Thrita. 2013 December; 2(4): 76-9.

DOI: 10.5812/thrita.13757
Published online 2013 November 10. Research Article

Music Therapy Reduces the Intensity of Pain Among Patients With Cancer
1,* 2 2 1
Madineh Jasemi , Samereh Eghtedar , Nader Aghakhani , Farzaneh Khodabandeh , Leyla
1 1
Sayadi , Neda Kheirkhahi
1Students Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran
2Faculty of Nursing and Midwifery, Urmia, University of Medical Sciences, Urmia, IR Iran

*Corresponding author: Madineh Jasemi, Students Research Committee, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, IR Iran. Tel: +98-9144462842,
Fax: +98-4114790364, E-mail: [email protected].

Received: July 22, 2013; Revised: September 1, 2013; Accepted: September 9, 2013

Background: Most of the cancer patients may suffer from pain; therefore, music therapy -as a noninvasive method- is sometimes used to
help reduce the pain of cancer patients.
Objective: To evaluate the effects of music therapy on pain in some patients with cancer.
Material and Methods: This semi-experimental study was performed at Urmia teaching hospital in 2011. A total number of 60 patients
with soft tissue cancer were randomly selected and allocated to control and intervention groups. Intervention group received 20-minute
music for three consecutive days. The degree of pain was measured by Visual Analog Scale (VAS) before and after music therapy. Data were
analyzed at the three times using SPSS and the information was described using mean, SD and analyzed by using t-test, ANOVA and Pearson.
Results: The results showed no significant differences in demographic variable between intervention and control groups. Intensity of
pain in intervention group in the three times showed significant diminution (P < 0.001); but in control group, pain intensity did not
change during the study (P = 0.12). There was significant relationship between intensity of pain and stage of the cancer (r = 0.46, P = 0.008)
and kind of cancer (r = 0.38, P = 0.002).
Conclusions: By considering positive effects of music on pain in patients with cancer, health care providers can use music and encourage
patients to use it for enhancing the effects of analgesics, decreasing the pain and promoting quality of life.

Keywords: Music Therapy; Pain; Cancer

1. Background erable side effects on the body and mind (8). Analgesics
are potentially addictive and their prolonged use may
With increasing life expectancy, chronic diseases includ-
result in drug dependency, hypotension, weakening of
ing cancer morbidity and mortality are growing in im-
vital functions, drowsiness, nausea, vomiting and even
portance (1). Such patients suffer from diseases for long
shock. Some of these methods are also time consuming
periods of time and after discharging from the hospital,
they mostly require home-based care and therapy. There- and costly to the health care systems (9, 10). Therefore, it
fore, several programs have been developed to manage is recommended to use non- pharmacological approach-
their needs (2). Cancer is a disease with many complica- es to relieve pain. Nurses use many non- pharmacologi-
tions such as pain (3). Thus according to the studies, pain cal approaches to relieve pain such as medication, imag-
affects a large proportion of this group of patients and ery, deep breathing and music (11). Music therapy can be
is often difficult to manage effectively (4). Thousands of done by sound stimuli, and it has been shown that music
these patients (in-hospital or out-of hospital) are suffer- therapy can help in reducing the level of pain (12). Listen-
ing from severe afflictions (5); as 20% to 90% of them ex- ing to music leads to muscle relaxation, distraction from
perience varying degrees of pain. There are many causes pain, reduction of pain intensity and decreased transfer
for pain in cancer, among which the growth of the tumor, of pain impulses to the central nervous system (7). Listen-
side effects of the treatment including chemotherapy, ing to music may also decrease heart rate, increase depth
radiation therapy, surgeries or background diseases are of breathing and positively affect anxiety, depression and
of note (6). In fact, pain is most common complaint of pain (13). Also, music therapy can be used at home (2). The
people for seeking help from the medical profession (7). use of music as a therapeutic tool has a long history, as in
Both medical and surgical methods are used to relieve the inscriptions discovered in Egypt, Greece, China, India
physical pains (4). Most of these treatments have consid- and Rome, music has been considered as a healing tool. It

Implication for health policy/practice/research/medical education:

Music Therapy is available for the management of pain with low cost and side effects; therefore, identification of music effects on the pain levels of can-
cer patients is very important for using it by health practitioners and nurses in the care plan of such patients, as it can enhance the quality of life in this
group if patients.
Copyright 2013, Kowsar Corp.This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
 Jasemi M et al.

has a calming effect and can reduce the use of analgesics pain [10]. Three days before the intervention, pain of the
(14). Although despite its effectiveness, it is not used as a subjects was assessed by using VAS. Then, patients of the
therapeutic intervention. Also, the effectiveness of music intervention group listened to their favorite music dur-
on reducing the pain has not been established to date. Ac- ing the next three days and were re-evaluated daily. Music
cording to the previous investigations the results of such was not played for the patients of the control group. The
studies are very limited with regard to their low quality intervention tool included a Sony walkman and a head-
and high risk of bias. The measurement of the efficacy is phone. A 20-minute music tape was prepared by consid-
done immediately after the intervention and thus the va- ering the comments of five experts, which was Mozzart
lidity of their results has been questioned (15). Also, most music (including sea sound, rain sound and water sound)
of the studies have evaluated the analgesic efficacy of mu- and was played at the bedside of the participants. Three
sic in acute pain, but patients with cancer may frequently days before and after music therapy, intensity of pain was
suffer from chronic pain (16). assessed for both groups. The amount of consumption of
analgesic drugs and their kind was also recorded in the
2. Objectives two groups during the study. Data were analyzed at the
The purpose of this study was to explore the effects of three time intervals using SPSS software 13 and the infor-
music therapy on intensity of pain in patients with can- mation was described using mean, SD and analyzed by
cer by using Visual Analog Scale (VAS). We also sought to using t-test, Pearson correlation coefficient and ANOVA.

4. Results
investigate the relationship between demographic vari-
ables and pain intensity.

3. Materials and Methods

Regarding demographic characteristics, 57.2% of the
participants of the intervention group were male, 61.8%
This semi-experimental study was conducted among 60 were between 30- 50 years old, 38.2% had education level
patients of Imam Khomeini teaching hospital of Urmia, below high school diploma and 93.3% were married. In the
2011. In fact by using a pilot study that was conducted control group, 51.9% of the subjects were male, 60% were
on 12 patients and with regard to 95% confidence inter- between 30- 50 years old, 63% had education level below
val and power test equal to 80%, the minimum sample high school diploma and 87.4% were married. There was
size for each group was estimated to be 30 patients. The no statistical difference in demographic variables of the
inclusion criteria were as follows: age of 18 - 65 years, pa- two study groups. Also, there was no significant differ-
tients in stage one, two or three of cancer, being able to ence between pain intensity mean of the participants of
communicate (in case of illiteracy), no previous history both groups. Comparison of pain intensity using ANOVA
of severe disorders including other malignancies and be- in the three time intervals before study showed no differ-
ing diagnosed within the last three months. In this study, ence in the control (P = 0.34) and intervention (P=0.67)
we enrolled patients with soft tissue cancer, bone cancer groups (Table 1). But pain intensity was reduced after
and leukemia who had pain. The two study groups were receiving music therapy in the experimental group (P <
almost equal with regard to age, sex, education and stage 0.001); however, there was no significant difference in
of the cancer. Most of the subjects had a soft tissue can- control group(P = 0.12) (Table 2). The mean number of dai-
cer (intervention group = 48%, control group = 54%) and ly consumed analgesic drugs in the intervention group
the majority of patients had stage three cancer (interven- was 2.34 1.27, but in the control group was 3.98 1.46,
tion group = 44%, control group = 40%). After obtaining which was significantly different (P = 0.03). Evaluation
informed written consent, the participants were divided of the relationship of demographic characteristics with
into the intervention and control groups by using simple pain intensity showed high mean and SD in bone cancer
random sampling. and stage three of cancer (Table 3). Using Pearson correla-
Data were collected using demographic questionnaire tion coefficient showed significant relationship between
and Visual Analog Scale (VAS) for pain intensity. Pain intensity of pain and stage of the disease (r = 0.46, P =
intensity was classified as no pain [0], mild pain [1-3], 0.008) as well as the intensity of pain and kind of cancer
moderate pain [3-6], severe pain [6-9] and intolerable (r = 0.38, P = 0.002).

Table 1. Comparison of the Intensity of Pain in the Three Times Before Intervention among the Intervention and Control Groups
Pain Group, Mean SD First Day Pain, Mean SD Second Day Pain, Mean SD Third Day Pain, Mean SD P Value
Control group 5.12 1.63 5.05 2.34 5.22 1.98 P = 0.34
Intervention group 5.32 1.97 5.92 1.24 5.46 2.06 P = 0.67

Thrita. 2013; 2(4) 77

 Jasemi M et al.

Table 2. Comparison of the Intensity of Pain in the Three Times After Starting the Intervention among the Intervention and Control
Groups
Pain Group, Mean SD First Day Pain, Mean SD Second Day Pain, Mean SD Third Day Pain, Mean SD P Value
Control group 5.83 1.86 5.13 2.72 5.65 2.37 P = 0.12
Intervention group 4.87 1.02 4.48 2.82 3.96 2.32 P < 0.001

that showed soothing music may have psychological and

Table 3. The Relationship between Demographic Characteris- physical outcomes in cancer patients (20). Another study
tics of Patients and Pain Intensity that was done by Kwekkeboom also showed that patients
Demographic Charac- Mean SD P Value with cancer who received music therapy experienced sig-
teristics nificantly less pain and stress compared to patients who
Sex P = 0.67 only received medication (21). The finding of Korczak D
study in Germany also showed that music reduces pain
Male 5.34 2.66
and anxiety and improves physiological parameters that
Female 5.76 2.56 may lead to relaxation and development of a positive
Age, y P = 0.34 mood (15).
18 - 30 years 5.57 2.24 With regard to the relationship between demographic
31 - 45 years 5.61 1.91
characteristics and intensity of pain, our findings dem-
onstrated significant relationships between intensity of
46 - 55 years 5.48 2.07
pain and stage of cancer as well as the kind of cancer. In
56 - 65 years 5.38 2.82 line with the results of our study, the study performed by
Marital status P = 0.21 Yousefinejad showed that patients with bone cancer and
Single 5.47 2.31 those with stage three cancer experienced higher levels
of pain intensity (22). In this study, we did not find any
Married 5.98 2.54
relation between other demographic variables and in-
Educational level P = 0.82 tensity of pain, while Kumar et al reported that Indian
Primary 5.22 2.31 females are more pain-sensitive than the males (23). This
Guidance 5.34 2.67 difference can be due to cultural and racial differences.
This study is limited by small sample size and the short
High school 5.42 2.37
follow up periods of participants; therefore, we propose
College 5.72 2.45 conducting further studies with larger sample sizes and
Type of Disease P < 0.001 longer follow-ups to confirm our results. In conclusion,
Soft Tissue Cancer 5.32 2.11 patients with cancer are in need of professional palliative
care for the improvement of their quality of life which is
Bone Cancer 6.13 2.32
in contrast with the goals of curative medicine that only
Leukemia 5.65 1.98
focuses on increasing the survival of patients. Therefore,
Stage of disease P = 0.003 using modalities such as music therapy by considering
1 5.14 1.28 its effects on reduction of pain among cancer patients,
2 6.09 2.21
its availability, low cost and no having side effects, can be
suggested to healthcare practitioners and nurses as well
3 6.24 2.46
as the patients' family. This study also supports the prac-
tice of evidence-based nursing for the care of patients
5. Discussion with cancer.

The results of the present study showed the positive ef- Acknowledgements
fect of music therapy on decreasing the pain of cancer
patients. The results of some studies performed in Turkey This study was supported by research deputy of Urmia
(17) and Iran (18) confirmed the reducing effect of music University of Medical Sciences. We would like to thank
therapy on distress and pain among these patients. Also, all the hospital authorities and staff as well as all the pa-
the findings of a research conducted by Uyar M et al. on tients who helped us in data collection.

Authors Contribution
the impact of music therapy on pain reduction of pa-
tients who were admitted to intensive care unit are con-
sistent with the results of our study (19). Our results are Study design: M. J., N. A.; data collection: M. J.; data analy-
also in line with the study conducted by Zhang JM et al. sis: M. J., L. S.; manuscript Writing: F. Kh., N. Kh.

78 Thrita. 2013; 2(4)

 Jasemi M et al.

Financial Disclosure related acute and delayed nausea: Assessment of Nausea in Che-
motherapy Research (ANCHoR), a randomised controlled trial.
The authors declare no conflict of interest. Health Technol Assess. 2013;17(26):1114.
11. Yekta ZP, Ebrahimi SM, Hosseini M, Nasrabadi AN, Sedighi S,

Funding/Support
Surmaghi MH, et al. Ginger as a miracle against chemotherapy-
induced vomiting. Iran J Nurs Midwifery Res. 2012;17(5):3259.
12. Lepage C, Drolet P, Girard M, Grenier Y, DeGagne R. Music de-
This research was supported by a research grant affili-
creases sedative requirements during spinal anesthesia. Anesth
ated to Urmia University of Medical Sciences, Iran. Analg. 2001;93(4):9126.
13. Bekhuis T. Music therapy may reduce pain and anxiety in chil-
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