Music has been used as a therapeutic intervention for centuries. The literature is replete with studies that have confirmed the effect of music on pain, anxiety, and other measures in a clinical setting. There is clearly documented evidence of the physiologic impact of music, including effects on parasympathetic activity, stress hormones levels and humoral immunity, suggesting its efficacy in decreasing stress-induced autonomic and neuroendocrine arousal and the facilitation of the relaxation response.

Music in the medical environment can be a safe and low-cost non-pharmacologic intervention to reduce anxiety and enhance relaxation in intensive care patients as well as to reduce pain perception, anxiety and stress levels in the Emergency Department (ED) setting. Live preferential music confers an advantage in that choice, preference, and familiarity can enhance music’s effectiveness as an intervention and can contribute to reductions in pain and anxiety.

Over the past two decades, partnerships between musicians, music therapists and clinical researchers have yielded unprecedented development of clinical interventions supported by rigorous scientific studies (Thaut & McIntosh, 2010). Hundreds of studies have confirmed the effect of music on reducing pain, anxiety, and other clinical measures such as vital signs. There is clearly documented evidence of the physiologic impact of music including effects on parasympathetic activity, stress hormones levels and immunity, suggesting its efficacy in decreasing stress-induced autonomic and neuroendocrine arousal and the facilitation of the relaxation response. 

Music in the medical environment can be a safe and low-cost non-pharmacologic intervention to reduce anxiety and enhance relaxation in intensive care patients as well as to reduce pain perception, anxiety and stress levels in the Emergency Department (ED) setting.  Live preferential music confers an advantage in that choice, preference, and familiarity with music can enhance its effectiveness as an intervention and contribute to reductions in pain and anxiety. The majority of the published work on music interventions in the clinical setting has focused on specific patient outcomes, with little evidence linking music to enhancement of the overall environment of care and more global health outcomes including impacts on cost of care and enhancement of caregiver satisfaction in high stress environments.

Mangoulia’s 2013 meta-analysis of music therapy and music medicine (music administered in healthcare by a musician who is not a music therapist) in intensive care concluded that music is a safe and low-cost non-pharmacologic intervention to reduce anxiety and enhance relaxation in intensive care patients (Mangoulia, 2013).  The study recognized live music as having more importance than recorded music as an intervention for this population. Another important meta-analysis, conducted in 2008, looked at 42 studies that measured the effects of music on pain and anxiety.  The analysis found that approximately half of the studies reported significant positive effects (Nilsson, 2008).

Music has been widely shown in various patient populations and procedures to positively affect pain control, pain tolerance, and pain perception (Henry, 1995; Whipple and Glynn, 1992; Nilsson, Rawal, & Unosson, 2003; Good, 1995; Good et al., 2001; Mitchell, 2006), as well as the need for anesthesia and sedation (Newman et. al, 2010; Lee et al., 2002).  Studies of music in emergency care have presented positive outcomes related to anxiety and stress (Holm & Fitzmaurice, 2008; Short & Ahern, 2009), pain management (Bauman & McManus, 2005; Negrete, 2011), and reduction of noise stress (Short et al., 2010). Most interventions use recorded music, and some are engaging technology such as iPods (Young et al., 2010). 

While most studies focus on use of recorded music, some investigation is taking place on the use of live music as an intervention for pain and anxiety.  More such research is needed, particularly in emergency and critical care services. Ferrer (2005) documented positive affects of live music on fear, fatigue, relaxation, diastolic blood pressure, and relaxation levels among patients receiving chemotherapy.  A study by Holmes et al (2006) suggests that live music has advantages over recorded music, a conclusion cited as well in Aldridge’s (1994) review of music therapy literature.  Live music has been shown to be beneficial for neonatal, pediatric, burn, post-operative, and palliative care populations (Teckenberg-Jansson et al., 2011; Hartlin et al., 2009; Tan et al., 2010; Galleghar, 2011; Engwall & Duppils, 2009).

Preferential music is also becoming the standard in music interventions as studies show that choice, preference, and familiarity with music can enhance its effectiveness as an intervention and can contribute to reductions in pain and anxiety (Dileo, 1999; Aldridge, 2004; Thaut & Davis, 1993; Cepeta, 2006).

Wider utilization in recent years of music in medical settings and partnerships between musicians/music therapists and clinical researchers are yielding advances in clinical interventions supported by scientific evidence (Thaut and McIntosh, 2010; Sonke, 2011). As brain imaging technologies have advanced in sophistication over the past twenty years, neurological research has been able to identify some of the structures that may underlie the outcomes noted above. Studies have shown that the neural networks that process music also process other functions, such as attention (Bengtsson et. al, 2009). As music occupies attention as a pleasurable stimulus, it has the potential to reduce anxiety and the perception of pain (Lin et al., 2011; Voss et al., 2004). 

Studies have shown that music can reduce the need for pain medication in emergency and other care.  Menegazzi et al (1991) demonstrated a significant decrease in pain among patients listening to recorded music during laceration repair in an emergency department.  Music has been shown to significantly reduce pain and anxiety during burn dressing changes (Tan et al., 2010; Son & Kim, 2006).  Smolen and colleagues (2002) demonstrated decreased administration of Versed® and meperidine during colonoscopy when self-selected recorded music was utilized.  Similarly, Schiemann (2002) reported lower use of analgesia, higher procedure completion rate and accelerated procedure time when music was used during colonoscopy.  Lee et al. (2002) also demonstrated a reduced need for sedation with music.

Stress and anxiety also significantly affects the perception of pain, and music has been widely demonstrated to reduce both in medical settings (Holm & Fitzmaurice, 2008; Richards et al., 2007; Dritsas, 2013). Music has also been shown to reduce anxiety among patients waiting for test results (Haun, Mainous & Looney, 2001), which is common in an Emergency Department.  Agwu & Okoye (2007) investigated the use of live preferential music during hysterosalpingography procedures. Patients who listened to music during the procedure had lower State Anxiety scores than a control group. 

Studies have shown music to be a risk-free alternative to pharmacological interventions, and to significantly reduce the costs of medical procedures such as CT scans (Loewy, et al., 2005; Walworth, 2005).  Walworth (2005) documented use of music during pediatric CT scans that almost entirely eliminated the need for sedation and anesthesia, eliminated overnight stays, yielded a 98% procedure success rate, put three hours of nursing time back on the floor per procedure, and documented cost savings of $567 per procedure. With over four million CT scans performed annually on children, the potential cost savings of using musicians for this procedure alone exceeds $2.25 billion nationally.  Far more such procedures are performed on adults in emergency and critical care centers than on children.

Investigations also suggest that music can have a positive affect on patient satisfaction.  Ricahrds et al. (2007) conducted a meta-analysis investigating the affects of music on pain perception and manifestation, anxiety, and satisfaction in acute care settings.  The study cited the low cost of music as a positive factor in its viability as an intervention for pain and anxiety and noted that, in numerous studies, patients were more satisfied with their care when music therapy was utilized.  While few studies focus specifically on patient satisfaction as a measure, more recent studies of music are including satisfaction as a measure, indicating positive affects, and suggesting the need for further research (Hunter et al., 2010; Sener et al., 2010) in this area.

Over 130 million people access emergency care in the U.S. each year.  Emergency departments are particularly stressful environments, and a major driver of high costs in healthcare. Few studies have investigated the impact of live preferential music in emergency departments specifically, where there is significant potential for positive impacts on care.  Menegazzi et al (1991) demonstrated a significant decrease in pain among patients listening to recorded music during laceration repair in an emergency department.  Weiland et al published evidence in a randomized control trial in 2011 that original music compositions can reduce anxiety in emergency department patients. To date, no other such randomized studies on live preferential music in Emergency Department settings exist. 

The Arts in Medicine Programs at the University of Florida (UF), in partnership with the UF Department of Emergency Medicine, is currently undertaking an innovative randomized controlled study utilizing a group of highly talented musicians to provide live preferential music in an ED and level one trauma center setting.  The project seeks to demonstrate that live preferential music in an emergency and trauma care setting can positively impact quality and cost of care, including utilization of pain medication and overall patient and staff satisfaction. 

The following recommendations for delivering music in the emergency and trauma care setting are results from phase one of our two-phase study.