Treating Chronic Pain: Therapeutic Music in Adult Palliative Care

Abstract

Problem and Purpose: Palliative care aims to provide maximum comfort to individuals suffering from life threatening illness. The chronic pain often seen in this population is multifocal, with physical, emotional, and psychosocial symptoms. Pain management in palliative care is often challenging due to medication side effects and frequently affects those with primary cancers as well as non-malignant terminal illness. Therapeutic music (TM) has been shown to reduce chronic pain in palliative care patients. Multiple studies and systematic reviews have demonstrated use of TM leads to significant reductions in chronic pain. The purpose of this doctoral project is to improve the quality of pain management for palliative care residents suffering from chronic pain by adding TM to the list of activities available to residents on the palliative care unit. Methods: This quality improvement project introduced nonpharmacologic pain management by initiating a TM program in the adult palliative care unit of an 88-bed rehabilitation and nursing home. Nursing and ancillary staff attended a 20-minute education session on the benefits and efficacy of TM in the reduction of chronic pain, and four members of the Activities Department were trained to conduct the TM sessions. The palliative care nurse practitioner identified 10 residents most likely to benefit from TM and enrolled them in the program. TM sessions were held for 30-60 minutes twice a week for seven weeks. Residents’ chronic pain scores were assessed before and after each TM session. Residents were also asked to rank their enjoyment of the intervention on a 4-point Likert scale after each session. During week four of the program residents requested an extension of TM sessions and all future sessions were scheduled for 60 minutes. However, all post session assessments were completed after 30-minutes. Results: While resident participation increased from 33% to 69% over the seven-week implementation period, the average weekly participation rate was 50% (n=5). All residents reported a significant decrease in chronic pain levels (mean 44.3%; p<0.01) after TM sessions and resident enjoyment scores averaged 3.5 on a 4-point Likert scale. Conclusion: The implementation of a therapeutic music program improved the quality of pain management for palliative care residents suffering from chronic pain.