Music Versus Distraction for Procedural Pain and Anxiety in Patients With Cancer

ONF 2003, 30(3), 433-440. DOI: 10.1188/03.ONF.433-440

Purpose/Objectives: To test the hypotheses that the effects of a music intervention are greater than those of simple distraction and that either intervention is better at controlling procedural pain and anxiety than treatment as usual.

Design: Randomized, controlled experiment.

Setting: A midwestern comprehensive cancer center.

Sample: 60 people with cancer having noxious medical procedures such as tissue biopsy or port placement or removal; 58 provided usable data.

Methods: Participants completed measures of pain and anxiety before and after their medical procedures and provided a rating of perceived control over pain and anxiety after the procedure.

Main Research Variables: Procedural pain, state anxiety, and perceived control over pain and anxiety.

Findings: Contrary to hypotheses, outcomes achieved with music did not differ from those achieved with simple distraction. Moreover, outcomes achieved under treatment as usual were not significantly different from those obtained with music or distraction interventions. Some patients found that the interventions were bothersome and reported that they wanted to attend to the activities of the surgeon and the medical procedure itself.

Conclusions: The effects of music, distraction, and treatment as usual are equivocal. In addition, patients have individual preferences for use of distraction during painful or anxiety-provoking procedures.

Implications for Nursing: Patients having noxious medical procedures should be asked about their desire to be distracted before and during the procedure and offered a strategy that is consistent with their preferences.

Jump to a section

    References

    Agency for Health Care Policy and Research. (1994). Management of cancer pain, clinical practice guidelines (No. 94-0592). Rockville, MD: U.S. Department of Health and Human Services.

    Beck, A.T. (1993). Cognitive therapy: Nature and relation to behavior therapy. Journal of Psychotherapy Practice and Research, 2, 345-356.

    Beck, S.L. (1991). The therapeutic use of music for cancer-related pain. Oncology Nursing Forum, 18, 1327-1337.

    Blount, R.L., Powers, S.W., Cotter, M.W., Swan, S., & Free, K. (1994). Making the system work: Training pediatric oncology patients to cope and their parents to coach them during BMA/LP procedures. Behavior Modification, 18(1), 6-31

    Bonk, V.A., France, C.R., & Taylor, B.K. (2001). Distraction reduces self-reported physiologic reactions to blood donation in novice donors with a blunting coping style. Psychosomatic Medicine, 63, 447-452.

    Bottomly, A. (1998). Anxiety and the adult cancer patient. European Journal of Cancer Care, 7, 217-224.

    Brown, C.J., Chen, A.C.N., & Dworkin, S.F. (1989). Music in the control of human pain. Music Therapy, 8(1), 47-60.

    Cepeda, M.S., Diaz, J.E., Hernandez, V., Daza, E., & Carr, D.B. (1998). Music does not reduce alfentanil requirement during patient-controlled analgesia (PCA) use in extracorporeal shock wave lithotripsy for renal stones. Journal of Pain and Symptom Management, 16, 382-387.

    Chlan, L. (1998). Music therapy. In M. Snyder & R. Linquist (Eds.), Complementary/alternative therapies in nursing (3rd ed., pp. 243-257). New York: Springer.

    Chlan, L., Evans, D., Greenleaf, M., & Walker, J. (2000). Effects of a single music therapy intervention on anxiety, discomfort, satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy. Gastroenterology Nursing, 23, 148-156.

    Chrisler, J.C. (1994). Commentary on anticipatory anxiety in women receiving chemotherapy for breast cancer. AWHONN's Women's Health Nursing Scan, 8(3), 18.

    Cleeland, C.S., Gonin, R., Hatfield, A.K., Edmonson, J.H., Blum, R.H., Stewart, J.A., et al. (1994). Pain and its treatment in outpatients with metastatic cancer. New England Journal of Medicine, 330, 592-696.

    Daveson, B.A., & Kennelly, J. (2000). Music therapy in palliative care for hospitalized children and adolescents. Journal of Palliative Care, 16, 35-38.

    DuHamel, K.N., Redd, W.H., & Vickberg, S.M. (1999). Behavioral interventions in the diagnosis, treatment, and rehabilitation of children with cancer. Acta Oncologica, 38, 719-734.

    Evans, D. (2002). The effectiveness of music as an intervention for hospital patients: A systematic review. Journal of Advanced Nursing, 37, 8-18.

    Greene, P.G., Seime, R.J., & Smith, M.E. (1991). Distraction and relaxation training in the treatment of anticipatory vomiting: A single subject intervention. Journal of Behavior Therapy and Experimental Psychiatry, 22, 285-290.

    Hawksley, H. (2000). Pain assessment using a visual analogue scale. Professional Nurse, 15, 593-597.

    Hilliard, R.E. (2001). The use of music therapy in meeting the multidimensional needs of hospice patients and families. Journal of Palliative Care, 17, 161-166.

    Hirsch, S., & Meckes, D. (2000). Treatment of the whole person: Incorporating emergent perspectives in collaborative medicine, empowerment, and music therapy. Journal of Psychosocial Oncology, 18(2), 65-77.

    Johnson, M.H., Breakwell, G., & Douglas, W. (1998). The effects of imagery and sensory detection distractors on different measures of pain: How does distraction work? British Journal of Clinical Psychology, 37, 141-154.

    Kelly, P., & Winslow, E.H. (1996). Needle wire localization for nonpalpable breast lesions: Sensations, anxiety levels, and informational needs. Oncology Nursing Forum, 23, 639-645.

    Kwekkeboom, K. (2001). Outcome expectancy and success with cognitive-behavioral interventions: The case of guided imagery. Oncology Nursing Forum, 28, 1125-1132.

    Levin, M., Mermelstein, H., & Rigberg, C. (1999). Factors associated with acceptance or rejection of recommendations for chemotherapy in a community cancer center. Cancer Nursing, 22, 246-250.

    Magill-Levreault, L. (1993). Music therapy in pain and symptom management. Journal of Palliative Care, 9, 42-48.

    McCloskey, J.C., & Bulechek, G.M. (2000). Nursing interventions classification (NIC). St. Louis, MO: Mosby.

    Miller, S.M. (1987). Monitoring and blunting: Validation of a questionnaire to assess styles of information seeking under threat. Journal of Personality and Social Psychology, 52, 345-353.

    Miller, S.M., Fang, C.Y., Diefenbach, M.A., & Bales, C.B. (2001). Tailoring psychosocial interventions to the individual's health-information processing style: The influence of monitoring versus blunting in cancer risk and disease. In A. Baum & B.L. Anderson (Eds.), Psychosocial interventions for cancer (pp. 343-362). Washington, DC: American Psychological Association.

    Mobily, P.R., Herr, K.A., & Kelley, L.S. (1993). Cognitive-behavioral techniques to reduce pain: A validation study. International Journal of Nursing Studies, 30, 537-548.

    Morasso, G., Constantini, M., Baracco, G., Borreani, C., & Capelli, M. (1996). Assessing psychological distress in cancer patients: Validation of a self-administered questionnaire. Oncology, 53, 295-302.

    Morrison, R.S., Ahronheim, J.C., Morrison, G.R., Darling, E., Baskin, S.A., Morris, J., et al. (1998). Pain and discomfort associated with common hospital procedures and experiences. Journal of Pain and Symptom Management, 15, 91-101.

    Newell, S., Swanson-Fisher, R.W., Girgis, A., & Ackland, A. (1999). The physical and psycho-social experiences of patients attending an outpatient medical oncology department: A cross-sectional study. European Journal of Cancer Care, 8, 73-82.

    O'Callaghan, C.C. (1996). Pain, music creativity, and music therapy in palliative care. Complementary Medicine International, 3(2), 43-48.

    Portenoy, R.K., Payne, D., & Jacobsen, P. (1999). Breakthrough pain: Characteristics and impact in patients with cancer pain. Pain, 81, 129-134.

    Puntillo, K.A., White, C., Morris, A.B., Perdue, S.T., Stanik-Hutt, J., Thompson, C.L., et al. (2001). Patients' perceptions and responses to procedural pain: Results from Thunder Project II. American Journal of Critical Care, 10, 238-251.

    Rhiner, M., Ferrell, B.R., Ferrell, B., & Grant, M.M. (1993). A structured nondrug intervention program for cancer pain. Cancer Practice, 1, 137-143.

    Rosenstiel, A.K., & Keefe, F.J. (1983). The use of coping strategies in chronic low back pain patients: Relationship to patient characteristics and current adjustment. Pain, 17, 33-44.

    Smith, M., Casey, L., Johnson, D., Gwede, C., & Riggin, O.Z. (2001). Music as a therapeutic intervention for anxiety in patients receiving radiation therapy. Oncology Nursing Forum, 28, 855-862.

    Smith, M.Y., Redd, W.H., Peyser, C., & Vogl, D. (1999). Post-traumatic stress disorder in cancer: A review. Psycho-Oncology, 8, 521-537.

    Snyder, M., & Chlan, L. (1999). Music therapy. Annual Review of Nursing Research, 17, 3-25.

    Somov, P.G. (2000). Time perception as a measure of pain intensity and pain type. Journal of Back and Musculoskeletal Rehabilitation, 14, 111-121.

    Speilberger, C.D. (1983). Manual for the State-Trait Anxiety Inventory. Palo Alto, CA: Consulting Psychologists Press.

    Standley, J. (1992). Clinical applications of music and chemotherapy: The effects on nausea and emesis. Music Therapy Perspectives, 10(1), 27-35.

    Turk, D.C. (1996). Psychological aspects of chronic pain and disability. Journal of Musculoskeletal Pain, 4, 145-153.

    van Zurren, F.J. (1998). The effects of information, distraction and coping style on symptom reporting during preterm labor. Psychology and Health, 13, 49-54.

    Vasterling, J., Jenkins, R.A., Tope, D.M., & Burish, T.G. (1993). Cognitive distraction and relaxation training for the control of side effects due to cancer chemotherapy. Journal of Behavioral Medicine, 16, 65-80.

    Villemure, C., & Bushnell, M.C. (2002). Cognitive modulation of pain: How do attention and emotion influence pain processing? Pain, 95, 195-199.

    Weber, S., Nuessler, V., & Wilmanns, W. (1997). A pilot study on the influence of receptive music listening on cancer patients during chemotherapy. International Journal of Arts Medicine, 5(2), 27-35.

    Williams, D.A. (1997). Acute procedural and postoperative pain: Patient-related factors in its undermanagement. American Pain Society Bulletin, 7(4), 8-11.

    Wint, S.S., Eshelman, D., Steele, J., & Guzzetta, C.E. (2002). Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. Oncology Nursing Forum, 29, E8-E15. Retrieved February 24, 2003, from http://www.ons.org/xp6/ONS/Library.xml/ONS_Publications.xml/ONF.xml/ONF…