And see below for the web version of MT student, Kelly Loh’s piece on Music Therapy and Pediatric Pain Management, which is featured in the AMTS Newsletter (2014, Issue 08):
Most children who are hospitalized experience pain. The continuous fear of painful procedures and the actual experience of pain make hospitalization a stressful and even traumatizing event. Perception of pain can be due to cognitive-developmental, emotional, spiritual and sociocultural factors, and may result in feelings of vulnerability, loss of control, anxiety, depression, withdrawal, and regression for the hospitalized child. Pediatric patients who may benefit from music therapy include patients undergoing procedural and postsurgical pain, patients with sickle cell disease, hemophilia, cystic fibrosis, cancer-related pain and trauma-related pain (eg. accident, burns, abuse and violence). Literature on the effects of music therapy in pain reduction often has reference to gate control theory, neuromatrix theory of pain and the decreased activation of the amygdala. For instance, pleasure derived from listening to or making music is correlated to decreased activity in the amygdala (Bradt, 2013).
Music therapy can assist in pain management through various music therapy interventions. In a receptive music therapy session, music has been described as a distraction, a relaxing agent, a mood enhancer, a provider of overriding sensory stimuli, and a mental escape. Receptive music therapy involves the use of music listening to help the child maintain a prolonged focus away from the pain. This could be done through music-assisted relaxation where the child learns to use music purposefully to promote relaxation, facilitate sedation, and decrease pain (Bradt, 2013). In a 2005 study at the Beth Israel Medical Center in New York,the effects of chloral hydrate and music therapy were evaluated and compared as safe and effective ways to achieve sleep/sedation in infants and toddlers undergoing electroencephalogram (EEG) testing. The study showed that music therapy may be a cost-effective, risk-free alternative to pharmacological sedation. In this study, the use of live music therapy rather than recorded music allows the music therapist to be a part of the environment, playing soothing music that relates to the patient, caregiver, and staff needs, thereby responding to the instant responses of the session. The use of familiar songs and lullabies, a soothing voice, and instruments such as the guitar and soft percussion can serve as tension release for babies/toddlers and their caretakers, allowing the children to sleep during an EEG or other diagnostic procedure. Live music can also be shifted in the moment or entrained to match the breathing rate of a child’s physiological response. Adapting the meter/tempo of music to match the breathing rate of a child’s response can enhance the child’s ability to relax. Patients receiving music therapy can easily be awakened and discharged without fearing side effects of medications, whereas patients sedated by chloral hydrate require careful monitoring through levels of care to discharge (Loewy, Hallan, Friedman, Martinez, 2005).
Other music therapy interventions include music-guided imagery, music entrainment, compositional and improvisational music therapy. Improvised music for integration is a method through drumming, toning, and chanting in an improvisatory style to help the child integrate the hurt (Bradt, 2013). Music therapy improvisation utilizes music making to actively engage the child with his/her surroundings in a playful manner to restore a sense of control, mastery, and even normalcy. Music-making brings about change in the child’s social role as well. Whereas the child may feel helpless in the hospital environment, resulting in dependent behaviors, active music-making transforms the child into a “doer,” enabling the child to experience the benefits of active engagement. The music therapist can help the child transfer this to contexts outside of the music therapy session (Nolan, 1997).
Pain assists us in avoiding physical harm, but unrelieved pain may be inherently harmful both psychologically and physiologically. Failure to intervene early in children’s pain may lead to impairment in functioning and disruption in families. Unaddressed pain heightens anxiety and fear, which, in turn, increases perception of pain (Gerik, 2005). By taking charge of some of the factors contributing to a painful experience, children may learn to re-conceptualize the pain experience as one they can partly control.
Bradt, J. (2013). Guidelines for music therapy practice in pediatric care: Pain management with children. (Vol. 2, pp. 15-65). NH, USA: Barcelona Publishers.
Gerik, S. (2005). Pain Management in Children: Developmental Considerations and Mind-body Therapies. Southern Medical Journal. Vol 98(3), pp 295-302.
Loewy J, Hallan C, Friedman E, Martinez C. (2005). Sleep/sedation in children undergoing EEG testing: A comparison of chloral hydrate and music therapy. Journal of PeriAnesthesia Nursing, Vol 2(5), pp 323-332.
Nolan, P. (1997). Music therapy in the pediatric pain experience: Theory, practice and research at Allegheny University of the Health Sciences. In J. V. Loewy (Ed.), Music therapy and pediatric pain (pp. 57–68). Cherry Hill, NJ: Jeffrey Books.”