Music therapy for reducing surgical anxiety - Clinical Innovations

By: Michele Brunges, Gail Avigne

Environmental sounds are part of people's everyday lives, and they elicit many different psychological and emotional responses. For example, the shriek of a police siren might induce surprise or fear; a baby's wail might provoke edginess and irritation; and a song on the radio might stimulate joy. Music in particular affects people deeply.

Past studies have demonstrated that the use of music can be an effective technique in the clinical area because it can distract patients and muffle the many sounds (eg, monitors, alarms) of a normal busy hospital. Researchers have confirmed that music that promotes relaxation can provide a noninvasive method of decreasing patients' anxiety and improving their emotional state. One study investigated listening to music as a method of reducing patients' anxiety during minor surgery with local anesthesia. The results showed that patients who listened to their choice of music during surgery experienced significantly lower anxiety levels, heart rates, and blood pressure than patients who did not listen to music. (1) Another study that produced similar results measured the effects of listening to music intraoperatively on patients' anxiety and blood pressure. (2)

Many studies have shown patients' psychological response to music. A study compared the effectiveness of playing music with the effectiveness of using a different kind of distraction, such as counting, to lessen procedure pain and anxiety in patients with cancer. Outcomes achieved with music did not differ from those achieved with simple distraction. Some patients found the interventions were bothersome and reported that they wanted to focus on the activities of the surgeon and the medical procedure itself. Patients were asked to choose between being distracted and listening to music before and during the procedure. The effects of music, distraction, and treatment were inconclusive. (3)

Recent research has looked at physiological responses associated with musical stimuli. One study that investigated event-driven skin conductance responses to musical emotions in humans demonstrated that music was a powerful elicitor of emotion and might induce autonomic nervous system response. Emotional arousal caused by music in that study evoked and modulated skin or conductance responses. (4)

Researchers also found that music can help reduce pain. For example, patients who listened to music and controlled their own pain with analgesia after gynecologic surgery experienced less pain man patients who only administered their own analgesia. (5)


Patients waiting for surgery experience anxiety and a fear of pain, and reducing their anxiety preoperatively may produce beneficial postoperative outcomes. Music is one method of enhancing patients' preoperative experience and decreasing anxiety. Researchers used findings from past studies and added new studies to develop the project in this article, which tested the use of music as a therapy during the preoperative period.

The effects of the music intervention were measured by physiological responses (ie, epinephrine secretion) and psychological responses (ie, questionnaire completion) to music.

Patients selected for this project were scheduled for total joint replacement, a stressful surgery that can alter patients' lifestyles. Researchers chose this group of patients because they easily could measure both types of responses to music therapy. Patients who undergo this type of procedure routinely have an indwelling catheter inserted before surgery, so researchers could measure urine epinephrine without applying additional invasive techniques.


During the neuroendocrine response to stress, the adrenal medulla is sympathetically stimulated to secrete dopamine, norepinephrine and epinephrine hormones--collectively called catecholamines. The adrenal glands release epinephrine, also called adrenaline, in response to signals from the sympathetic nervous system. Stress, exercise, and emotions, such as fear, trigger these signals.

Epinephrine commonly is referred to as the hormone that induces the tight or flight response. When epinephrine is released, the heart beats more strongly, blood pressure rises, more blood flows to the brain and muscles, and the rate of breathing increases. (6) Blood and urine can be tested for epinephrine.


After the project was explained to potential participants, they were asked if they wanted to be involved. Patients who agreed to be part of the study were assigned to one of two groups. One group did not listen to music. The other group listened with headphones to music from portable compact disc (CD) players while they waited for a minimum of 30 minutes in the preoperative holding area. The music selection consisted of music-enhanced nature sounds, such as the sea, thunder, rainstorms, wind, and waterfalls. The patients ranged in age from 39 to 81. Twenty-three males and 21 females participated. Patients who listened to the music agreed to complete a questionnaire that asked them about their perceptions of the music's effect.

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AORN Journal, Nov, 2003 by Michele Brunges, Gail Avigne

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