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Page 1: Role of Adjuvant Music Therapy

ROLE OF ADJUVANT

MUSIC THERAPY

Dr.T.Varun Raju

Senior Laparoscopic & GI Surgeon

OMNI Hospitals

Kukatpally Hyderabad

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Historical aspects Long before acoustics came to be understood in Europe as

a subject of study, the ancient Arab, Greek and Indian

civilizations were already familiar with the therapeutic

role of sounds and vibrations and the later day concepts

pertaining to them.

As Plato (428 BC-348 BC), one of the world's most

influential philosophers, stated in the Republic (written

around 380BC): “Music moulds character, when modes of

music change, the fundamental laws of the state change

with them." He also wrote that "Music is medicine to the

soul“ and "Justice is to the soul as health is to the body.

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Historical aspects During the time of the RENAISSANCE AND BEYOND (1580-1750

AD), the PHYSICIAN used music to effect desired emotional and physiological changes.

During the ROMANTIC ERA (2nd half of 18th C. – early 20th C.), the PHYSICIANMUSICIAN used music listening, active music-making, and live musical performances in their work with patients of all ages and disabilities.

TWENTIETH CENTURY ~ BIRTH OF MUSIC THERAPY AS A PROFESSIONAL HEALTH CARE DISCIPLINE.

Rapid urbanization resulted in large mental hospitals. One attempt to turn these mental asylums into active treatment centres was through music played by hospital and community musicians.

Page 4: Role of Adjuvant Music Therapy

Historical aspects

Furthermore, with the return of World War II veterans traumatized by their

horrific war experiences, and their remarkable responses to music, there was

a growing interest in the therapeutic and rehabilitative value of music – both

live and recorded (thanks to Edison's invention of the phonograph in 1877).

At the same time, an increasing number of publications were presenting the

case for music therapy and for training music therapists who were able to use

specific music skills in the assessment and treatment of patients of all ages and

presenting a wide range of disabilities.

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Historical aspects

The need for specially trained music therapists was realized

in 1944 with the establishment of the first training program at

Michigan State University. In 1950 the first Association for

Music Therapy was founded in the United States, and in

2010, the American Music Therapy Association celebrated 60

years of development and growth.

Music Therapy has become a recognized professional health

care discipline.

For information on the state of music therapy throughout the

world, go to www.voices.no {World Forum for Music

Therapy}.

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Historical aspects

Music Therapists draw from ancient healing traditions and

from evidence –based research on the behavioural and

cognitive effects of music (behaviour-oriented music

therapy), the physiological effects of music (medical model of

music therapy) and the psychological effects (insight-oriented

music therapy ~ psychodynamic,analytical).

“Music therapy is a systematic process of intervention

wherein the therapist helps the client to promote health,

using music experiences and the relationships that develop

through them as dynamic forces of change.” (1998, p.20)

(Kenneth Bruscia, a key player and prolific writer )

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Research,Education,Publications, Associations 1. The earliest known reference to music therapy appeared in

1789 in an unsigned article in Columbian Magazine titled "Music Physically Considered."

2. (1806). Atlee and Mathews were both students of Dr.Benjamin Rush, a physician and psychiatrist who was a strong proponent of using music to treat medical diseases.

3. Interest in music therapy continued to gain support during the early 1900s leading to the formation of several short-lived associations.

4.In 1903, Eva Augusta Vescelius founded the National Society of Musical Therapeutics. In 1926, Isa Maud Ilsen founded the National Association for Music in Hospitals.

And in 1941, Harriet Ayer Seymour founded the National Foundation of Music Therapy.

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Research,Education,Publications, Associations 5. In the 1940s, three persons began to emerge as innovators

and key players in the development of music therapy as an organized clinical profession.

6. E. Thayer Gaston, known as the "father of music therapy," was instrumental in moving the profession forward in terms of an organizational and educational standpoint.

7. The first music therapy college training programs were also created in the 1940s. Michigan State University established the first academic program in music therapy (1944) and other universities followed suit, including the University of Kansas, Chicago Musical College, College of the Pacific, and AlvernoCollege.

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Research,Education,Publications,

Associations

The National Association for Music Therapy (NAMT) was

founded at a meeting in New York City on June 2, 1950.

NAMT operated from 1950-1997 and saw the creation of a

board-certification program (1985), a critically-acclaimed

Senate Hearing on Aging (1991), and the growth of music

therapy from a few dozen practitioners to thousands.

The American Association for Music Therapy (AAMT) was

established in 1971. Many of the purposes of AAMT were

similar to those of NAMT, but there were differences in

philosophy, education and approach.

Page 10: Role of Adjuvant Music Therapy

Research,Education,Publications,

Associations .CBMT has been fully-accredited by the National Commission

for Certifying Agencies since 1986 and is committed to maintaining certification and recertification requirements that reflect current music therapy practice. To date, there are over 5,000 certificants who hold the credential Music Therapist-Board Certified (MT-BC). CBMT and AMTA are separate, independent organizations.

Currently, AMTA is the intellectual home of and serves over 5,000 music therapists. It publishes two research journals as well as a line of publications, serves as an advocate for music therapy on the state and federal levels, promotes music therapy through social media streams, and provides research bibliographies, podcasts, scholarships, and newsletters to its members.

Page 11: Role of Adjuvant Music Therapy

Music therapy as an adjuvant therapeutic tool

in medical practice: an evidence-based

summary

TA Mattei*, AH Rodriguez

Department of Neurosurgery, University of Illinois, College of

Medicine at Peoria, Peoria, Illinois, USA

Corresponding author Email:

[email protected]

Page 12: Role of Adjuvant Music Therapy

Materials and methods

A literature search was conducted using the following

criteria: supportive, peer-reviewed, scientific music

therapy research on human subjects, available in the

English language, dating from 1990 until 2012 and

listed on the PubMed/Medline database in the form

of randomised and non-randomised clinical trials,

meta-analyses and systematic reviews. A multi-word,

multi-search approach was used, utilising various

combinations of terms such as ‘music’, ‘therapy’,

‘anxiety’, ‘pain’, ‘symptoms’, ‘patient’, ‘anxiolytic’,

‘analgesic’, ‘vitals’, ‘heart rate’ and ‘blood pressure.

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All articles that met the criteria were then

systematically categorised twice based on

two separate categories: variables under

investigation (e.g. anxiety, pain, analgesic

use, vital signs and biochemical markers)

and level of evidence provided by the

research study according to its design (non-

randomised or randomised controlled

clinical trial, meta-analysis or systematic

review).

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Results

Forty-nine studies met the proposed search criteria,

consisting of six systematic reviews, three meta-

analyses, 33 randomised and seven non-randomised

clinical trials. The primary variables targeted by these

studies included anxiety/sedative requirements (42

studies), vital signs (30 studies), pain/analgesic use

(22 studies), mood/depression (five studies) and

biochemical markers related to pain, fear and anxiety

(seven studies).

Page 15: Role of Adjuvant Music Therapy

ResultsThe authors found that music therapy has already been

investigated scientifically in a broad array of clinical settings

in several medical fields including family medicine,

paediatrics, internal medicine, nursing, gastroenterology,

cardiology, pulmonology, haematology and oncology,

otolaryngology, urology, obstetrics and gynaecology, surgery,

anaesthesiology, interventional radiology, neurology and

psychiatry.

Page 16: Role of Adjuvant Music Therapy

Conclusion

The results of this review suggest that music therapy

may be useful as an adjuvant therapy in medical

practice in a broad variety of clinical settings, from

the general clinical exam room to specific scenarios

involving interventional procedures and surgical

operations. This review provides a useful evidence-

based summary for both generalists and specialists

about the current scientific evidence of the beneficial

effects of music therapy as an adjuvant tool in

medical practice.

Page 17: Role of Adjuvant Music Therapy

ConclusionMoreover, as music therapy represents a very inexpensive

and safe therapeutic tool, which has been shown to positively

influence several physiological variables related to anxiety,

stress response and pain, the presented scientific evidence

is intended to increase awareness among the medical

community of the possible benefits of the widespread

application of music therapy throughout modern medical

practice.

Page 18: Role of Adjuvant Music Therapy

References1. Misic P, Arandjelovic D, Stanojkovic S, Vladejic S, Mladenovic J. Music Therapy. Eur Psychiatry

2010 Jan;839.

2. Bradt J, Dileo C, Grocke D, Magill L. Music interventions for improving psychological and physical

outcomes in cancer patients. Cochrane Database Syst Rev 2011 Aug(8):CD006911.

3. Bradt J, Dileo C. Music for stress and anxiety reduction in coronary heart disease patients.

Cochrane Database Syst Rev 2009 Apr(2):CD006577.

4. Evans D . The effectiveness of music as an intervention for hospital patients: a systematic review.

J Adv Nurs 2002 Jan;37(1):8-18.

5. Galaal KA, Deane K, Sangal S, Lopes AD. Interventions for reducing anxiety in women undergoing

colposcopy. Cochrane Database Syst Rev 2007 Jul(3):CD006013.

6. Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. Music for pain and anxiety in children

undergoing medical procedures: a systematic review of randomized controlled trials. Ambul Pediatr

2008 Mar–Apr;8(2):117-28.

7. Nilsson U . The anxiety- and pain-reducing effects of music interventions: a systematic review.

AORN J 2008 Apr;87(4):780-807.

8. Loomba RS, Arora R, Shah PH, Chandrasekar S, Molnar J. Effects of music on systolic blood

pressure, diastolic blood pressure, and heart rate: a meta-analysis. Indian Heart J 2012: May–

Jun;64(3):309-13.

9. Rudin D, Kiss A, Wetz RV, Sottile VM. Music in the endoscopy suite: a meta-analysis of

randomized controlled studies. Endoscopy 2007 Jun;39(6):507-10.

10. Tam WW, Wong EL, Twinn SF. Effect of music on procedure time and sedation during

colonoscopy: a meta-analysis. World J Gastroenterol 2008 Sep;14(34):5336-43.

Page 19: Role of Adjuvant Music Therapy

References 11. Aragon D, Farris C, Byers JF. The effects of harp music in vascular and thoracic surgical patients. Altern Ther

Health Med 2002 Sep–Oct;8(5):52-4, 56–60.

12. Binek J, Sagmeister M, Borovicka J, Knierim M, Magdeburg B, Meyenberger C. Perception of gastrointestinal

endoscopy by patients and examiners with and without background music. Digestion 2003;68(1):5-8.

13. Bringman H, Giesecke K, Thörne A, Bringman S. Relaxing music as premedication before surgery: a randomised

controlled trial. Acta Anaesthesiol Scand 2009 Jul;53(6):759-64.

14. Buffum MD, Sasso C, Sands LP, Lanier E, Yellen M, Hayes A. A music intervention to reduce anxiety before

vascular angiography procedures. J Vasc Nurs 2006 Sep;24(3):68-73.

15. Chan MF, Chan EA, Mok E, Kwan Tse FY. Effect of music on depression levels and physiological responses in

community-based older adults. Int J Ment Health Nurs 2009 Aug;18(4):285-94.

16. Chan YM, Lee PW, Ng TY, Ngan HY, Wong LC. The use of music to reduce anxiety for patients undergoing

colposcopy: a randomized trial. Gynecol Oncol 2003 Oct;91(1):213-7.

17. Chlan L, Evans D, Greenleaf M, Walker J. Effects of a single music therapy intervention on anxiety, discomfort,

satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy. Gastroenterol

Nurs 2000 Jul–Aug;23(4):148-56.

18. Cooke M, Chaboyer W, Schluter P, Hiratos M. The effect of music on preoperative anxiety in day surgery. J Adv

Nurs 2005 Oct;52(1):47-55.

19. Han L, Li JP, Sit JW, Chung L, Jiao ZY, Ma WG. Effects of music intervention on physiological stress response

and anxiety level of mechanically ventilated patients in China: a randomised controlled trial. J Clin Nurs 2010

Apr;19(7–8):978-87.

20. Hatem TP, Lira PI, Mattos SS. The therapeutic effects of music in children following cardiac surgery. J Pediatr (Rio

J) 2006 May–Jun;82(3):186-92.

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Western Michigan University

ScholarWorks at WMU

Music Therapy and Quality of Life: The Effects of

Musical Interventions on Self-Reported and

Caregiver-Reported Quality of Life in Older Adults

with Symptoms of Dementia

Alisha Snyder

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Pain Manag Nurs. 2014 Mar;15(1):406-25. doi:

10.1016/j.pmn.2012.08.010. Epub 2012 Oct 26.

Music as an adjuvant therapy in control of pain and symptoms in

hospitalized adults: a systematic review.

Cole LC1, LoBiondo-Wood G2.

Abstract

The objective of this review is to evaluate the evidence regarding the use of music as an adjuvant therapy for pain control in hospitalized adults.

The search terms music, music therapy, pain, adults, inpatient, and hospitalized were used to search the Cochrane Library, Cinahl, Medline, Natural Standard, and Scopus databases from January 2005 to March 2011.

(A systematic review conducted by the Cochrane Collaboration has extensively covered the time frame from 1966 to 2004.)

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Seventeen randomized controlled trials met criteria for review and inclusion.

Seven of the research studies were conducted with surgical patients, three with medical patients, one with medical-surgical patients, four with intensive care patients, and two with pregnant patients.

The combined findings of these studies provide support for the use of music as an adjuvant approach to pain control in hospitalized adults.

The use of music is safe, inexpensive, and an independent nursing function that can be easily incorporated into the routine care of patients.

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J Music Ther. 2015 Spring;52(1):1-77. doi: 10.1093/jmt/thv004.

Epub 2015 Apr 15.

A systematic review of music-based interventions for

procedural support.

Yinger OS1, Gooding LF2.

BACKGROUND:

Individuals undergoing medical procedures frequently

experience pain and anxiety. Music-based interventions have

the potential to help alleviate these symptoms.

OBJECTIVE:

This review investigated the effects of music-based

interventions (music therapy and music medicine) on pain

and anxiety in children and adults undergoing medical

procedures.

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METHODS:

This systematic review examined randomized controlled trial

music intervention studies to manage patient-reported pain

and/or anxiety during medical procedures.

All studies were published in English and peer-reviewed

journals. Quality and risk of bias were assessed using criteria

from the Checklist to Evaluate a Report of a

Nonpharmacological Trial (CLEAR-NPT).

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RESULTS:

Fifty studies met inclusion criteria, the majority of which (84%) had a high risk of bias. It was not possible to perform a meta-analysis because studies varied greatly in terms of medical procedure and intervention type. Results varied across studies, with approximately half (48%) indicating less anxiety for music intervention participants; fewer studies (36%) reported less pain for music intervention participants.

CONCLUSIONS:

There is a need to clearly define and differentiate between music therapy and music medicine interventions in procedural support research.

Further research is necessary to determine which patients would benefit most from music interventions during medical procedures, and which interventions are most beneficial.

To improve research quality and reduce risk of bias, when designing studies investigators need to carefully consider factors related to design, including randomization, treatment allocation concealment, blinding outcome assessors, and intention-to-treat analysis.

In addition, more detailed intervention reporting is needed when publishing results.

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The Effect of Music on the Human Stress Response

Myriam V. Thoma,1,2 Roberto La Marca,2 Rebecca

Brönnimann,2 Linda Finkel,2 Ulrike Ehlert,2 and Urs M.

Nater3,*

Robert L. Newton, Editor

Background

Music listening has been suggested to beneficially impact health via stress-reducing effects.

However, the existing literature presents itself with a limited number of investigations and with discrepancies in reported findings that may result from methodological shortcomings (e.g. small sample size, no valid stressor).

It was the aim of the current study to address this gap in knowledge and overcome previous shortcomings by thoroughly examining music effects across endocrine, autonomic, cognitive, and emotional domains of the human stress response.

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Methods

Sixty healthy female volunteers (mean age = 25 years) were exposed to a standardized psychosocial stress test after having been randomly assigned to one of three different conditions prior to the stress test: 1) relaxing music (‘Miserere’, Allegri) (RM), 2) sound of rippling water (SW), and 3) rest without acoustic stimulation (R).

Salivary cortisol and salivary alpha-amylase (sAA), heart rate (HR), respiratory sinus arrhythmia (RSA), subjective stress perception and anxiety were repeatedly assessed in all subjects.

We hypothesized that listening to RM prior to the stress test, compared to SW or R would result in a decreased stress response across all measured parameters.

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Results

The three conditions significantly differed regarding cortisol response (p = 0.025) to the stressor, with highest concentrations in the RM and lowest in the SW condition.

After the stressor, sAA (p=0.026) baseline values were reached considerably faster in the RM group than in the R group.

HR and psychological measures did not significantly differ between groups.

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Conclusion

Our findings indicate that music listening impacted the

psychobiological stress system.

Listening to music prior to a standardized stressor

predominantly affected the autonomic nervous system (in

terms of a faster recovery), and to a lesser degree the

endocrine and psychological stress response.

These findings may help better understanding the beneficial

effects of music on the human body.

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Arq Bras Cardiol. 2009 Nov;93(5):534-40.

Music therapy effects on the quality of life and the blood pressure of

hypertensive patients.

Zanini CR1, Jardim PC, Salgado CM, Nunes MC, Urzêda FL,

Carvalho MV, Pereira DA, Jardim Tde S, Souza WK. Brasil.

BACKGROUND:

Arterial Hypertension (AH) is a mass disease, with

consequences for the cardiocirculatory system, since its

complications raise the rates of morbidity and mortality.

Controlling blood pressure (BP) reduces complications and

may preserve the quality of life (QOL) of patients.

Studies show positive effects of music therapy as an adjuvant

in the treatment of several diseases.

OBJECTIVE:

to evaluate the effect of music therapy on the QOL and BP

control of hypertensive patients.

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METHODS:

This was a controlled clinical study that evaluated patients of both genders, aged over 50 years, with stage 1 hypertension, in use of medication and enrolled in multidisciplinary service for treatment of hypertension.

They were divided into an experimental group (EG) and a control group (CG).

The EG, in addition to the conventional treatment, participated in weekly music therapy sessions for twelve weeks.

The CG received the standard treatment of the service.

Before and after the intervention, the SF-36 questionnaire was applied in both groups, and the BP of each patient was measured.

The voice, an important element of communication, reflecting the patient's physical, mental and emotional state, was the main resource used.

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STATISTICS:

Student T-test and Wilcoxon test were considered significant

at p <0.05.

RESULTS:

The groups were initially similar in gender, age, education,

and the assessed QOL.

In the initial and final comparison of EG patients, we

observed a significant improvement on the QOL (p <0.05)

and BP control (p <0.05), with no change in adhesion.

CONCLUSIONS:

Music therapy has contributed to an improvement on the

QOL and BP control of patients, suggesting that this activity

may represent a therapeutic approach to help strengthen the

programs of multidisciplinary care of hypertensive patients.

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INFLUENCE OF MUSIC THERAPY ON HYPERTENSIVE PATIENTS

WITH EARLY POST-INFARCTION ANGINA. September 2016

Mitrovic, P.; Stefanovic, B.; Paladin, A.; Radovanovic, M.;

Radovanovic, N.; Rajic, D.; Matic, G.; Subotic, I.; Vasiljevic, Y.;

Bulatovic, V.

Objective:

Most studies have shown that early post-infarction angina (EPA) implies an unfavorable long-term prognosis among patients with acute myocardial infarction (AMI).

Unrelieved anxiety combined with hypertension (HTA) can produce an increase in sympathetic nervous system activity leading to an increase in cardiac workload.

The purpose of this study was to evaluate the effectiveness of music therapy for reduction of anxiety and pain in patients with HTA and EPA.

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Design and method:

The effectiveness of music in reducing anxiety and pain during

EPA attacks was tested using a two-group pretest-posttest

experimental design with 220 patients with HTA and EPA.

Patients were randomly assigned to receive 30 min of sedative

music (N = 110) or treatment as usual (N = 110).

Anxiety, pain sensation, and pain distress were measured with

visual analogue scales at start of chest pain episodes and 30

min later.

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Results:

Repeated measures MANOVA indicated significant group

differences in anxiety, pain sensation, and pain distress from

pretest to posttest (p = 0.0018).

Post hoc dependent t-tests and univariate repeated measures

ANOVA (p = 0.0184) indicated that in the sedative music,

anxiety, pain sensation, and pain distress all decreased

significantly (p = 0.0118), while in the treatment as usual

group, no significant differences occurred.

Independent t-tests indicated significantly less posttest

anxiety, pain sensation, and pain distress in the sedative music

group than in treatment as usual groups (p = 0.0208).

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Conclusions:

Sedative music was more effective than treatment as usual

in decreasing anxiety and pain in patients with HTA and EPA.

Patients with HTA should have beneficial of using sedative

music as an adjuvant to medication during EPA episodes.

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The Therapeutic Effect Of Indian Classical Music on

Physiological And Psychological Parameters Of

Hypertension in Geriatric Patients

Manasi M Godbole and Anita Basavaraj

Hypertension. 2014;64:A628

Aim:

To evaluate the effect of Indian classical music as evidence

based treatment for hypertension and anxiety level reduction.

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Method:

Pre-selected 60 geriatric patients (60-85years) were randomly

assigned to Study Group(SG){n=30}and Control

Group(CG){n=30}.

The SG, in addition to conventional treatment, received 20

minutes of pre-recorded Indian classical music therapy for 4

sessions.

The CG received standard treatment alone.

Blood pressure (BP), pulse rate (PR) and respiratory rate (RR)

were taken before and after each session.

Psychological assessment was done at the start and at the

conclusion of final session.

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Results:

Comparing pre and post parameters of all the sessions, the

intervention resulted in a statistically significant reduction in BP

and RR in both groups and significant reduction in PR only in

the SG.

Further analysis revealed a more statistically significant

reduction in BP, PR and RR and anxiety levels in the SG as

compared to CG after music session.

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Conclusion:

This study indicates the use of Indian classical music as an

innovative therapeutic approach in modern era for prevention

or in conjunction with antihypertensive medications for blood

pressure management in geriatric patients.

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Format: AbstractSend to

Indian J Surg. 2014 Oct;76(5):363-70. doi:

10.1007/s12262-012-0705-3. Epub 2012 Aug 1.

Effect of the Raga Ananda Bhairavi in Post Operative Pain Relief

Management.

Kumar TS1, Muthuraman M2, Krishnakumar R2.

Abstract

Music is considered as an universal language and has influences the

human existence at various levels.In recent years music therapy has

evolved as a challenge of research with a clinical approach involving

science and art. Music therapy has been used for various therapeutic

reasons like Alzheimer's disease,Hypertension and mental disorders to

name a few. We conducted a study to establish the effect of the

classical ragam Anandhabhairavi on post operative pain relief

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. A randomized controlled study involving 60 patients who were to undergo surgery was conducted at PSG Institute of Medical Sciences and Research,Coimbatore.

30 patients selected at random and were exposed to the ragamAnandhabhairavi which was played in their room pre operatively (from the day they got admitted for surgery) and 3 days post operatively.

The control group did not listen to the music during their stay in the hospital. An observation chart was attached in which the requirement of analgesics by the patient was recorded.

On completion of the study and on analysis,the ragam Anandhabhairavi had a significant effect in post operative pain management which was evidenced by the reduction in analgesic requirement by 50 % in those who listened to the ragam.A significant p value of <0.001 was obtained.

KEYWORDS:

Analgesic requirement; Anandhabhairavi; Music therapy; Pain management; Post operative pain


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