被動式音樂應用在疑似或確診癌症病人診斷性切片檢查及手術之疼痛緩解－系統性文獻回顧與統合分析

The Pain-Relief Efficacy of Passive Music-Based Interventions in Cancer Patients Undergoing Diagnostic Biopsies and Surgery: A Systematic Review and Meta-Analysis

10.6224/JN.201802_65(1).10

洪彩慈(Tsai-Tzu Hung)；劉育真(Yu-Chen Liu)；蔡佩靜(Pei-Cheng Tsai)；林梅鳳(Mei-Feng Lin)

音樂治療 ； 癌症病人 ； 診斷性切片檢查 ； 手術 ； 疼痛緩解 ； music-based intervention ； cancer patient ； diagnostic biopsy ； surgery ； pain relief

護理雜誌

65卷1期（2018 / 02 / 01）

70 - 82

繁體中文

背景：音樂是常使用於住院病人的非藥物性疼痛緩解策略。目的：透過系統性文獻回顧及統合分析，檢視被動式音樂對疑似或確診癌症病人在診斷性切片檢查及手術疼痛的緩解效應，並找出具臨床實證的應用策略與建議。方法：在Cochrane Library/Trials、PubMed、PsycINFO、CINHAL、台灣期刊論文索引系統五個中英文資料庫，搜尋2016年以前的隨機對照性試驗研究，以modified Jadad scale 3分以上者列為統合分析之題材，使用comprehensive meta-analysis進行資料處理及分析。結果：共12篇研究納入分析，發現被動式音樂對診斷性切片檢查及手術疼痛具有緩解效應，整體效果量（Hedges's g）為小至中度-.42（p = .02）；次群組分析顯示：麻醉方式、介入環境、頻次及音樂治療師是顯著影響疼痛緩解效應的調節因子。結論／實務應用：本統合分析證實被動式音樂能有效減緩疑似或確診癌症病人，接受診斷性切片檢查或手術疼痛。建議未來可將之應用在全身麻醉手術前後，於等候室或病房環境、每日提供2－3次、由音樂治療師執行或指導的方案，乃為被動式音樂介入緩解疼痛的重要關鍵。

Background: Music-based intervention is commonly used as a non-pharmacological strategy to reduce pain in hospitalized patients. Purpose: To conduct a systematic review and meta-analysis to examine the effects of passive music-based interventions on pain relief in cancer patients undergoing diagnostic biopsies and surgeries and to identify the moderating variables in order to identify clinically validated interventional strategies and related suggestions. Methods: Studies using an RCT (randomized clinical trial) design that were published before 2016 were collected from the following databases: Cochrane Library/Trials, PubMed, PsycINFO, CINHAL, and Index to Taiwan Periodical Literature System. The high-quality studies, defined as those earning a modified Jadad scale score ＞ 3, were then analyzed using comprehensive meta-analysis software. Results: The passive music-based interventions had a small-to-moderate overall effect (g = -.42, p = .02) on pain relief in the subjects undergoing diagnostic biopsies and surgery in the analyzed studies (n = 12). Subgroup analysis identified the moderating variables affecting pain reduction as the type of anesthesia administered and the settings, frequency, and music therapist that were used in the intervention. Conclusion/Implications for Practice: Passive music-based interventions have a significant pain reduction effect and may be used as an effective, non-pharmacologic intervention for cancer patients undergoing diagnostic biopsies and surgery. Delivering 2-3 intervention sessions daily, using a certificated music therapist to deliver/guide the sessions, holding the sessions in waiting-room or ward settings, and administering a general anesthesia were identified as the crucial factors impacting the effectiveness of music intervention on pain relief.

1. Alam, M.,Roongpisuthipong, W.,Kim, N. A.,Goyal, A.,Swary, J. H.,Brindise, R. T.,Yoo, S.(2016).Utility of recorded guided imagery and relaxing music in reducing patient pain and anxiety, and surgeon anxiety, during cutaneous surgical procedures: A single-blinded randomized controlled trial.Journal of the American Academy of Dermatology,75(3),585-589.
2. Beck, A. T.(1993).Cognitive therapy: Nature and relation to behavior therapy.Journal of Psychotherapy Practice and Research,2(4),342-356.
3. Binns-Turner, P. G.,Wilson, L. L.,Pryor, E. R.,Boyd, G. L.,Prickett, C. A.(2011).Perioperative music and its effects on anxiety, hemodynamics, and pain in women undergoing mastectomy.AANA Journal,79(4, Suppl.),S21-S27.
4. Borenstein, M.,Hedges, L. V.,Higgins, J. P. T.,Rothstein, H. R.(2009).Introduction to meta-analysis.New York, NY:John Wiley & Sons.
5. Bradt, J.,Dileo, C.,Magill, L.,Teague, A.(2016).Music interventions for improving psychological and physical outcomes in cancer patients.Cochrane Database of Systematic Reviews,8,Art. No.: CD006911.
6. Carlson, L. E.,Bultz, B. D.(2008).Mind-body interventions in oncology.Current Treatment Options in Oncology,9(2-3),127-134.
7. Cepeda, M. S.,Carr, D. B.,Lau, J.,Alvarez, H.(2010).Music for pain relief.Cochrane Database of Systematic Reviews,2,Art. No.: CD004843.
8. Chi, G. C.-H.-L.,Young, A.,McFarlane, J.,Watson, M.,Coleman, R. L.,Eifel, P. J.,Richardson, M.(2015).Effects of music relaxation video on pain and anxiety for women with gynaecological cancer receiving intracavitary brachytherapy: A randomised controlled trial.Journal of Research in Nursing,20(2),129-144.
9. Cohen, J.(1988).Statistical power analysis for the behavioral sciences.Mahwah, NJ:Lawrence Erlbaum Associates.
10. Danhauer, S. C.,Vishnevsky, T.,Campbell, C. R.,McCoy, T. P.,Tooze, J. A.,Kanipe, K. N.,Cruz, J.(2010).Music for patients with hematological malignancies undergoing bone marrow biopsy: A randomized controlled study of anxiety, perceived pain, and patient satisfaction.Journal of the Society for Integrative Oncology,8(4),140-147.
11. Domar, A. D.,Eyvazzadeh, A.,Allen, S.,Roman, K.,Wolf, R.,Orav, J.,Baum, J.(2005).Relaxation techniques for reducing pain and anxiety during screening mammography.American Journal of Roentgenology,184(2),445-447.
12. Fletcher, J.(2007).What is heterogeneity and is it important?.BMJ: British Medical Journal,334,94-96.
13. Garza Villarreal, E. A.,Brattico, E.,Vase, L.,Østergaard, L.,Vuust, P.(2012).Superior analgesic effect of an active distraction versus pleasant unfamiliar sounds and music: The influence of emotion and cognitive style.PLoS One,7(1),e29397.
14. Kaunisto, M. A.,Jokela, R.,Tallgren, M.,Kambur, O.,Tikkanen, E.,Tasmuth, T.,Kalso, E. A.(2013).Pain in 1,000 women treated for breast cancer: A prospectivestudy of pain sensitivity and postoperative pain.Anesthesiology,119(6),1410-1421.
15. Kongsawatvorakul, C.,Charakorn, C.,Paiwattananupant, K.,Lekskul, N.,Rattanasiri, S.,Lertkhachonsuk, A. A.(2016).Limited impact of music therapy on patient anxiety with the large loop excision of transformation zone procedure: A randomized controlled trial.Asian Pacific Journal of Cancer Prevention,17(6),2853-2856.
16. Kumar, N.(2007).,未出版
17. Kwekkeboom, K. L.(2003).Music versus distraction for procedural pain and anxiety in patients with cancer.Oncology Nursing Forum,30(3),433-440.
18. Kwekkeboom, K. L.(2001).Pain management strategies used by patients with breast and gynecologic cancer with postoperative pain.Cancer Nursing,24(5),378-386.
19. Lee, J. H.(2016).The effects of music on pain: A meta-analysis.Journal of Music Therapy,53(4),430-477.
20. Li, X. M.,Yan, H.,Zhou, K. N.,Dang, S. N.,Wang, D. L.,Zhang, Y. P.(2011).Effects of music therapy on pain among female breast cancer patients after radical mastectomy: Results from a randomized controlled trial.Breast Cancer Research and Treatment,128(2),411-419.
21. Mahon, E. M.,Mahon, S. M.(2011).Music therapy: A valuable adjunct in the oncology setting.Clinical Journal of Oncology Nursing,15(4),353-356.
22. Moher, D.,Liberati, A.,Tetzlaff, J.,Altman, D. G.,The PRISMA Group(2009).Preferred reporting items for systematicreviews and meta-analyses: The PRISMA statement.PLoS Medicine,6(7),e1000097.
23. Moore, R. A.,Straube, S.,Aldington, D.(2013).Pain measures and cut-offs - 'no worse than mild pain' as a simple, universal outcome.Anaesthesia,68(4),400-412.
24. Nilsson, U.(2008).The anxiety- and pain-reducing effects of music interventions: A systematic review.AORN Journal,87(4),780-807.
25. Oremus, M.,Wolfson, C.,Perrault, A.,Demers, L.,Momoli, F.,Moride, Y.(2001).Interrater reliability of the modified Jadad quality scale for systematic reviews of Alzheimer's disease drug trials.Dementia and Geriatric Cognitive Disorders,12(3),232-236.
26. Robb, S. L.,Carpenter, J. S.,Burns, D. S.(2011).Reporting guidelines for music-based interventions.Journal of Health Psychology,16(2),342-352.
27. Rosenthal, R.,DiMatteo, M. R.(2001).Meta-analysis: Recent developments in quantitative methods for literature reviews.Annual Review of Psychology,52(1),59-82.
28. Rosnow, R. L.,Rosenthal, R.,Rubin, D. B.(2000).Contrasts and correlations in effect-size estimation.Psychological Science,11(6),446-453.
29. Shabanloei, R.,Golchin, M.,Esfahani, A.,Dolatkhah, R.,Rasoulian, M.(2010).Effects of music therapy on pain and anxiety in patients undergoing bone marrow biopsy and aspiration.AORN Journal,91(6),746-751.
30. Shen, Y. W.,Zhang, X. M.,Lv, M.,Chen, L.,Qin, T. J.,Wang, F.,Yang, J.(2015).Utility of gonadotropin-releasing hormone agonists for prevention of chemotherapy-induced ovarian damage in premenopausal women with breast cancer: A systematic review and meta-analysis.OncoTargets and Therapy,8,3349-3359.
31. Soo, M. S.,Jarosz, J. A.,Wren, A. A.,Soo, A. E.,Mowery, Y. M.,Johnson, K. S.,Shelby, R. A.(2016).Imaging-guided core-needle breast biopsy: Impact of meditation and music interventions on patient anxiety, pain, and fatigue.Journal of the American College of Radiology,13(5),526-534.
32. Téllez, A.,Sánchez-Jáuregui, T.,Juárez-García, D. M.,García-Solís, M.(2016).Breast biopsy: The effects of hypnosis and music.International Journal of Clinical and Experimental Hypnosis,64(4),456-469.
33. Tsai, H. F.,Chen, Y. R.,Chung, M. H.,Liao, Y. M.,Chi, M. J.,Chang, C. C.,Chou, K. R.(2014).Effectiveness of music intervention in ameliorating cancer patients' anxiety, depression, pain, and fatigue: A meta-analysis.Cancer Nursing,37(6),E35-E50.
34. Tsivian, M.,Qi, P.,Kimura, M.,Chen, V. H.,Chen, S. H.,Gan, T. J.,Polascik, T. J.(2012).The effect of noise-cancelling headphones or music on pain perception and anxiety in men undergoing transrectal prostate biopsy.Urology,79(1),32-36.
35. Villemure, C.,Bushnell, C. M.(2002).Cognitive modulation of pain: How do attention and emotion influence pain processing?.Pain,95(3),195-199.
36. Wang, Y.,Tang, H.,Guo, Q.,Liu, J.,Liu, X.,Luo, J.,Yang, W.(2015).Effects of intravenous patient-controlled sufentanil analgesia and music therapy on pain and hemodynamics after surgery for lung cancer: A randomized parallel study.The Journal of Alternative and Complementary Medicine,21(11),667-672.
37. Zengin, S.,Kabul, S.,Al, B.,Sarcan, E.,Doğan, M.,Yildirim, C.(2013).Effects of music therapy on pain and anxiety in patients undergoing port catheter placement procedure.Complementary Therapies in Medicine,21(6),689-696.
38. Zhang, J. M.,Wang, P.,Yao, J. X.,Zhao, L.,Davis, M. P.,Walsh, D.,Yue, G. H.(2012).Music interventions for psychological and physical outcomes in cancer: A systematic review and meta-analysis.Supportive Care in Cancer,20(12),3043-3053.
39. 李秀枝、吳聖良(2010)。病人主訴術後疼痛強度與護理人員評估結果差異之比較。護理雜誌，57(3)，60-68。
40. 胡文郁、陳宛榆、羅淑芬、陳書毓、黃瀚心、陳幼貴(2011)。成人癌症疼痛臨床照護指引。腫瘤護理雜誌，11(增訂刊=Suppl.)，87-127。
41. 莊其穆(2011)。臨床醫師如何閱讀統合分析（Meta-analysis）的論文。臺灣醫界，54(2)，74-82。
42. 黃如萍、葉美玲(2011)。統合分析的出版誤差。源遠護理，5(2)，51-55。

1. 陳雅紅,張蓉馨,周佳諦,李淑儀(2022)。照護一位大腸癌病人術後併行永久性腸造瘻口的護理經驗。源遠護理，16(增訂刊)，13-20。
2. 陳俞君,林永樺(2023)。照護一位哺乳期間罹患乳癌病人之護理經驗。新臺北護理期刊，25(1)，138-146。
3. 薛錡蔚(2022)。照顧一位男性鼻咽癌術後身體心像改變之加護經驗。志為護理-慈濟護理雜誌，21(4)，107-116。
4. 周郁秀(2023)。音樂治療對心理健康之療效原理以及應用。諮商與輔導，455，14-16。
5. (2024)。音樂治療於腎臟切片病人成效之系統性文獻回顧暨統合分析。長庚護理，35(3)，1-12。