Patients who listen to music with surgery report less pain and anxiety

Would you like a little Vivaldi with your valve replacement? Or, Brahms with your bariatric surgery? Care for some Coldplay with your colonoscopy? The idea that "music has charms to soothe a savage breast" is not just anecdotal.

When patients listen to music before, during, or after surgery, they have less postoperative pain, anxiety, and need for pain medication, according to a systematic review and meta-analysis published August 13, 2015, in The Lancet. Patients also report increased satisfaction.

Currently, music is not used routinely as a therapeutic intervention with surgery, which might be due to ignorance or skepticism about the effectiveness of music, the authors suggest. “We believe that sufficient research has been done to show that music should be available to all patients undergoing operative procedures,” they concluded.

In this study, researchers in the United Kingdom at Brunel University, in Uxbridge, and Queen Mary University of London reviewed 72 randomized trials involving nearly 7,000 patients that investigated the impact of music on postoperative recovery in adult patients undergoing any form of surgical procedure.

Their analysis of the data showed that patients had a modest but statistically significant reduction in anxiety after surgery and had more satisfaction after listening to music. They also reported less pain and needed less pain medication compared with control subjects.

Listening to music at any time seemed effective, although there was a trend for better outcomes if patients listened to music before surgery rather than during or after, the researchers found.

“Patients should be able to choose the type of music they would like to hear, but whether this music should be of their own choice or from a playlist is unclear,” the authors recommended. When patients were allowed to select their own music, they had a slightly greater (but non-significant) reduction in pain and use of pain medication. But they also had a slightly greater (but non-significant) uptick in anxiety when they could choose their own music as opposed to having no choice.

The only caveats are that the music should not interfere with or distract the surgical team, or impede communication with patients during an awake procedure, the researchers noted.

Several mechanisms could explain music’s effect on patients, the authors noted. “Modern theories of pain suggest that pain experience is affected by physical and psychological factors. Cognitive activities such as listening to music can affect perceived intensity and unpleasantness of pain, enabling patients’ sensation of pain to be reduced,” they wrote. “Another potential mechanism could be reduced autonomic nervous system activity, such as reduced pulse and respiration rate and decreased blood pressure.”

In a related comment in the same issue, Paul Glasziou, PhD, professor of evidence-based medicine at Bond University, Queensland, Australia, wrote, “Music is a simple and cheap intervention, which reduces transient discomforts for many patients undergoing surgery. A drug with similar effects might generate substantial marketing … Although many research questions remain, this should not inhibit implementation of a sensible choice for patients now.”