Music as an adjunct cost-effective therapeutic innovation for Management of Pain in Trauma Patients: A Systematic Review and Meta-analysis

Music as an adjunct cost-effective therapeutic innovation for Management of Pain in Trauma Patients: A Systematic Review and Meta-analysis

Pratyush Kumar , Oshin Puri, Yogesh Bahurupi
Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India; AIl India Institute of Medical Sciences, Rishikesh, India

Introduction: Music therapy reduces pain perceived, alleviates mood and promotes relaxation, regular breathing and rest. Being a readily available and inexpensive therapy, its efficacy for Management of Chronic Pain, such as that experienced by Trauma patients needs further exploration in low resource settings.

Objective: To determine the effectiveness of Music Therapy as an adjuvant therapeutic intervention in trauma patients of adult and pediatric age group in the pre and post procedural period.

Method: PubMed (n=175), Trip Medical Database (n=278) and ClinicalTrials.Gov (n=28) were searched for ‘Trauma’, ‘Music’ & ‘Pain’. Studies identified from inception were imported to EndNote X9 Library and duplicates removed. Only completed RCTs (Pubmed; n-16, TMD; n=2, CT.Gov; n=6) were screened using Title, Abstract and full text (n=41). Data extracted from 12 studies, was analyzed in Review Manager 5.4.

Result: Due to significant heterogeneity (Chi² = 365.17, P < 0.00001; I² = 97%), inverse variance random effect meta-analysis was done. Scores of the various pain measurement scales from a total of 852 patients from 12 studies revealed a pooled Standard Mean Difference of 0.31 [-0.61, 1.22]. Test for overall effect Z = 0.66 (P = 0.51) indicates that there is no significant difference in pain outcomes between Music Adjuvant therapy (MAT) Vs. Conventional Analgesic care. Subgroup analysis reveals a significant favor [Z = 1.18 (P = 0.24)] to MAT in patients of non-malignant pain of traumatic origin while in burn trauma patients it has no significant benefit [Z = 2.23 (P = 0.03)]. Similarly, as per pooled evidence, MAT is highly effective in the pediatric age group [Z = 1.00 (P = 0.32)] while no significant benefit in the adult age group [Z = 1.11 (P = 0.27)].

Conclusion: The pooled evidence suggests that both interventions significantly improve pain outcomes but Music therapy does not have any significant benefit over conventional therapy when compared as a whole. Although, in patients of non-malignant pain of traumatic origin, MAT has significantly high benefit while for Burn trauma patients, MAT has no proven significant benefit over conventional therapy. Evidence from the meta analysis indicates high efficacy of MAT in children while non such benefit can be proven in adult age group. Therefore, MAT could be a potential inexpensive therapeutic adjuvant in non-malignant pain of traumatic origin (for example post fracture reduction, post operative pain, etc.) and for pain management in children.