THE EFFECT OF MUSIC THERAPY AND GUIDED IMAGERY ON POSTOPERATIVE PAIN, ANXIETY AND MEDICATION USE: A PROSPECTIVE RANDOMIZED STUDY

Zoyla Almeida-Parra, Luis Mendez, Orlando Gómez-Marín, Namita Jhamb, Giselle Ghurani, Nicholas Lambrou, Emery Salom, Patty Hlavin, Manuel Penalver,

University of Miami , Division of Gynecologic Oncology, University of Miami School of Medicine, Miami, Florida

   Objective: Adequate control of postoperative pain continues to pose a challenge for the surgeon. Music therapy with guided imagery (MT/GI) has been shown to ameliorate symptoms and perception of pain. The objective of this study was to evaluate the effect of MT/GI on postoperative pain, anxiety and analgesic use.

   Methods: Prospective randomized study of 81 patients with major gynecologic procedures. Study participants were randomized to two intervention groups: MT/GI plus analgesic (MT/GI group, n = 44) vs. analgesic only (control group, n= 37). Information was recorded before surgery and at pre and post intervention on days 1, 2 and 3 post surgery. It included: pain and anxiety (assessed by using the Visual Analogue Scale, VAS); medication use in equivalent morphine dosages; pulse and mean arterial blood pressure (MAP). Statistical analyses included within and between group comparisons of the above parameters and also of the pre and post intervention differences in those parameters. Statistical techniques included chi-square analysis, paired and independent sample t-tests, Wilcoxon signed rank tests and Mann-Whitney tests.

   Results: There were no significant differences between intervention and control groups with respect to potential confounders such as age, marital status, procedure performed, and smoking; past history of surgery or medical conditions; and pre-operative pain, anxiety, pulse and MAP. Within the MT/GI group, at each assessment day, there was a significant decrease (p-value < 0.05) from pre to post intervention with respect to pain, anxiety, medication use, pulse and MAP. Mean decreases in these parameters were significantly higher in the MT/GI group when compared to the control group at each assessment day. In addition, 100% of the patients in the MT/GI group said they would recommend music therapy to other patients and would use it again for control of their postoperative pain.

   Conclusion: Music therapy and guided imagery play a significant role in decreasing pain and anxiety in patients undergoing gynecological surgery. It also decreases analgesic intake for control of pain. This may translate into decreased side effects from narcotic use with a better quality of life for patients in the immediate postoperative period.