Musical Mindfulness for Pain in the ED Waiting Room

Plain-language summary

Studies have shown that 60-70% of patients in the Emergency Department (ED) experience pain. With pain being such a broad issue in the ED, the ED is expected to deliver safe and effective treatment of pain. However, with the current ongoing opioid epidemic, it is important to consider other methods, both pharmacologic and nonpharmacologic, of pain reduction. Jazz music specifically has been demonstrated to have therapeutic effects on pain that can be used to lower the quantity of opioids administered to patients. Non-pharmacological interventions in the emergency department for pain typically consist of splinting an injury, applying heat or cold, or various distractions following initial and sequential pain assessment. Pharmacological interventions for pain in the Emergency Department involve the administration of acetaminophen, muscle relaxers, topical anesthetics, opioids, to name a few. In the emergency department (ED), providers are increasingly hesitant to prescribe opioids over the past decade due to the current opioid epidemic, in which there is an increasing proportion of people that develop an addiction to opioids, including those that are prescribed to them for pain management.. While emergency medicine providers' decrease in opioid prescriptions pertains to their implementation of opioid-prescribing policies, little evidence has been found demonstrating a direct link in these policies to decreases in substance misuse. Consequently, providers find themselves needing to become ingenious in their approach to pain in patients through the integration of pharmacologic and non-pharmacologic mediums of analgesia. A recent randomized controlled trial (RCT) from Brigham and Women's Hospital in Boston sought to identify the qualitative responses from patients in the ED following the arbitrary distribution of either supervised or unsupervised music therapy over a time period of 4 hours. The initial results found that, generally speaking, music therapy may lower reported pain and anxiety scores. Furthermore, stronger results were identified in case subjects with higher initial reports of pain via a pain catastrophizing scale, implying that a higher baseline of pain results in more relief from music therapy. One shortcoming in the article is the lack of analysis with reported results and the biopsychosocial model of pain. Heavy emphasis is placed on the psychological and social components of pain in the Brigham and Women's article through the implementation of the Pain Catastrophizing Scale and Brief Pain Inventory scoring done during the RCT, but no focus on linked biological changes in the subjects through the music therapy intervention. The purpose of this study is to (i.) assess the effect of a video training about musical pain management followed by a 15-minute music listening intervention on self-reported pain scores in ED patients with neck and back pain. The investigators also aim to (ii.) evaluate patient satisfaction and emotional response following the intervention. Opioid medications are commonly used to reduce substantial pain, and music therapy has been found to reduce associated pain and anxiety in patients, then the use of music therapy could be an aid in medicine to reduce opioid intake. The investigators hypothesize that the usage of a training on musical pain management combined with a specified jazz musical intervention will produce a significantly lower measured pain score in comparison to a video on mindful pain management followed by the patient's choice of activities.

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