It is a known fact that the opioid epidemic is upon us. Doctors and other care providers face the constant dilemma between treating patients by their ethical standards and abiding by the ever-tightening guidelines set by regulating bodies such as the Drug Enforcement Agency (DEA). Even with the best intentions, dose reduction and changes can lead patients to desperation, and even suicide. In 2016, 12,101 people in the United States died from unintentional drug overdoses involving prescription opioids. This does not differentiate those who succumbed to polypharmacy.
Concurrent and Adjunctive Medications
We see that concurrent and adjunctive medications for conditions such as neuropathy, anxiety, depression, and insomnia inadvertently add to the risk of addiction and death. Insurance companies have the power to help the patient and the provider by adding safer, abuse-deterrent options to their formulary. However, carriers such as Medicare and Medicaid opt for more cost-effective drugs and require patients to attempt a minimum of three standard narcotics first – making the situation more difficult.
As a result, these limitations have made way for alternative modalities of pain modulation to arise. Some
therapies have their roots in Eastern Medicine such as acupuncture and reflexology; others in nature like Cannabinoid (CBD) Oil. Nonpharmacological interventions do not have the side effects and addiction risks commonly associated with medications. Listening to music triggers a well-defined neurochemical response, creating positive and negative emotions through endogenous opioids within the brain.
The chemical pathways used in music therapy are the same reward pathways as food, drug, and sexual pleasure. Pain relief occurs with the release of endorphins, changes in catecholamine levels, or distraction via memories the music elicits. According to several studies, listening to and performing music modifies serotonin, epinephrine, dopamine, oxytocin, and prolactin; and activates the nucleus accumbens, the anticipatory pleasure network. Music’s simplicity and basic ability to ‘help with pain’ make it the perfect adjunct to any pain medication regimen. Acute pain, caused by initial injury or surgical intervention, is a common starting point for opioid use and abuse. To augment this, hospital-based personnel set out to prove music limits narcotic use with easy implementation. The American Journal of Critical Care published a study confirming that lower doses, frequency of pain medications, and sedation were required when music
was used in the critical care setting.
They also found a significant decrease and control in respiratory rate, breaths per minute, heart rate, as well as self-reported pain and anxiety levels. Anesthesiology and surgical studies found similar effects on vital signs as well as lower complaints of, and interventions for, pain post-operatively when music is played during surgical procedures. The most clinically significant results were found in those who underwent local anesthesia procedures. The non-pharmacological benefits of music were noted in pediatric patients who listened to 30 minutes of Rihanna, Taylor Swift, and other singers of their choice giving them a significant reduction in pain after major surgery. As a result, strategies such as music therapy allow for safer options for pain management in hospitalized patients, especially since many of them are left with poor pain control due to fears of post-administration complications.
In addition to the benefits of listening to preferred music, researchers sought to evaluate whether characteristics like tempo, harmony, melody, instrumentation, volume, and pitch influence music’s overall therapeutic effect. It was determined that bright, with low intensity and music slower in tempo, has the most positive effect on reported pain levels. Furthermore, researchers found that music without lyrics also seemed to provide a more substantial response.
Overall, the use of music as an adjunct to pain management is proven to be effective time and time again. Its ease of use allows it to be initiated in the hospital for acute pain and at-home care for chronic pain. Altogether, implementing music therapy does not solely rest on the responsibility of the hospital staff, doctor, or health care provider. The patient or family can discuss and arrange music to use as part of their daily regimen. Through earphones, 30 minutes twice a day, patients can enjoy their favorite tunes–preferably slow, low, and bright, with or without lyrics- to provide significant non-pharmacological pain reduction and control.
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