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

Abstract courtesy of Neuromusic News, Fondazione Mariani
J Med Internet Res 2020 May 20;22(5):e18537
A brief music app to address pain in the emergency department: prospective study
Chai PR1,2,3,4, Schwartz E5, Hasdianda MA6, Azizoddin DR2, Kikut A6, Jambaulikar GD6, Edwards RR5, Boyer EW1,4, Schreiber KL5
1 Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 2 Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, MA, USA; 3 The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Boston, MA, USA; 4 The Fenway Institute, Boston, MA, USA; 5 Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 6 Department of Emergency Medicine, Brigham and Women’s Hospital, Boston, MA, USA

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. 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. 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. 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. 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.
and for our Italian friends…
I medici di emergenza affrontano la sfida di alleviare il dolore acuto ogni giorno. Nonostante gli oppioidi siano un potente trattamento per il dolore, l’epidemia di oppioidi ha dato il via alla ricerca di alternative analgesiche che possano ridurre la dose o la durata dell’esposizione agli oppioidi. Se da un lato le terapie comportamentali e la medicina complementare sono efficaci, dall’altro sono difficili da implementare nei dipartimenti di emergenza. La musica è una potenziale terapia aggiuntiva che ha dimostrato efficacia nella gestione del dolore. L’obiettivo degli Autori era comprendere la fattibilità e il potenziale di effetto di una nuova app musicale per affrontare il dolore acuto e l’ansia nei pazienti ricoverati in un’unità di osservazione del dipartimento di emergenza. Questo studio prospettico di coorte ha arruolato pazienti ricoverati in un’unità di osservazione del pronto soccorso con dolore che avevano ricevuto prescrizioni di oppioidi. Gli Autori hanno raccolto dati sul dolore di base e le caratteristiche psicosociali tra cui ansia, disturbi del sonno e dolore catastrofico usando questionari validati. I partecipanti hanno ricevuto un intervento musicale basato su smartphone e hanno ascoltato la musica in modo supervisionato (fornito da un assistente di ricerca 3 volte durante il loro soggiorno) o in modo non supervisionato (musica utilizzata a piacere dal partecipante). L’app raccoglieva i punteggi di dolore e ansia pre-musica e post-musica e i partecipanti fornivano un feedback qualitativo sull’accettabilità dell’utilizzo dell’intervento musicale. Gli Autori hanno arruolato 81 partecipanti e assegnati casualmente 38 a un gruppo non supervisionato e 43 a un gruppo supervisionato. Il dolore medio in entrambi i gruppi era 6,1 (1,8) su un possibile punteggio di 10. Un totale di 43 (53%) ha riferito di un precedente utilizzo di app musicali a casa. Gli Autori hanno osservato una riduzione complessivamente modesta ma significativa del dolore (differenza media da -0,81, 95% Cl da -0,45 a -1,16) e dell’ansia (differenza media da -0,72, 95% Cl da -0,33 a -1,12) dopo le sessioni di musica. La riduzione del dolore e dell’ansia variava sostanzialmente tra i partecipanti. Gli individui con dolore basale più elevato, pensiero catastrofico (riguardo al dolore) o ansia hanno riportato un maggiore sollievo. I cambiamenti nel dolore erano correlati ai cambiamenti dell’ansia (Pearson p=0,3, P=.02), ma non variavano tra gruppi supervisionati e non supervisionati. Al termine dello studio, 46/62 (74%) hanno riferito di apprezzare l’intervento musicale, 57/62 (92%) hanno riferito che l’app era facile da usare e 49/62 (79%) hanno riferito che sarebbero stati disposti a usare l’intervento musicale a casa. Un intervento musicale basato su smartphone ha ridotto il dolore e l’ansia tra i pazienti in un’unità di osservazione del dipartimento di emergenza, senza alcuna differenza tra l’uso supervisionato e non supervisionato. Gli individui che hanno riportato la maggiore riduzione del dolore dopo le sessioni di musica includevano quelli che hanno ottenuto il punteggio più alto nella valutazione basale del pensiero catastrofico, suggerendo che potrebbero esserci popolazioni specifiche di pazienti che potrebbero trarre maggiori benefici dall’uso della musica come aggiunta analgesica nel dipartimento di emergenza. Il feedback qualitativo ha suggerito che questo intervento era fattibile e accettabile dai pazienti del pronto soccorso.

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Published on 20.05.20 in Vol 22, No 5 (2020): May

Chai PR, Schwartz E, Hasdianda MA, Azizoddin DR, Kikut A, Jambaulikar GD, Edwards RR, Boyer EW, Schreiber KL
A Brief Music App to Address Pain in the Emergency Department: Prospective Study
J Med Internet Res 2020;22(5):e18537
URL: https://www.jmir.org/2020/5/e18537
DOI: 10.2196/18537
PMID: 32432550
PMCID: 7270860

UC MERCI Project Wins $300K Award for Music and Science Research

UC MERCI

Scott Makeig, research scientist and director of the Swartz Center for Computational Neuroscience at the Institute for Neural Computation of UC San Diego, has brought together a research group from four UC campuses who have won a $300,000 President’s Research Catalyst Award, one of five such awards across the UC system announced by President Janet Napolitano.

The group’s research, which uses music to understand the human brain, “brings together UC experts on music listening, performance, neuroscience, brain imaging, and data science to understand the transformative potential of music for health and cognition,” says Napolitano’s announcement.

Makeig and his colleagues are among the first to receive the new awards, which will channel $10 million over three years to fund research in areas of strategic importance, such as sustainability and climate, food and nutrition, equity and social justice, education innovation, and health care.

“It’s gratifying to know our work on the frontiers of music, systems neuroscience, and human experience has been recognized for its potential value,” said Makeig. “I’m especially pleased for my collaborators. This is a true team effort by scientists from different disciplines with common interests in musical experience and communication.”

His winning project proposes “an American center for the scientific study of musical experience, communication, and behavior.” The UC Music Experience Research Community Initiative (UC MERCI) will allow UC researchers to share cutting-edge resources and collaboratively develop methods to understand – and enhance – music’s ability to affect and even transform the human mind.

Working with Makeig on the project are John Iversen, Sarah Creel, and Gert Lanckriet of UC San Diego; Ramesh Balasubramaniam, UC Merced; Petr Janata, UC Davis; and Mark Tramo, UCLA. Under the initiative, a group of graduate students will work together across the four campuses. California music-industry groups may also be involved.

“The study of musical experience and communication is truly interdisciplinary,” said Makeig. “For centuries, humanists and scientists have studied music and language from different angles and for varied purposes at conservatories and universities around the globe. We now have an opportunity to gain new understanding by using new scientific tools including brain imaging and computation.”

“A thorough and systematic study of music cognition requires a truly multidisciplinary effort, bringing together neuroscience, psychology, cognitive science, linguistics, medicine and, of course, music. While the UC system has much invested in individuals, technologies, and methodologies for studying each of these separately, a systematic interdisciplinary effort to tackle music-cognition problems could enable UC to attain worldwide prominence in these research areas.”

 

Above information taken directly from full press release by Paul K. Mueller, which may be found here.

More information on MERCI may be found here.