JMIR Publications

ABSTRACT

Background:

Emergency physicians face the challenge of relieving acute pain daily. While opioids are a potent treatment for pain, the opioid epidemic has ignited a search for non-opioid analgesic alternatives which may decrease the dose or duration of opioid exposure. While behavioral therapies and complementary medicine are effective, they are difficult to deploy in the ED. Music is a potential adjunctive therapy that has demonstrated effectiveness in managing pain. Here, we explored the feasibility and effectiveness of a smartphone-based music intervention to address acute pain in the ED.

Objective:

To measure the feasibility and acceptability of a smartphone-based music intervention for acute pain in the ED.

Methods:

This prospective cohort study enrolled patients admitted to an ED observation unit with pain who had received orders for opioids. Baseline pain and psychosocial characteristics including anxiety, sleep disturbance, and pain catastrophizing were gathered using validated questionnaires. Participants received a smartphone-based music intervention and music listening occurred in either a supervised (RA-delivered music session three time during their stay) or unsupervised manner (music used ad lib by participant). The app collected pre-music and post-music pain and anxiety scores, and participants provided qualitative feedbakc regarding acceptability of operating the music intervention.

Results:

81 participants were enrolled and 38 randomized to unsupervised, 43 randomized to supervised groups. Average pain in both groups was 6.1 +/- 1.8 out of 10. 53% reported use of music apps at home. An overall modest but significant decrease in pain (-0.81 CI:-0.45, -1.16) and anxiety (-0.72 CI:-0.33, -1.12) was observed after music sessions. Substantial variability was seen in the reduction amongst participants, with individuals with higher baseline pain, catastrophizing about pain, or anxiety reporting greater relief. Changes in pain were related to changes in anxiety (Pearson Rho: 0.3, p=0.02), but did not vary between supervised and unsupervised groups. Upon conclusion of the study, 74% (N=46) reported they liked the music intervention and 92% (n=57) reported the app was easy to use. Seventy nine percent (N=49) reported they would be willing to use the music intervention at home.

Conclusions:

A smartphone-based music intervention decreased pain and anxiety among patients in an emergency department observation unit, with no difference seen between supervised and unsupervised use. Individuals reporting the greatest reduction in pain after music sessions included those scoring highest on baseline assessment of catastrophic thinking, suggesting there may be specific patient populations that may benefit more from using music as an analgesic adjunct in the emergency department. Qualitative feedback suggested that this intervention was feasible and acceptable by emergency department patients.