Music therapy (MT) is a recognized modality for pain and anxiety reduction. Although its efficacy has been demonstrated in various clinical settings, its application in emergency departments (ED) remains controversial. This study aims to study the effects of MT in reducing pain and anxiety among patients visiting the ED with pain complaints.

A single-center, randomized controlled trial was conducted at Ramathibodi Hospital, Bangkok, from July 2023 to September 2024. During each month of the study period, three days were randomly selected for the MT group, and another three days were designated for the non-MT group. All participants received standard analgesia and completed pre- and post-session questionnaires to assess pain, anxiety, satisfaction, and ED service quality before and one hour after analgesia. The MT group received MT sessions, each lasting 30-40 min.

Sixty-three patients participated (31 MT group, 32 control group). The MT group showed a significant reduction in pain scores of 1.52 points compared to 0.09 in the non-MT group (p 0.002). Anxiety score was also significantly reduced in the MT group by 1.87 points compared to 0.44 points in the non-MT group (p 0.026). The most significant improvements were observed in non-trauma-related pain and anxiety. Satisfaction scores increased in both groups (0.48 vs. 0.47 points; p 0.946), with no significant difference. However, MT significantly improved perceived ED service quality (0.98 vs. 0.10 points; p 0.001).

In this study, we found that music therapy, when combined with standard analgesia, effectively reduced pain and anxiety in patients presenting to the ED, particularly those with non-trauma-related pain.

TCTR20231109003. Registration site Thai Clinical Trials Registry. URL: https://www.thaiclinicaltrials.org/show/TCTR20231109003 . Date of approval: 20 June 2023.

The μ-opioid receptor (MOR) system mediates incentive motivation and the hedonic component of primary rewards such as food and sex. However, there is no direct in vivo evidence for the involvement of the MOR system in pleasure derived from aesthetic rewards such as music.  METHODS: We measured MOR availability with positron emission tomography (PET) and the agonist radioligand [11C]carfentanil with high affinity for MORs during the listening of pleasurable music and neutral baseline condition. Haemodynamic responses associated with dynamic pleasure ratings during listening to music and control stimuli were measured using functional magnetic resonance imaging (fMRI).

The PET results revealed that pleasurable music increased [11C]carfentanil binding in several cortical and subcortical regions, including ventral striatum and orbitofrontal cortex, known to contain "hedonic hotspots". [11C]carfentanil binding in the nucleus accumbens during the music condition was associated with number of pleasurable chills, linking the subjective experience of pleasure to striatal opioid release. Individual variation in baseline MOR tone influenced pleasure-dependent haemodynamic responses during music listening in regions associated with interoceptive, sensorimotor, and reward processing.

These findings provide the first neuroimaging evidence that pleasurable music modulates MOR system function. The results indicate that the μ-opioid system governs complex aesthetic rewards in addition to biologically essential primary rewards.

Colonoscopy is a standard diagnostic procedure, yet pre-procedural anxiety remains a prevalent concern. While pharmacological interventions are available, non-pharmacological approaches such as reflexology offer a promising alternative. Despite its therapeutic potential, comparative evidence on foot and hand reflexology in this setting is limited. This study aimed to evaluate their effects on pre-colonoscopy anxiety and physiological parameters.

This randomized clinical study was conducted from November 2022 to August 2023 at the Amir al-Momenin Educational and Therapeutic Center in Arak, Iran. A total of 105 patients were randomly assigned to three equal-sized groups (n = 35) using block randomization: foot reflexology, hand reflexology, and a control group. Patients in the intervention groups received a 30-min reflexology session. Anxiety levels were assessed using the Spielberger State-Trait Anxiety Inventory (STAI-Y1), a validated tool for measuring situational anxiety. Physiological indices, including systolic and diastolic blood pressure, heart rate, and arterial oxygen saturation (SpO2), were measured immediately before and after the intervention.

There were no significant differences in clinical outcomes among the groups at baseline (p > 0.05). However, following the intervention, the mean anxiety scores in both reflexology groups (foot reflexology: 44.39 ± 5.21; hand reflexology: 45.6 ± 4.49) were significantly lower than that of the control group (48.05 ± 4.81) (p = 0.008), as determined by one-way analysis of variance (ANOVA). The anxiety reduction was more pronounced in the foot reflexology group than the hand reflexology group, although this difference did not reach statistical significance (p > 0.05). Additionally, post-intervention assessments revealed significant differences in systolic blood pressure (foot reflexology: 123.48 ± 16.40 mmHg; hand reflexology: 122.65 ± 14.97 mmHg; control group: 132.14 ± 18.48 mmHg) and heart rate (foot reflexology: 78.60 ± 9.54 bpm; hand reflexology: 78.25 ± 11.41 bpm; control group: 85.05 ± 10.82 bpm) across the groups (p < 0.05). However, no significant differences were observed for diastolic blood pressure or arterial oxygen saturation (SPO2) between groups (p > 0.05).

The findings of this study indicate that reflexology, particularly foot reflexology, can significantly reduce anxiety and lead to improvements in physiological parameters, such as systolic blood pressure and heart rate, in patients undergoing colonoscopy. These results highlight the potential of reflexology as an effective complementary method for managing anxiety and enhancing patient comfort during medical procedures.

Music listening for pain relief is well studied in diverse healthcare settings, but its implementation remains challenging. While healthcare providers generally have a positive attitude, there is a lack of knowledge about healthcare recipients' perceptions and attitudes. Therefore, the aim of this study is to explore healthcare recipients' perceptions of listening to music for pain management, focusing on their general attitudes, implementation strategies and subjective experiences of how music helps (or does not help).

A multi-method study comprising a quantitative survey and qualitative interviews. It is a follow-up conducted 6 months after a randomised experimental study, which assessed the influence of different music genres on pain tolerance. At the end of the original experiment, participants received advice on listening to music in painful situations.

Rotterdam, The Netherlands.

The survey involved 169 participants (age mean 30.6, SD 9.8; 61.9% female) who participated in the initial trial. Following this, 20 in-depth interviews were conducted.

Perceptions of music for pain management were investigated, revealing general trends in the quantitative survey data. Data-led thematic analysis of the qualitative interviews focused on individual perceptions.

Participants showed a high willingness to use music for pain relief, particularly for so-called emotional pain (eg, anxiety, stress and heartbreak). Individual attitudes varied regarding different situations, types of music and types of pain. Barriers such as not considering the option and social sensitivity within healthcare contexts were discussed. A proactive approach by healthcare professionals and autonomy of healthcare recipients were suggested to overcome these barriers. Interestingly, the 'wrong' type of music or the 'wrong' situation were mentioned as non-beneficial or even harmful.

Awareness of individual needs and potential negative effects is crucial for the use of music for pain relief. A proactive and personalised approach is needed to effectively implement music in healthcare.

Background/Objectives: Audio and audiovisual distraction can be effective additive tools to reduce anxiety and pain in patients receiving outpatient procedures (OP). Audiovisual distraction tools already showed positive effects on pain perception in some urological procedures. To identify the effects of audio and audiovisual distraction on pain and anxiety in patients receiving perineal prostate biopsy (PPB), we performed a prospective randomized controlled study. Methods: We recruited 168 male patients undergoing PPB which were randomized into three groups: a control group (CG), an audio distraction group (ADG) and an audiovisual distraction group (AVDG). The CG received no intervention, while the ADG received audio distraction and the AVDG received audiovisual distraction while PPB was performed. The primary endpoint was pain perception, measured in the Numeric Rating Scale (NRS) and Visual Analogue Scale (VAS). Secondary endpoints were subjective and objective procedure time (SPT/OPT), heart rate, blood pressure, cortisol blood levels and scores in the State-Trait Anxiety Inventory (STAI) questionnaire. Results: Demographics of each group were similar (CG = mean age (a) = 69.5; ADG a = 67 years; AVDG a = 67). We did not find any significant difference regarding our primary endpoint, pain perception (p = 0.384). In contrast, we examined a highly significant difference between SPT and OPT, comparing AVDG to CG (p < 0.001) and AVDG to ADG (p < 0.001), but not for ADG to CG (p = 0.348). There was no significant difference in the secondary endpoints, heart rate, blood pressure, STAI scores and willingness to repeat the procedure. Conclusions: Our study shows that audiovisual distraction can significantly shorten SPT for patients receiving PPB, which may represent their comfort throughout the procedure. To accelerate the wider implementation of audiovisual distraction as a cost-efficient tool in outpatient urological procedures, further studies should examine its effect on different OPs with a more heterogeneous patient group.

Patients with acute cardiovascular disease require out-of-hospital care during the most critical and vulnerable periods of their illness. This study aims to evaluate the influence of musical intervention in patients with acute cardiovascular disease during transfer in Advanced Life Support (ALS) ambulances using an analytical randomized controlled case-control experimental study conducted according to CONSORT guidelines. Forty-one subjects took part in the study. The patients required the administration of nitrates/antiarrhythmics (n = 11, 26.8%), (n = 5, 12.2%) antiemetics, and (n = 7, 17.1%) opioids. Statistically significant differences were found for blood pressure and the variable cardiovascular drugs between groups. The use of music therapy to complement other health measures in ALS ambulances lowers blood pressure values and reduces the need to administrate cardiovascular drugs, thus avoiding their possible side effects. It is easy to implement, has a low cost and should be monitored and controlled as a specific nursing intervention, included in the care of patients transferred by ambulances on a routine basis.

Perioperative music interventions are promising, with substantial beneficial effects on patients. However, adequate reporting is crucial for interpreting the outcomes and implementing the interventions. Our objective is to analyze the reporting quality of perioperative music interventions and to provide recommendations and a research agenda for future trials.

This study utilized data from a systematic review, that was conducted as part of a separate previous analysis by Geensen, Dirven et al. For this analysis, a PROSPERO registration (CRD42023427138) was formalized. The Template for intervention Description and Replication (TiDieR) checklist was adapted and used. Nineteen intervention items were assessed, categorized in the aim, the core and the implementation.

Due to narrowed inclusion criteria, ten music intervention studies were included. None of the studies completely reported all intervention items. The reporting of core intervention items were poorly described. Complete description of implementation items, such as fidelity and modifications, was scarce.

Perioperative music studies often lack the complete reporting of essential intervention items. This hinders replicability, generalization of the results and might contribute to research waste. We recommend adequate reporting in future studies to avoid these problems, by using our adapted TIDieR checklist.

Pregnancy is associated with physical, physiological and hormonal changes, that significantly influence sleep. Pregnancy-related insomnia is associated with a higher risk of complications during pregnancy and labor as well as postpartum depression. Music is widely used to promote sleep, as it is easily accessible, non-pharmacological and without side effects, but the effect of music-listening for pregnancy-related insomnia is unclear.

Eight electronic databases were searched for RCTs investigating the effect of music listening on pregnant women with insomnia. Two researchers independently screened the identified studies for eligibility and post-intervention data were extracted. We assed risk of bias using the Cochrane risk of bias assessment (RoB1). A random-effects meta-analysis was conducted to assess changes in subjective sleep quality following a music-based intervention compared to controls.

Four RCTs (348 participants) were included in the systematic review and meta-analysis. Music interventions significantly reduced sleep problems (MD -1.38, 95 % CI -2.56 to -0.19; p = 0.02) compared to no treatment or treatment as usual. Since it is not possible to blind participants to the music interventions, all the studies were rated with high risk of bias in at least one domain.

This review suggests that listening to music at bedtime may improve sleep quality in pregnant women with symptoms of insomnia, but more studies are needed to fully establish the effect.

Mechanical ventilation is one of the most important supportive treatments used in critically patient care. The majority of patients dependent on mechanical ventilation experience pain. There are little data on the effect of music on pain in mechanically ventilated patients.

The aim of this review is to determine the effect of music on pain in patients connected to mechanical ventilation.

The protocol of this systematic review was registered with PROSPERO (CRD42024548456) and PRISMA guidelines were followed in reporting the study. The search was conducted in Pubmed, Web of Science, Scopus and Cochrane Library databases without year limitation. Inclusion and exclusion criteria were created considering the PICOS criteria. The selection of studies and the quality assessment of the studies reviewed were made by two independent researchers. The reviewed articles were analysed with the data extraction form developed by the researchers. The quality of the included studies was evaluated using the Joanna Briggs Institute tool.

Ten studies (n = 603) were included in the scope of the review. In the majority of the included studies, it was found that music had positive effects on reducing pain in patients connected to mechanical ventilation. The studies included in the review showed differences in terms of sample size, music duration, type, and evaluation tools. Studies have not found any harmful effects of music application on patients.

In the studies included in this systematic review, it was determined that music had a positive effect on reducing pain in patients connected to mechanical ventilation.

Managing pain in patients receiving mechanical ventilated support is extremely crucial, and considering the study results, it is thought that it is necessary to include music intervention in intensive care. As music intervention is easy, safe and economical, it can be incorporated into nursing care by intensive care nurses.

The purpose of this study is to evaluate the effectiveness of music therapy on physiological response and anxiety in perioperative ophthalmic patients. Furthermore, to explore the differentiation of intervention effects based on different intervention timing and music types.

Five databases including PubMed, Embase, Web of Science, the Cochrane library and CINAHL were adopted for comprehensive search, from the inception of the database to October 2024. Reported according to the PRISMA 2020 statement. Methodological quality was assessed using Version 2 of the Cochrane tool for assessing risk of bias in randomized trial (Rob2). Revman manager 5.4 software was used for meta-analysis.

Nine studies (1331 patients) were included. The meta-analysis results showed that the intervention effect of the music intervention group was better than that of the control group, which had positive effects on lower systolic blood pressure (SBP) [mean difference (MD)=-5.86, 95% confidence interval (CI)=-7.97~-3.74, Z = 5.44, p < 0.001], lower diastolic blood pressure (DBP) (MD=-3.57, 95%CI=-6.80~-0.35, Z = 2.17, p = 0.03) and reducing anxiety [standard mean difference (SMD)=-0.80, 95%CI=-0.94~-0.66, Z = 11.2, p < 0.001)], but not statistically significant for heart rate/pulse rate (HR/PR) change (MD=-1.08, 95%CI=-2.29 ~ 0.12, Z = 1.77, p = 0.08). The subgroup analysis results showed that music intervention before surgery, as well as before and during surgery, could reduce the function of SBP and DBP (p-values all less than 0.05); All types of music have significance in reducing SBP (p-values all less than 0.001); Better intervention effect in binaural beats music (BBM) group than control group in decreasing HR/PR (p = 0.01) can be found; Regardless of the timing of intervention (preopertive, p < 0.001; intraoperative, p = 0.008; preoperative and intraoperative, p < 0.001) or the type of music (BBM, p < 0.001; other types of music, p < 0.001), music therapy has a significant effect on reducing patient perioperative anxiety compared to the control group.

Overall, music therapy contributes to reducing both SBP and DBP, and anxiety level for perioperative ophthalmic patients. The intervention timing of preoperative, or both in preoperative and intraoperative, as well as music type of binaural beats, may have better effects on clinical indicators.

This systematic review was registered a priori with PROSPERO in September 22, 2023. PROSPERO registration number: CRD42023465797.

Patients experience clinically significant anxiety from the time they are recommended to undergo total knee arthroplasty (TKA). This study aimed to evaluate the efficacy of a preoperative intervention regarding anxiety levels in patients undergoing TKA for knee osteoarthritis (OA) and to evaluate whether patient characteristics affect the effectiveness of the intervention according to anxiety level.

This retrospective observational study recruited 89 patients who underwent TKA under general anesthesia for knee OA. The preoperative multidisciplinary intervention comprised rehabilitation education and an interview with an orthopedic surgeon regarding surgical preparation status. The State-Trait Anxiety Inventory (STAI)-X was administered before and after the preoperative intervention. Patients with baseline clinically meaningful state anxiety (CMSA) status were divided into a group that improved to a non-CMSA status (improved group) and a group that showed no change in CMSA status after the preoperative multidisciplinary intervention (non-improved group).

The mean STAI-X score significantly decreased from 46.5 points before the preoperative multidisciplinary intervention to 37.4 points after the intervention (P < 0.001). The proportion of patients with CMSA also significantly decreased from 36.0% before the intervention to 14.6% after the intervention (P < 0.001). The preoperative pain scale score was significantly higher in the non-improved group than in the improved group. The Tegner activity level was significantly lower in the non-improved group than in the improved group. The preoperative knee function scores, KSS and WOMAC scores, in the non-improved group were significantly worse than in the improved group. Additionally, the preoperative STAI-X score was significantly higher in the non-improved group than in the improved group.

For patients undergoing TKA, the implementation of a patient-specific preoperative multidisciplinary intervention, which consists of preoperative rehabilitation education and a surgeon interview, helps reduce preoperative anxiety. However, these preoperative multidisciplinary interventions may not be effective in patients who present with severe pain, poor functional status, or high anxiety levels before surgery.

Combined biopsy (CBx) is a combination of multiparametric magnetic resonance imaging (MpMRI)-targeted prostate biopsy (FBx) and systematic biopsy (SBx). CBx offers highly accurate diagnostic rates, but the increased number of cores taken and the longer procedure time may pose challenges in tolerability compared to traditional biopsies in terms of pain and anxiety. This situation leads to the need to evaluate pain and anxiety.

In a tertiary hospital in Turkey, 149 patients with suspicious lesions (PI-RADS ≥ 3 on MpMRI) who underwent transrectal CBx were included between May 2023 and August 2023. Following FBx, patients underwent a 12-core systematic biopsy. During CBx, 78 patients listened to classical music, while 71 patients used noise-canceling headphones without music. Ten minutes after the procedure, patients completed the Visual Analog Scale (VAS) and the State-Trait Anxiety Inventory (s-STAI, t-STAI) questionnaires to measure pain and anxiety. s-STAI determines how anxious a person feels at a specific moment. t-STAI indicates the general level of anxiety a person experiences independently of their current situation.

Median VAS score was 3.6 (3.0 - 4.3) in the music group and 5.4 (4.4 - 6.9) in the control group (p < 0.001). The median s-STAI score was 38 (34 - 44) in the music group and 44 (39 - 48) in the control group (p < 0.001). For t-STAI scores, no significant difference between groups was observed.  Conclusion: Incorporating music during CBx, alongside traditional pain management, effectively reduces pain and anxiety levels. Its cost-effectiveness, accessibility, and non-invasive nature make routine use of music during CBx procedures advantageous for pain palliation.

Postoperative delirium is a frequent complication with negative consequences for neurosurgical patients. Recorded music has been shown to reduce the incidence of delirium, however its economic benefit remains unclear. This study aimed to investigate the cost-effectiveness of perioperative music in preventing postoperative delirium.

This study used data from a randomized controlled trial (Clinical Trials.gov; NCT04649450) that compared the effect of perioperative music with standard of clinical care on the occurrence of postoperative delirium in patients undergoing craniotomy at the Erasmus Medical Centre. The primary outcome of this study is the cost-effectiveness of the music intervention. A trial-based cost-effectiveness analysis (CEA) was conducted from a societal perspective. Mean costs were calculated using bootstrapping with 95% confidence intervals. Secondary outcomes included postoperative complications, mortality, cognitive functioning, and quality of life. Costs and patient outcomes were assessed separately for the initial hospital admission and long-term follow-up until 6 months after discharge.

This study included 91 patients in the intervention group and 93 in the control group. On average, medical costs during initial admission were lower, albeit not statistically significant, in the music group compared to the control group (€ 11,819 vs. € 13,106), mostly due to a shorter length of stay. Total costs over the 6-month period were nearly identical between the groups, at € 18,587 and € 18,571 in the music and control group, respectively.

Pre-recorded perioperative music may be a cost-effective intervention for reducing postoperative delirium in neurosurgical patients, possibly by decreasing healthcare utilization and costs during primary admission. Further studies are needed to confirm its potential as a cost-effective intervention.

Enhanced recovery after surgery (ERAS) protocols facilitates a standardized patient care regimen with a goal of reducing the metabolic stress of surgery. Adapted to head and neck free flap reconstructive surgery in 2017, these protocols focused on several key domains such as perioperative nutritional optimization, multimodal pain control, and early mobilization. Studies have shown that in addition to ERAS implementation, the maintenance and improvement of ERAS protocol compliance rates improve perioperative outcomes such as hospital length of stay and decrease major postoperative complications.

Chronic pain is a debilitating disease that is usually comorbid to anxiety and depression. Current treatment approaches mainly rely on analgesics but often neglect emotional aspects. Nonpharmacological interventions, such as listening to music, have been incorporated into clinics to provide a more comprehensive management of chronic pain. However, the underlying mechanisms of music-mediated pain relief are not fully understood.

Our aim was to evaluate the effects and mechanisms of music exposure in an animal model of chronic pain.

We injected mice with the complete Freund adjuvant (CFA) inflammatory agent into the hind paw and housed them for 14 days with background music, or ambient noise, during their active period (Mozart K.205, overnight). The effect of music exposure on nociception, anxiety-like behaviors, and depression-like behaviors was evaluated through different paradigms, including the hot plate, Von Frey, elevated plus maze, splash, and tail suspension tests. In addition, we conducted fiber photometry experiments to investigate whether music influences dopamine dynamics in the nucleus accumbens (NAcc), a crucial region involved in pain processing, anhedonia, and reward.

Our findings indicate that music exposure prevents the decrease in NAcc activity observed in CFA-injected mice, linking with a sex-dependent reduction in allodynia, anxiety-like behaviors, and depression-like behaviors. Accordingly, female mice were more sensitive to music exposure than male mice.

Collectively, our findings provide compelling evidence for the integration of music as a nonpharmacological intervention in chronic pain conditions. Moreover, the observed effect on NAcc suggests its potential as a therapeutic target for addressing chronic pain and its associated symptoms.

Music has long been recognized as a noninvasive and cost-effective means of reducing pain. However, the selection of music for pain relief often relies on intuition rather than on a scientific understanding of the impact of basic musical attributes on pain perception. This study examines how a fundamental element of music-tempo-affects its pain-relieving properties. One important finding in research on temporal dynamics of music is that people tend to sing or tap at a characteristic rate when asked to produce a simple melody. This characteristic rate, known as the spontaneous production rate (SPR), is consistent across different rhythm production tasks and may reflect the output of an endogenous oscillator. According to dynamical systems theory, SPRs represent optimal efficiency, minimizing energy expenditure while maximizing behavioral accuracy. This study examined whether aligning music tempo with individual SPRs could enhance the hypoalgesic effects of music. First, participants' SPRs were measured by asking them to produce a familiar melody at a comfortable rate. Next, they were asked to rate painful thermal stimulations under 4 conditions: music modified to match participants' SPR, music modified to be 15% faster or 15% slower than participants' SPR, and silence. Results revealed that musical tempos matching participants' SPR produced stronger reductions in pain compared to faster or slower tempo conditions, supporting the hypothesis that musical tempo aligned with individual rates is optimal for reducing pain. These findings underscore the individual-specific effects of musical tempo on pain perception, offering implications for personalized pain management strategies.

Listening to music has been shown to reduce pain and anxiety before, during, and after invasive coronary procedures.

To perform a systematic review and meta-analysis to explore the effect of therapeutic use of music on both, perioperative and postoperative outcomes of invasive coronary procedures.

An exhaustive literature search of 3 electronic databases (MEDLINE, Scopus, Cochrane CENTRAL) was conducted from inception until 10th December 2023. The results of our analyses are presented as standard mean difference (SMD) or weighted mean difference, with 95%CI and pooled using a random effects model. A P value < 0.05 was considered significant in all cases.

From 21 studies, 2141 participants were included in our analysis. The pooled analysis demonstrated that music listening significantly improves post-procedural pain (SMD = -0.78, 95%CI: -1.34 to -0.23; P = 0.006), anxiety (SMD = -0.86, 95%CI: -1.43 to -0.29; P = 0.003), heart rate [mean difference (MD) = -3.38, 95%CI: -5.51 to -1.25; P = 0.002], and systolic blood pressure (MD = -5.89, 95%CI: -9.75 to -2.02; P = 0.003). There was no significant improvement in diastolic blood pressure (MD = -3.22, 95%CI: -6.58 to 0.14; P = 0.06) or respiratory rate (MD = -0.97, 95%CI: -1.98 to 0.03; P = 0.06).

Music listening can be used in healthcare settings for patients undergoing invasive coronary procedures to reduce anxiety levels and improve their physiological parameters.

Randomized controlled trials and meta-analyses have provided evidence of the positive effects of perioperative music interventions on pain, anxiety, and stress. However, the cost-effectiveness is unknown. The objective of this study was to analyze the cost-effectiveness of the implementation of a music intervention in the perioperative care of patients undergoing colorectal surgery.

A post hoc analysis was performed on patients included in the Implementation of Music Intervention in the PeRiOperatiVe standard care study: a clinical implementation study comparing the effects of perioperative music interventions (post-implementation group, N = 50) to standard care in colorectal surgery (pre-implementation group, N = 50). Main outcomes analyzed were postoperative pain scores and healthcare costs. Propensity score matching with inverse probability weighting was applied. Incremental costs and cumulative pain score differences were estimated using bootstrap analysis with 1000 replications.

Median age of the entire patient population was 62.5. Mean sum of postoperative pain scores on postoperative days 0 to 3 was 9.8 (range 0-40) (95% confidence interval [CI] 8.3-11.4) and 9.9 (95% CI; 7.0-12.9) in the pre- and post-implementation group, respectively (P = 0.970). The total costs were not significantly different between the pre- and post-implementation group in the entire group (€7000 versus €8,070, mean difference of €1070 (bootstrap 95% CI - €1190 - €3336), P = 0.353). Incremental costs were €1288 and €5030 (intention-to-treat and per protocol analysis, respectively) per clinically relevant decrease in pain during postoperative day 0-3.

The implementation of music intervention does not lead to a significant difference in costs. These results can aid clinicians considering the implementation of perioperative music.

 Perioperative music can positively affect postoperative pain, opioid requirement, and anxiety. These effects are even present when music is played solely during general anesthesia. This study assesses the effect of implementing perioperative music as standard patient care in elective bariatric metabolic surgery (BMS).

This prospective study compared the preimplementation (control) and postimplementation (intervention) groups between March and October 2023. The control group did not receive music, while the intervention group received patient-selected music using headphones and a tablet. Music was provided as standard during anesthesia. Only patients undergoing elective BMS (primary ring augmented Roux-en-Y gastric bypass) were included. The primary outcome was postoperative pain on a 10-point scale (numeric rating scale, NRS) on the first postoperative day. The secondary outcomes included postoperative nausea, patient satisfaction, and opioid and antiemetic requirements. Results: In the control group, 66 patients were included, while 65 were included in the intervention group. Median NRS scores were 5 in both groups, showing no significant difference (p = 0.325). Medication use (analgesics and antiemetics) was similar in both groups. Patient satisfaction scores were high at 8 (8-9) and 9 (8-10), respectively, with no significant difference (p = 0.137). In the intervention group, most patients (86%) want to listen to music during subsequent surgical procedures.

Implementing perioperative music in BMS did not significantly reduce postoperative pain or postoperative medication use. As the bariatric perioperative tract is already well-received without music, it poses a challenge for detecting notable improvements. However, the strong patient preference for music during future surgeries emphasizes the positive perception of music in perioperative care.

The present study was conducted to determine the effect of non-pharmacological interventions before cataract surgery on preoperative anxiety.

Systematic review and meta-analysis.

Five databases were systematically searched until 9 June, 2024. The risk of bias was evaluated using the ROBIN-I instrument for non-randomised studies and risk of bias 1 (ROB1) for RCTs. For cases with heterogeneity, random effects, rather than fixed effects, were reported, and subgroup analysis was performed based on the type of intervention. The investigation of publication bias was done in the form of a funnel plot, the Egger regression test and the Trim-and-Fill test. Meta-regression analysis was performed to examine the impact of possible confounding factors on the effect size. Sensitivity analysis evaluated the robustness of our findings by excluding quasi-experimental studies and applying the Knapp-Hartung method to assess their influence on the overall results.

A random-effects meta-analysis of 22 studies and 1998 participants revealed that non-pharmacological interventions (back massage, hand massage, foot massage, music, educational video, patient education, aromatherapy and relaxation techniques) significantly reduced mean preoperative anxiety compared to the control group. The subgroup analysis indicated that all interventions were effective in reducing preoperative anxiety; however, hand and foot massage did not yield significant effects. Meta-regression analysis showed a significant correlation between the percentages of women with effect size. The sensitivity analysis confirmed the robustness of non-pharmacological interventions, while the Knapp-Hartung method maintained the overall effect size but indicated wider confidence intervals. More high-quality research is needed to validate these interventions and establish clearer guidelines.

No Patient or Public Contribution.

Opioid overprescription after colorectal surgery can lead to adverse events, persistent opioid use, and diversion of unused pills. This study aims to assess the extent to which opioids prescribed at discharge after elective colorectal surgery are consumed by patients.

This prospective cohort study included adult patients (≥ 18 yo) undergoing elective colorectal surgery at two academic hospitals in Montreal, Canada. Patients completed preoperative questionnaires and data concerning demographics, surgical details, and perioperative care characteristics (including discharge prescriptions) were extracted from electronic medical records. Self-reported opioid consumption was assessed weekly up to 1-month post-discharge. The total number of opioid pills prescribed and consumed after discharge were compared using the Wilcoxon signed-rank test. Negative binomial regression was used to identify predictors of opioid consumption.

We analyzed 344 patients (58 ± 15 years, 47% female, 65% laparoscopic, 31% rectal resection, median hospital stay 3 days [IQR 1-5], 18% same-day discharge). Most patients received a TAP block (67%). Analgesia prescription at discharge included acetaminophen (92%), NSAIDs (38%), and opioids (92%). The quantity of opioids prescribed at discharge (median 13 pills [IQR 7-20]) was significantly higher than patient-reported consumption at one month (median 0 pills [IQR 0-7]) (p < 0.001). Overall, 51% of patients did not consume any opioids post-discharge, and 63% of the prescribed pills were not used. Increased opioid consumption was associated with younger age (IRR 0.99 [95%CI 0.98-0.99]), higher preoperative anxiety (1.02 [95%CI 1.00-1.04]), rectal resections (IRR 1.45 [95%CI 1.09-1.94]), and number of pills prescribed (1.02 [95%CI 1.01-1.03]).

A considerable number of opioid pills prescribed at discharge after elective colorectal surgery are left unused by patients. Certain patient and care characteristics were associated with increased opioid consumption. Our findings indicate that post-discharge analgesia with minimal or no opioids may be feasible and warrants further investigation.

So far, the psychometric properties of the Persian version of the Pain Anxiety Symptom Scale have not been assessed in Iran. Therefore, this study was conducted to determine the validity and reliability of the Persian version of the Pain Anxiety Symptom Scale among a group of Iranian patients in Amol.

This methodological study was conducted in 2023 with a sample of 400 postoperative patients from Amol, Iran, selected through convenience sampling. The dataset was divided into two groups of 200 for exploratory and confirmatory factor analyses. Construct validity was assessed using maximum likelihood exploratory factor analysis with Promax rotation, supported by Horn's parallel analysis and network analysis to visualize item relationships. Confirmatory factor analysis, convergent and discriminant validity was performed on the second dataset. Reliability was evaluated through various statistical measures, including Cronbach's alpha, McDonald's omega, average inter-item correlation coefficient, composite reliability, and maximal reliability (MaxR).

Among the 400 participants, the mean age was 44.38 years (SD = 13.49), with 152 (46.1%) being women and 178 (53.9%) men. Most participants (n = 268, 81.2%) had an education level lower than a diploma, and 93 individuals (28.2%) reported a history of surgery. The results of exploratory factor analysis with Promax rotation developed two factors accounting for 66.29% of the variance comprising 15 items. Also, after necessary modifications during confirmatory factor analysis, the final model was approved. As for reliability, the Cronbach's alpha, composite reliability, and MaxR for all constructs were greater than 0.7, demonstrating good internal consistency and construct reliability.

According to the results, the Persian version of the Pain Anxiety Symptom Scale has a valid structure and acceptable reliability. This scale can be used by health professionals in many ways.

Define the impact of the implementation of evidence-based music medicine (MM) on pain management outcomes after abdominal and pelvic surgery when combined with usual care.

This quality improvement project implemented MM in a hospital postanesthesia care unit using a pretest-posttest design. The Roy Adaptation Model and Kotter's Change theory guided all project phases.

Nursing staff were educated in-person, via electronic formats and paper handouts. A convenience sample of adults who underwent abdominal or pelvic surgery was offered a preselected MM playlist (via earphones and MP3 players) in addition to usual care during the Phase I recovery period. The outcomes included administered opioids (oral morphine milligram equivalents), pain levels (numerical rating scale), heart rate, respiratory rate, and systolic blood pressure. The outcomes for those who accepted MM (music group) were compared to those for patients admitted to the postanesthesia care unit 1 month before project implementation (baseline group).

The music group data revealed highly significant reductions in heart rate (P = .008, Cohen's d = 0.57) and systolic blood pressure (P < .001, Cohen's d = 0.78) at 30 minutes compared with pretest data. In contrast, the baseline group data showed no effect on systolic blood pressure levels (P = .274). The music group showed higher clinical significance (1.8 to >2-fold higher effect size) on reducing numerical rating scale scores at 30 minutes (music group: P < .001, Cohen's d = 1.19; baseline group: P = .008, Cohen's d = 0.55) and the final period in phase I (music group: P < .001, Cohen's d = 1.71; baseline group: P < .001, Cohen's d = 0.93). The mean morphine milligram equivalents dose for the music group (29.5 ± SD 19.8) compared with the baseline group (33.0 ± SD 26.6) was not significantly different (P = .376, Cohen's d = 0.18).

Adding MM with usual care leads to statistically and clinically significant reductions in pain indicators in adults who had abdominal or pelvic surgeries versus usual care alone.

Patients undergoing surgery experience perioperative anxiety and pain. Music has been shown to reduce perioperative anxiety, pain and medication requirement. This study assessed the feasibility and effectiveness of implementing a perioperative music intervention.

A prospective pre- and post-implementation pilot study was conducted to assess adherence to the intervention and the initial effect of music on postoperative pain scores (Numerical Rating Scale, 0-10) compared to a control group. Secondary outcomes encompassed pain scores throughout hospital admission, anxiety levels, medication usage, complications and hospital stay length.

Adherence to the music intervention was preoperative 95.2%, intraoperative 95.7%, postoperative 31.9% and overall 29.7%. The intervention did influence postoperative pain. Patient's willingness to receive music was high (73%), they appreciated the intervention (median 8.0, interquartile range 7.0-9.0) and healthcare professionals were willing to apply the intervention. Music significantly reduced postoperative anxiety (2.0 vs. 3.0, p = 0.02) and the consumption of benzodiazepines on the first postoperative day (number of patients: zero [0%] vs. five [10%], p = 0.04).

Implementation of music resulted in reduced postoperative anxiety and decreased consumption of benzodiazepines, and the strategy was feasible, but adjustments are needed to improve postoperative adherence. Both patients and healthcare professionals had a positive attitude towards the intervention.

The importance of music in intensive care medicine is still controversial and the mechanisms of music are unclear. It is important whether different music styles (classical music [CM], Heavy Metal [HM] show measurable effects on blood pressure (BP) or heart rate (HR) in humans or not. It is also unclear whether behavioral patterns are influenced by music (CM, HM) in animals.

We studied the influence of CM (Bach, Orchestral Suite No. 3, BWV 1068) and HM (Band Disturbed: Indestructible) compared to a control group (CO) without music exposure in 120 healthy subjects (60 study subjects, 60 control subjects) and 36 young pigs (18 Pietrains, 18 Wiesenauer Minipigs) according to an identical study protocol (21 minutes of music exposure (CM, HM) or 21 minutes of no music (C0).

We were able to clearly demonstrate in 36 pigs that CM led to significantly more activity behavior than HM or CO (p<0,01). HM caused significantly more stress behavior than CM or CO (p<0,01). In humans, there was a decrease in BPsyst, BPdiast or HR (beats per minute [bpm]) among CM: decrease BPsyst -7,5±9,1 mm Hg, BPdiast -4,9±7,5 mm Hg, HR -7,2±10,2 bpm. This was observed less frequently in HM: BPsyst -3,6±7,1 mm Hg, BPdiast -2,7±6,9 mm Hg, HR -5,9±9,0 bpm. The influence of BP and HR was significantly lower in CO compared to music: BPsyst -2,3±7,2 mm Hg, BPdiast -2,0±7,3 mm Hg, HR -5,8±12,3 bpm.

BP and HR in humans and behavioral patterns in animals are clearly influenced by music. CM leads more frequently to activity behavior in animals and to lower BP and HR in humans compared to HM or CO. In both animal breeds, stress behavior was observed more frequently in HM compared to CM or CO. Therefore, music may play a role in intensive care medicine.

Patients undergoing hemodialysis (HD) face significant challenges; however, non-pharmaceutical interventions hold potential for enhancing their quality of life. This paper evaluates the effects of music therapy on various mental and physiological outcomes in patients undergoing HD.

This systematic review and meta-analysis followed the PRISMA 2020 guidelines. A comprehensive database search conducted up to May 21, 2024, identified studies for inclusion based on PICOS criteria. The methodological quality of these studies was assessed using the Cochrane risk-of-bias tool and Review Manager 5.4. For the meta-analysis, R and Stata/SE 15.1 were used, applying a random-effects model in cases of significant heterogeneity, and a fixed-effects model when heterogeneity was minimal.

Twenty-four studies involving 1703 participants were analyzed. Music therapy significantly decreased anxiety (SMD: -0.72, 95 % CI: -0.97 to -0.46, I²: 83 %), pain (SMD: -1.22, 95 % CI: -1.68 to -0.75, I²: 93 %), depression (SMD: -0.85, 95 % CI: -1.31 to -0.39, I²: 77 %), stress (SMD: -0.93, 95 % CI: -1.17 to -0.68, I²: 41 %), and adverse reactions associated with HD (SMD: -0.67, 95 % CI: -0.88 to -0.46, I²: 0 %), all showing strong effect sizes (p < 0.001 for all). However, no significant changes were observed in sleep quality, fatigue, satisfaction with HD, systolic or diastolic blood pressure, heart rate, or finger temperature. A slight reduction in respiration rate (p = 0.0072) and an increase in oxygen saturation (p = 0.0056) were noted. While music therapy showed promising results, the notable heterogeneity in pain and anxiety outcomes suggests careful interpretation, although no significant publication bias was detected.

Music therapy has demonstrated encouraging outcomes in improving the well-being of patients undergoing HD, particularly in reducing anxiety, pain, and stress. However, due to notable heterogeneity and methodological issues such as small sample sizes and inconsistent blinding, further high-quality research is needed to confirm these findings and establish more robust evidence.

Gastrointestinal (GI) cancers are the most common malignancies, while surgical intervention remains the sole therapeutic approach offering the possibility of a definite cure for cancer. Perioperative anxiety negatively impacts the recovery of GI cancers. Recently, mounting studies have demonstrated that proper nursing interventions may alleviative perioperative anxious illnesses in patients with GI cancers. We conducted a first comprehensive review to summarize all the current evidence on this topic. After a systematically search in the six common databases, eighteen relevant studies were included for further analysis. The present review highlighted that there is a high prevalence of perioperative anxiety in patients with GI cancers (e.g., colorectal cancer, gastric/stomach cancer, hepatocellular carcinoma, gallbladder cancer, and esophageal cancer), while specific nursing interventions are the reliable methods to reduce postoperative anxiety. These nursing strategies include, but are not limited to, therapeutic listening intervention, implementing perioperative music, predictive nursing, progressive relaxation exercises, psychological interventions in the nursing care, comprehensive nursing, continuous nursing care, video-based nursing education, multidisciplinary cooperative continuous care, accelerated rehabilitation nursing, TCM nursing, evidence-based early warning nursing, target nursing care, and high-quality nursing. Since several limitations existed in the eligible studies as well as in this review, a well-designed multicenter RCT with large sample size is still warranted for the confirmation of nursing intervention for managing perioperative anxiety in patients with GI cancers. Also, future studies should focus on the long-term effects of relevant interventions, specific patient populations, multidisciplinary approaches, technological innovations, and educational programs.

Background: Music-based intervention has been advocated as a nonpharmacologic approach for the perioperative control of pain and anxiety in surgical patients. However, its impact on patients with preoperative anxiety has not been clearly established. Our study aimed to examine the impact of music-based intervention administered before, during, and after surgery on postoperative opioid consumption and pain levels, as well as preoperative anxiety, depression, and pain catastrophizing. We hypothesized that, compared to a control group, music-based intervention would be effective in reducing opioid requirements and mood disorders. Methods: This study was a single-center, prospective, single-blinded, randomized controlled trial. Inclusion criteria isame-day or observation surgery. Exclusion criteria included American Society of Anesthesiologists physical status IV, use of spinal anesthesia, PROMIS Anxiety T-scores ≤ 57.4 and ≥74.1, preoperative chronic opioid use, transgender surgery, and history of drug or alcohol abuse. Music-based intervention was developed by a certified music therapist. Each patient was randomized to receive standard of care (SC) or SC plus music-based intervention before, during, and after surgery. The primary end point was postoperative oral morphine equivalents (OMEs) over 5 days following surgery using the area under the curve (AUC)Secondary end points were PROMIS Anxiety, PROMIS Depression scores Pain Catastrophizing Scale scores, postoperative nausea and vomiting, time of hospital discharge, and patient satisfaction (0 = totally unsatisfied to 10 = completely satisfied). Results: A total of 75 patients were randomized to a music-based intervention (n = 33) or control (n = 42) group. Patients in the music-based intervention group consumed 56.7% less opioids than those in the control group (AUC was 2.8 in the music-based intervention group vs. 6.4 in the control group, absolute standardized mean difference (aSMD) = 0.34 (-0.17, 0.85)). No difference in pain scores was recorded between groups. Music-based intervention also reduced anxiety on postoperative day (POD)2 (aSMD = 0.38 (-0.16, 0.91)), depression on POD2 (aSMD = 0.31 (-0.23, 0.84)) and POD4 (aSMD = 0.24 (-0.29, 0.77)), and pain catastrophizing on POD1 (aSMD = 0.24 (-0.3, 0.77)). Conclusions: Our data support the use of music-based intervention to reduce postoperative opioid requirements. Music-based intervention may also reduce anxiety, depression, and pain catastrophizing.

Complementary and integrative medicine (CIM) is increasingly being integrated into preoperative, intraoperative, and postoperative phases to enhance patient outcomes, manage symptoms, and improve overall well-being. CIM encompasses a broad range of therapies and practices that are not typically part of conventional medical care, such as herbal and non-herbal medicine, yoga, acupuncture, meditation, chiropractic care, and dietary supplements. This review explores the existing evidence on the application, benefits, and challenges of CIM therapies and practices in surgical settings, highlighting the importance of integrating these therapies and approaches with conventional medical practices to enhance patient outcomes.

Opioids are commonly used to reduce pain after surgery; however, there are severe side effects and complications associated with opioid use, with addiction being of particular concern. Recent practice has shifted to reduce opioid consumption in surgery, although a specific protocol for rhinoplasty is still in progress. This paper aims to expand on the protocol previously established by the senior author based on updated evidence and details. This was accomplished by first high-lighting and summarizing analgesic agents with known opioid-reducing effects in the surgical field, with a particular focus on rhinoplasty, then compiling these analgesic options into a recommended protocol based on the most effective timing of administration (preoperative, intraoperative, postoperative). The senior author's previous article on the subject was referenced to compile a list of analgesic agents of importance. Each analgesic agent was then searched in PubMed in conjunction with "rhinoplasty" or "opioid sparing" to find relevant primary sources and systematic reviews. The preferred analgesic agents included, as follows: preoperative, 1000 mg oral acetaminophen, 200 mg of oral celecoxib twice daily for 5 days, and 1200 mg oral gabapentin; intraoperative, 0.75 μg/kg of intravenous dexmedetomidine and 1-2 mg/kg injected lidocaine with additional 2-4 mg/kg per hour or 1.5 cc total bupivacaine nerve block injected along the infraorbital area bilaterally and in the subnasal region; and postoperatively, 5 mg oral acetaminophen and 400 mg of oral celecoxib. When choosing specific analgesic agents, considerations include potential side effects, contraindications, and the drug-specific mode of administration.

Although intraoperative music is purported to mitigate postoperative pain after some procedures, its application has never been explored in abdominal wall reconstruction (AWR). We sought to determine whether intraoperative music would decrease early postoperative pain following AWR.

We conducted a placebo-controlled, patient-, surgeon-, and assessor-blinded, randomized controlled trial at a single center between June 2022 and July 2023 including 321 adult patients undergoing open AWR with retromuscular mesh. Patients received noise-canceling headphones and were randomized 1:1 to patient-selected music or silence after induction, stratified by preoperative chronic opioid use. All patients received multimodal pain control. The primary outcome was pain (NRS-11) at 24 ± 3 h. The primary outcome was analyzed by linear regression with pre-specified covariates (chronic opioid use, hernia width, operative time, myofascial release, anxiety disorder diagnosis, and preoperative STAI-6 score).

178 patients were randomized to music, 164 of which were analyzed. 177 were randomized to silence, 157 of which were analyzed. At 24 ± 3 h postoperatively, there was no difference in the primary outcome of NRS-11 scores (5.18 ± 2.62 vs 5.27 ± 2.46, p = 0.75). After adjusting for prespecified covariates, the difference of NRS-11 scores at 24 ± 3 h between the music and silence groups remained insignificant (p = 0.83). There was no difference in NRS-11 or STAI-6 scores at 48 ± 3 and 72 ± 3 h, intraoperative sedation, or postoperative narcotic usage.

For patients undergoing AWR, there was no benefit of intraoperative music over routine multimodal pain control for early postoperative pain reduction.

ClinicalTrials.gov: NCT05374096.

Audio-analgesia is one of the unexplored aspects of behavior management in pediatric dentistry, and recently, there have been many new inclusions in shades of noise that were previously just limited to white noise, like brown noise and pink noise.

The aim of the study was to evaluate and compare the effectiveness of white noise, brown noise, and pink noise on dental anxiety in pediatric patients undergoing primary tooth extraction.

Multiarm, triple-blinded, parallel-group randomized controlled trial.

Forty children belonging to the age group of 8-12 years having their first dental visit with primary teeth indicated for extraction were included in our study. We evenly divided the 40 children into four groups: Group A (white noise), Group B (pink noise), Group C (brown noise), and Group D (cartoon music), which served as the control. We assessed the patient's anxiety using Venham's Picture Test and a pulse oximeter, as well as their pain using the Visual Analog Scale (VAS) both preoperatively and postoperatively. We also noted changes in the patient's pulse after administering local anesthesia.

All groups have shown significant differences in dental anxiety and pain, preoperatively and postoperatively, but pink noise was found to be effective even in maintaining pulse rate intraoperatively.

In pediatric dentistry, audio distraction is an innovative, noninvasive, and effective behavior management technique that can effectively manage dental anxiety in children.

The Clinical Trials Registry of India (CTRI) has prospectively registered the study under the CTRI number CTRI/2024/01/061679.

Music is a promising (adjunctive) treatment for both acute and chronic pain, reducing the need for pharmacological analgesics and their side effects. Yet, little is known about the effect of different types of music. Hence, we investigated the efficacy of five music genres (Urban, Electronic, Classical, Rock and Pop) on pain tolerance. In this parallel randomized experimental study, we conducted a cold pressor test in healthy volunteers (n = 548). The primary outcome was pain tolerance, measured in seconds. No objective (tolerance time) or subjective (pain intensity and unpleasantness) differences were found among the five genres. Multinomial logistic regression showed that overall genre preference positively influenced pain tolerance. In contrast, the music genres that participants thought would help for pain relief did not. Our study was the first to investigate pain tolerance at genre level and in the context of genre preference without self-selecting music. In conclusion, this study provides evidence that listening to a favored music genre has a significant positive influence on pain tolerance, irrespective of the kind of genre. Our results emphasize the importance of individual music (genre) preference when looking at the analgesic benefits of music. This should be considered when implementing music in the clinical setting.

Music therapy is a rapidly evolving multidisciplinary field. But there has been no research analyzing the latest research status and development trends in this research field from a macro perspective. We aim to identify hotspots, knowledge base, and frontiers in the field of music therapy through bibliometric analysis.

All data were retrieved from the Web of Science core database from January 1, 2013 to December 31, 2022.CiteSpace and Bibliometrix software were employed for bibliometric analysis and visualization analysis.

A total of 2,397 articles were included. In the past decade, there has been a consistent increase in the number of publications. The countries and institutions with the largest production in this field are the USA and the University of London. Based on the analysis of the total number of citations, centrality, and production, the results show that the most influential journals are PLoS One and Cochrane Database Syst Rev. Keyword co-occurrence analysis and highly cited study analysis are mainly used to analyze research hotspots in the field of music therapy, while the keyword burst analysis is employed to explore frontiers and potential developmental trends. Hot keywords include "interventions", "anxiety" and "randomized controlled trial". The burst keywords include "validity", "preterm infants", and "mild cognitive impairment". In the ranking of highly cited study, the top ranked studies are "Music-based interventions in neurological rehabilitation" and "Music interventions for improving psychological and physical outcomes in cancer patients".

In the past decade, the research focus in music therapy was the effect of music therapy on neurological diseases and the improvement of psychological symptoms such as pain and anxiety. The neurophysiological mechanisms that bring about these therapeutic effects need to be future researched.

Surgical pain affects postoperative sleep quality, and they jointly form a vicious cycle of mutual influence. The cycle of postoperative pain and sleep disorders could lead to delirium, cardiovascular disease, and hyperalgesia, which significantly affect patients' postoperative recovery. Thus, exploring this phenomenon is of great importance for surgical patients, and warrants further investigation.

By employing bibliometric methods, this study systematically analyzes the publications on postoperative pain-sleep disorders, identifies research trends and field dynamics, and ultimately provides insights for further progress in this research area.

In this study, we searched the Web of Science database for studies on postoperative pain and sleep disorders from 2013 to 2023, and analyzed the number of publications, journals, authors, institutions, country regions, and keywords by utilizing CiteSpace, VOSviewer, and Bibliometrix.

The 1894 retrieved publications showed a trend of increasing number of publications and correlations between postoperative pain and sleep disorders from 2013 to 2023. The top countries for publications included the USA, China, etc., establishing a global collaborative network centered around the USA, China, and Europe. The top institutions for publications included University of California System, Harvard University, etc. The top authors include Christine Miaskowski, Steven M. Paul, Qiuling Shi, etc. These publications involved multiple disciplines including surgery, neurology, and anesthesiology, and various research funds including NIH, HHS, NSFC, etc. The top journals for publications included the European Archives of Oto-Rhino-Laryngology, etc. Keywords that appear most frequently in this field include "pain", "surgery", "quality of life", "sleep", "depression", and "outcomes". The thematic map indicated that the hot topics in this area include obstructive sleep apnea, tonsillectomy, children, pain, quality of life, and sleep. The undeveloped topics with research potential included postoperative pain, analgesia and dexmedetomidine, breast cancer, fatigue, and lung cancer.

The increased number of publications and correlations between postoperative pain and sleep disorders, and the collaborative network across the USA, China, and Europe indicate a growing global interest in this area. This study also provides valuable insights into the trend of hot topics and frontiers and shows that this is an evolving and dynamic research area.

Mental health affects maternal well-being and indirectly affects the development of fetal brain structures and motor and cognitive skills of the offspring up to adulthood. This study aimed to identify specific characteristics of music interventions that improve validated maternal outcomes.

Randomized controlled trials and systematic reviews investigating music interventions during pregnancy were identified from the start of data sources up to December 2023 using MEDLINE, the Cochrane Central Register of Controlled Trials, or Web of Science.

Using Covidence, 2 reviewers screened for randomized controlled trials with ≥3 music interventions during pregnancy and applied either the Perceived Stress Scale score, State-Trait Anxiety Inventory score, Edinburgh Postnatal Depression Scale score, or blood pressure as outcomes.

The Cochrane risk-of-bias tool 2, the checklist to assess Trustworthiness in RAndomised Clinical Trials, and the reversed Cohen d were applied. This review was registered in the International Prospective Register of Systematic Reviews (registration number: CRD42022299950).

From 251 detected records, 14 randomized controlled trials and 2375 pregnancies were included. Music interventions varied from 3 to 84 active or passive sessions with either patient-selected or preselected music and a duration of 10 to 60 minutes per session. Thereby, 2 of 4 studies observed a significant decrease in the Perceived Stress Scale, 8 of 9 studies observed a significant decrease in the State-Trait Anxiety Inventory, and 3 of 4 studies observed a significant decrease in the Edinburgh Postnatal Depression Scale. Blood pressure was significantly reduced in 3 of 4 randomized controlled trials. The Cochrane risk-of-bias tool 2 was "high" in 5 of 14 studies or "with concerns" in 9 of 14 studies. Stratifying the Cohen d in 14 intervention arms suggested a big effect in 234 of 469 mothers on blood pressure and in 244 of 489 mothers on maternal anxiety and a medium effect in 284 of 529 mothers on maternal anxiety. Small or very small effects on blood pressure, the Edinburgh Postnatal Depression Scale, and the Perceived Stress Scale were observed in 35 of 70, 136 of 277, and 374 of 784 mothers-to-be, respectively.

Our study found a general positive effect of music interventions on maternal stress resilience. This was independent of the music but was influenced by the frequency and empathy of the performances. How far music interventions may improve postnatal development and skills of the offspring should be increasingly evaluated with follow-ups to interrupt vicious epigenetic circles during global pandemics, violent conflicts, and natural catastrophes. El resumen está disponible en Español al final del artículo.

Comorbid chronic neuropathic pain and anxiety is a common disease that represents a major clinical challenge. The underlying mechanisms of chronic neuropathic pain and anxiety are not entirely understood, which limits the exploration of effective treatment methods. Glutamatergic neurons in the ventrolateral periaqueductal gray (vlPAG) have been implicated in regulating pain, but the potential roles of the vlPAG in neuropathic pain-induced anxiety have not been investigated. Herein, whole-cell recording and immunofluorescence showed that the excitability of CamkIIα neurons in the vlPAG (vlPAGCamkIIα+ neurons) was decreased in mice with spared nerve injury (SNI), while electroacupuncture (EA) activated these neurons. We also showed that chemogenetic inhibition of vlPAGCamkIIα+ neurons resulted in allodynia and anxiety-like behaviors in naive mice. Furthermore, chemogenetic activation of vlPAGCamkIIα+ neurons reduced anxiety-like behaviors and allodynia in mice with SNI, and EA had a similar effect in alleviating these symptoms. Nevertheless, EA combined with chemogenetic activation failed to further relieve allodynia and anxiety-like behaviors. Artificial inhibition of vlPAGCamkIIα+ neurons abolished the analgesic and anxiolytic effects of EA. Overall, our study reveals a novel mechanism of neuropathic pain-induced anxiety and shows that EA may relieve comorbid chronic neuropathic pain and anxiety by activating vlPAGCamkIIα+ neurons.

Hospitalized patients undergoing surgery or procedures may experience negative symptoms. Music is a nonpharmacological complementary approach and is used as an intervention to reduce anxiety, stress, and pain in these patients. Recently, music has been used conveniently in clinical situations with technology devices, and the mode of providing music is an important factor in technology-based music interventions. However, many reviews have focused only on the effectiveness of music interventions.

We aimed to review randomized controlled trials (RCTs) of technology-based music interventions for reducing anxiety and pain among patients undergoing surgery or procedures. We examined the clinical situation, devices used, delivery methods, and effectiveness of technology-based music interventions in primary articles.

The search was performed in the following 5 electronic databases: PubMed, MEDLINE (OvidSP), CINAHL complete, PSYCINFO, and Embase. This systematic review focused on technology-based music interventions. The following articles were included: (1) RCTs, (2) studies using interactive technology (eg, smartphones, mHealth, tablets, applications, and virtual reality), (3) empirical studies reporting pain and anxiety outcomes, and (4) English articles published from 2018 to 2023 (as of January 18, 2023). The risk of bias was assessed using the Cochrane Risk of Bias tool version 2.

Among 292 studies identified, 21 met the inclusion criteria and were included. Of these studies, 9 reported that anxiety scores decreased after music interventions and 7 reported that pain could be decreased before, during, and after procedures. The methodology of the music intervention was important to the results on anxiety and pain in the clinical trials. More than 50% (13/21, 62%) of the studies included in this review allowed participants to select themes themselves. However, it was difficult to distinguish differences in effects depending on the device or software used for the music interventions.

Technology-based music interventions could help reduce anxiety and pain among patients undergoing surgery or procedures. The findings of this review could help medical teams to choose a practical methodology for music interventions. Future studies should examine the effects of advanced technology-based music interventions using smart devices and software that promote interactions between medical staff and patients.

Music interventions can alleviate patient anxiety and improve post-surgical satisfaction. However, it remains uncertain whether personal music preferences affect efficacy. The authors tested whether personal music intervention with patient-selected songs played ad libitum is more effective than standard therapist-designed treatment with classical music.

A prospective, parallel-group, single-blinded, randomized controlled trial with 229 participants (aged 18-60 years) previously scheduled for elective surgery. Data analyses followed a modified intention-to-treat principle. The patients were randomized into three groups: Standard care without music (Control), therapist-designed classic music treatment (TT), or personal music intervention with patient-selected songs played ad libitum by the patient (PI). All patients received standard post-anaesthesia care, and music intervention was started upon arrival at the post-anaesthesia care unit. Primary outcomes were anxiety and overall satisfaction at discharge. In contrast, secondary outcomes were systolic blood pressure during music intervention, the sleep quality of the night after surgery, and the occurrence of postoperative nausea and vomiting within the first 24 h after surgery.

Compared with therapist-designed music treatment, personal intervention decreased systolic blood pressure (T 0 : 124.3±13.7, 95% CI:121-127.7; T 20min : 117.6±10.4, 95% CI:115-120.1; T 30min : 116.9±10.6, 95% CI:114.3-119.4), prevented postoperative nausea and vomiting (Control: 55.9%, TT: 64.6%, PI: 77.6%), including severe postoperative nausea (VAS score>4; Control: 44.1%; TT: 33.8%; PI: 20.9%) and severe emesis (Frequency≥3, Control: 13.2%; TT: 7.7%; PI: 4.5%). None of the treatments affected sleep quality at night after surgery (Median, Q1-Q3, Control: 3, 1-3; TT: 3, 1-4; PI: 3, 1-3.5). Personal, but not therapist, music intervention significantly prevented anxiety (Control: 36.4±5.9, 95% CI:35.0-37.9; TT: 36.2±7.1, 95% CI: 34.4-37.9; PI: 33.8±5.6, 95% CI: 32.4-35.2) and emesis (Control: 23.9%; TT: 23.4%; PI: 13.2%) and improved patient satisfaction (Median, Q1-Q3, C: 8, 6-8; TT: 8, 7-9; PI: 8, 7-9).

Personal music intervention improved postoperative systolic blood pressure, anxiety, nausea, emesis, and overall satisfaction, but not sleep quality, as compared to therapist-designed classic intervention.