1. Kiernan, Jason Micheal PhD, RN, ACNP


A call to expand the study and use of this effective adjunct therapy.


Article Content

Music-listening interventions (MLIs) involve purposeful listening to music with the intention of achieving a desired clinical outcome. They often involve passive listening to prerecorded music, either selected by the person engaging in the intervention or chosen by a clinician. MLIs are gaining an impressive amount of positive data in a wide variety of clinical settings. Pain mitigation is one area where MLIs have demonstrated statistically significant results in many studies, across many clinical sites. Yet, translation of this evidence into creative and relevant routine applications in daily nursing practice has yet to make a strong appearance in the clinical practice literature.


Many clinicians are unaware that music interventions have ascended to the "recommended" level within clinical practice guidelines. The Oncology Nursing Society lists music as a nonpharmacological intervention "likely to be effective" within their clinical practice recommendations for pain mitigation (Clinical Journal of Oncology Nursing, June 2017). Additionally, the American Pain Society and the American Society of Regional Anesthesia and Pain Medicine both support music interventions for mitigation of postoperative pain (The Journal of Pain, February 2016). For vaccinations, the World Health Organization advocates for music's use as a means to reduce both pain and distress.


With this level of evidence and their inclusion in various clinical practice guidelines, MLIs deserve clinical consideration by RNs in practice. Imagine the scenario of a unit nurse caring for a patient in a postoperative setting. When the patient requests the next dose of the prescribed opioid medication, the nurse could also suggest an MLI based on the evidence that music therapy can offer an additional degree of pain relief. It is possible the patient will find that the additional relaxation or pain relief listening to music provides may extend the effect of the opioid, allowing for a greater interval between doses, thus in turn reducing opioid-related adverse effects. Even if the intervention were to act in a small way to mitigate pain, the cumulative effects over time could produce impressive clinical outcomes.


Nurses in practice may wonder how much pain relief can be anticipated when MLIs are administered in this fashion. If an opioid dose provides a 50% reduction in pain, could adding an adjunct music intervention offer an additional 5% to 10% reduction in pain? Unfortunately, the state of MLI science has not yet grown to this level of specificity. However, there is good news on the horizon. Determining an MLI "dose" (loosely defined as how much of an MLI is needed to create an effect) has been identified as a research priority by the National Institutes of Health at a music-based symposium (Neuron, March 21, 2018), and this kind of publicity is likely to encourage MLI researchers to begin dose-response trials. Additionally, having nurses make use of MLI pain mitigation data offers an excellent opportunity to illustrate how the mechanisms of cross-communication work between clinicians and researchers. As more nurses make use of MLIs in clinical practice, new questions will inevitably arise.


To date, music interventions have not demonstrated adverse effects in clinical trials. This should not, however, presume that these interventions are completely harmless. By expanding MLIs into practice, RNs could provide a far larger clinical context from which potential adverse effects or contraindications for MLI use could be elicited. It is possible that an IV pump alarm may go unnoticed during a music intervention or other sound signals necessary for safety remain unheeded. Nurses know these scenarios and are best suited to ensure that future research considers effects outside the relationship between music listening and whichever physiological or psychological dependent variable is under study.


The state of MLI science is robust enough at present for MLI to find its way as a complementary, adjunctive modality for pain mitigation into regular practice scenarios for many nurses. Continued work into anxiety, mood, and fatigue may bring new areas of intervention to practice. Music alone has been used with therapeutic intent for millennia, and music intervention research has exploded in the past quarter century. It is time to bring the healing qualities of music to the bedside.