Controlling pain following major surgery in pediatric patients can be difficult. Although opioid analgesics are effective, they may cause respiratory problems in young patients. As a result, physicians are conservative in prescribing them for children; therefore, postoperative pain control in these patients is often less than ideal.
The conundrum is the subject of research recently undertaken by a father and daughter team.1 Santhanam Suresh, MD, is professor of anesthesiology and pediatrics at Northwestern University Feinberg School of Medicine, in Chicago, Illinois. He is also chair of pediatric anesthesiology at Ann & Robert H. Lurie Children’s Hospital of Chicago. His daughter, Sunitha Suresh, designed the project when she was a student in biomedical engineering minoring in music cognition at Northwestern’s McCormick School of Engineering and Applied Science. She will graduate from Johns Hopkins Medical School this year.
MUSIC, STORIES, OR SILENCE
The team evaluated the analgesic effects of listening to music and audiobooks in children who had recently undergone major surgery. They recruited 60 children ranging in age from 9 years to 14 years for their randomized prospective study. Fifty-four subjects were included in the study, all of whom were scheduled to undergo major surgical procedures, including orthopedic, neurosurgical, urologic, or general surgeries. The researchers divided the young patients into three groups. Two groups listened to 30 minutes of music or stories through noise-canceling headphones in a therapy session, while the third group, the control group, simply heard silence. The team was hoping to reduce the children’s pain burden with two audio treatments within a 48-hour postoperative period.
Prior to the surgery the researchers gave the patients in the music group playlists that included pop, country, rock, and classical genres from which to make their selections. If the children were in the audiobook group, they chose from a list of short audiobooks and stories, including The Hobbit, Alice in Wonderland, and The Complete Tales of Peter Rabbit. Selections were made before the operative procedures so that the patients could choose what they wanted to listen to before they felt the effects of anesthesia.
Two audio treatment sessions took place within 48 hours after surgery. The team used the Faces Pain Scale-Revised FPS-R to evaluate each patient’s pain twice, first before an audio treatment and then again 30 minutes after the treatment.2 They calculated the difference between post and pretreatment pain scores as the main therapeutic effect for this study.
CAN MUSIC REPLACE MEDICATION?
The authors wrote that the most important finding of their study was how effectively the music or audiobooks reduced the children’s pain. They believe that the audio therapy worked by distracting the brain and allowing it to focus on something other than pain. Using regression analysis, they demonstrated that the children in the audio therapy group reported a 1-point reduction on the 10-point pain scale after an hour of audio therapy treatment compared with those in control group.
No difference was seen in the children’s pain scores regardless of how high the scores were at the beginning of the audio therapy session. The audio treatments still worked to reduce their pain. Furthermore, allowing the patients to choose their own music increased the effectiveness of the therapy. The patients were distracted by the music they wanted to hear, or the stories that they found interesting. The music and audiobook groups achieved the same degree of pain relief. In contrast, patients in the control group did not experience any effects from listening to silence.
PORTABLE PAIN CONTROL
An intriguing aspect of this investigation was the finding that the patients were able to continue audio treatment at home after their discharge. The authors noted that administering IV drugs for pain reduction is difficult, and often impossible, in ambulatory patients or after the patients are discharged and at home. The researchers suggest that audio therapy should be made available to minimize pain in children undergoing major surgery, and they call for further research including measurements of anxiety as well as analgesia.
Bette Weinstein Kaplan is a medical writer based in Tenafly, New Jersey.
1. Sunitha Suresh BS, De Oliveira GS Jr, Suresh S. The effect of audio therapy to treat postoperative pain in children undergoing major surgery: a randomized controlled trial [published online ahead of print January 3, 2015]. Pediatr Surg Int. 2015.
2. Hicks CL, von Baeyer CL, Spafford PA, et al. The Faces Pain Scale-Revised: toward a common metric in pediatric pain measurement. Pain. 2001;93(2):173-183.