during treatment accomplishes, which is to reduce anxiety, but in addition to this, post-treatment also aims to reduce patients pain levels and the duration of their stay. After most surgeries, most patients would require morphine to reduce the pain they feel. Since music is capable of distracting people, it could be used to divert patients attention away from their pains. When exposed to music immediately after an operation, perceived pain is significantly lower than compared to those who are not exposed to music. More importantly the amount of opioid, in this case morphine, is considerably lower. Patients in the music group only requires an average of 1.0mg while the control patients require 2.9mg of morphine[14]. This finding benefits females that have undergone cesarean section. These females are not exposed to opioid during the operation due to the side effects it may cause the new born. Music in this case acts similar to pain killers during and shortly after the operation to alleviate the pain. In addition, after the operation, when the female can have opioid, the amount required is lower due to the extended exposure to music[15].
As a Drug
Music has already shown to relieve stress, reduce anxiety, and is an effective pain killer. So how effective would music be as a kind of pseudo drug? In terms of effectiveness as an anti anxiety drug, it could be comparable to the drug midazolam, if not more effective[9]. However when looked in terms of a pain killer, this question won't be answered through any normal clinical trial, since it would be unethical to omit painkiller during surgery. Instead music is tested along side with normal medication. It has already been stated that music reduces the amount of painkillers required after surgery, but prior to surgery music is capable to reduce the amount of anesthetic required to go under. 2.7mg/kg/h of propofol is required to cause ansethesia. When music is applied the amount required is lowered to about 2.2mg/kg/h to achieve the same effect[13]. Even though music cannot be tested by itself, the effects it has on reducing drug consumption is highly important. Since less drugs consumed would lead to lower adverse side effects.
Other
Music can also be utilized in other aspects other than just for surgical use. An example of this would be the use of music in people who suffer from Alzheimer. When music is applied, both a reduction in anxiety and depression is seen[16]. Another use for music that has been put into practice is mood regulation of adolescents. Music down regulates negative emotions and up regulates positive emotion[17]. Finally music has been shown to improve cognition after stroke[18].
An interesting topic! Perhaps something you can look deeper into is how different genres of music may improve or reduce the efficacy of treatment. Not sure about the validity of what I'm about to mention, but apparently country music is considered to promote depression and even suicide!
Thank you for your input. Also i didn't know country music could cause such negative effects, that could be something fun to read up on.
Hey! Nice job so far, I'll definitely be linking your page to mine. Speaking of, perhaps you can add a few examples of music application in various pathologies such as Alzheimer's, Parkinson's, depression, etc. (see the musical brain group). I know that music is indeed used as an alternative treatment for Alzheimer's and appears to have stress-reducing affects.
Thank you! I took your suggestion and went looking for music effects on Alzheimer. I placed in an "other" section to see other musical effects that are not surgically related. It may be thin now, but i will try to add more.
I really enjoyed the relaxing music you've posted - it's very creative to demonstrate the relaxing effects of listening to music while people are reading your wiki! As Zahra mentioned above, our group ("The Musical Brain") has taken a closer look at the effects of listening to music in different contexts. I noticed that you have a section on physiological effects; I discuss that too in my wiki ("The Role of Music Therapy in Stroke Rehabilitation"), so feel free to link it. I've also wondered about the effects that music might have in the OR, so it was interesting to see the results of listening to music during surgery. Great work!
Thank you for your nice comment :).
I thought putting music on this page was an excellent touch. It makes learning about your topic interactive which is awesome.
I'm sure you've noticed already and it's easily fixed but one your citations in your intro isn't working. Also, I was wondering if there was anything in your research talking about the effects of other genres of music like jazz or indie? Other than that keep up the great work!
Thank you!! Through the research that I manage to compile, most clinical trails state that the music played are non lyrical. I have not read anything about the specific of music such as jazz or indie.
Cool topic and your page is very organized! maybe you could consider looking into how specific rhythms may create different effects? I'm not sure if it could be considered therapeutic but I've heard that Bach's music is good for studying because of its even, steady rhythm. Also, a video that might be of interest to you is "Neil Harbisson: I listen to color". It's a Tedtalk by a colour blind person who explains how he can "hear" colour via a device that changes colour into different frequencies. Check out the video, it's really fascinating :)
http://www.youtube.com/watch?v=ygRNoieAnzI
Fascinating topic, and I thought the attached music file was very relaxing. In the introduction you mentioned that music therapy compared to medicine does not have harmful side effects. Are you implying that all medicine have side effects or MOST medicine have side effects? What about natural herbs like chinese medicine? Also, maybe add a section where the results of both medication and music therapy is compared, that will strengthen the argument for musical therapy. Overall very well done.
Hey there,
Even though the deadline for submission has passed, I was wondering if in the classical music vs heavy metal example, it is known was specifically makes latter have a disadvantage? The tempo? vocals? having lyrics? Thought itd just be interesting to look for future studies, if it has yet to be done!
Hi Martin!
I absolutely love this topic. I vaguely remember a presenter in first year psychology present her research to us about this. You definitely have all your facts straight, and I particularly enjoyed reading "As A Drug". The ability of music to subside some of the symptoms of the CNS and ANS and the degree to which medical practices (i.e. giving anesthetics) can be altered and reduced!
As an offer of criticism: in the first paragraph you put an example of classical music being far more effective than heavy metal. Perhaps start that sentence with "For instance, classical music is far more effective…"
Hi there! Your page is very interesting! I never really understood why some people claim to gain concentration from music while others claim it is a source of distraction. Your research had made it clear to me that the latter fact is more accurate. Great work!
I have to say this topic is one of the most interesting one I have seen so far — especially with that soothing background music :p.
But I have one question. Do you know if there are any cases where music was played during surgery or during sleep? I'm just wondering if music can have the same stress-relieving effect when we are not fully conscious. Because I have heard of a few anecdotes where doctors turn on a happy music during their surgery. It would be really good if we could just play music while we sleep and wake up without any stress.