Researchers have found a potential way to reduce moderate to severe pain, and anxiety following open-heart surgery.
It may be as simple as listening to music.
In the November issue of Pain, a research team led by a UNMC College of Nursing doctoral student, published “Sedative music reduces anxiety and pain during chair rest after open-heart surgery.” The peer-reviewed journal publishes research on the nature, mechanisms, and treatment of pain.
First author Jo Voss, Ph.D., who graduated recently from UNMC, found that sedative music and scheduled rest had significant positive effects on anxiety and pain after surgery in open heart patients during the first time in a chair, a maneuver that triggers an increase in anxiety and pain.
Though the benefits of sedative music and scheduled rest have been documented in patients, the effects had not been examined in postoperative open-heart patients during their first time in a chair.
“As early as eight to 12 hours after surgery while still in the intensive care unit, patients are assisted to a sitting position in a chair,” said Dr. Voss, an assistant professor at South Dakota State University in Rapid City. “Despite opioid medication, moderate to severe anxiety and pain have been reported during chair rest after cardiac surgery. The patient’s first time sitting in a chair after this major surgery causes pain and anxiety. Their anxiety tends to enhance pain.”
Pain and anxiety are the most common problems for patients following coronary artery bypass grafting or valve replacement. The pain is caused by the stimulation of peripheral nerve endings in the muscles and tissue that have been cut and traumatized during surgery.
Dr. Voss conducted the study to find other ways of reducing pain and anxiety to an acceptable level. As a critical care nurse, she takes care of patients following heart surgery.
“Drugs alone sometimes aren’t quite enough,” Dr. Voss said. “We need to find additional ways to decrease anxiety and pain. My belief is if patient anxiety and distress is reduced, then pain is also reduced.”
Sixty-two patients in a rural hospital participated in the six-month study in 2002. Patients were randomly assigned to three groups: a control group in which patients sat resting in the chair without control of noise and interruptions; a rest group in which patients rested in a chair undisturbed for 30 minutes; and a music group in which patients rested undisturbed in a chair for 30 minutes listening to sedative music of their choice.
Sedative music was considered slow (60 to 80 beats a minute), melodic and instrumental (without words) — like slow jazz, harp, flute, orchestral and piano.
Dr. Voss recorded activity, blood pressure, heart rate, anxiety, pain sensation, and pain distress.
“As I was gathering this information, I quickly realized there were pretty big differences,” Dr. Voss said. “I didn’t really know how important the data would be later on.”
Researchers found significantly less pain and anxiety differences between patients who listened to sedative music than those who received just scheduled rest or treatment as usual.
In the music group, she noticed little or no movement and after 30 minutes, she turned the music off expecting those asleep would wake up, but they didn’t. She had to wake them up.
In the rest group, she noticed patients would open their eyes or readjust themselves in their chairs when they heard noise in the hall. In the control group she observed a lot of movement and anxiousness.
“Patients in the music group had 72 percent less anxiety, 57 percent less pain sensation and 69 percent less pain distress than the control group. Further, patients who received music had 59 percent less anxiety, 51 percent less pain sensation and 60 percent less pain distress than the patients in the rest group,” she said.
Researchers theorize the positive effects of sedative music provides a distraction from the pain and helps patients relax, said Bernice Yates, Ph.D., UNMC College of Nursing, who participated in the study and was Dr. Voss’ research advisor. “I think the study has applicability in many different nursing areas,” she said. “There are so many situations where patients experience pain and anxiety and uncertainty in their recovery. Music makes patients feel much more confident about dealing with their pain.”
According to 2002 statistics from the American Heart Association, about 686,000 open-heart surgeries are performed each year in the United States.
The researchers’ findings strongly support the use of sedative music in combination with medication to reduce anxiety and pain during early activities such as chair rest after open-heart surgery. Researchers say sedative music also may benefit other patients with pain and anxiety.
“Health care providers should feel confident in using music for postoperative open-heart patients and should try it with other patients to decrease anxiety and pain. From a clinical perspective, sedative music is low risk, and it is therefore recommended in addition to pain medication to relieve anxiety and pain for cardiac patients during chair rest following surgery,” Dr. Voss said.
Besides Drs. Voss and Yates, others participating in the study were: Marion Good, Ph.D., Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland; Mara Baun, Ph.D., University of Texas at Houston School of Nursing; Austin Thompson, M.D., UNMC College of Medicine; and Melody Hertzog, UNMC College of Nursing.
The grant was funded in part by the Phi Chapter of Sigma Tau International, Honor Society of Nursing provides leadership and scholarship in practice, education and research to enhance the health of all people.