Tuning out pain

Diana Meyer, as a veteran nurse, has seen plenty of pain. Pain, or at least discomfort, is nearly universal among hospital patients. Yet it remains difficult to treat. Pain is subjective, and that's the big problem, says Meyer. "For your broken leg, you may say your pain is an 8 [on a scale of 10], even with medication. And I may say, really? My pain's a 2," she says. Studies have shown that the most common pain treatment—medication—is effective for less than 40 percent of patients. Adding to the problem is the fact that many strong pain medications, such as opioids, can put patients at risk of being oversedated, possibly causing their breathing to slow to unsafe rates or stop altogether. "Getting to no pain, in many instances, is actually too dangerous for the patient," Meyer says.

If more meds aren't the answer, what is?

While studying for her doctorate at Johns Hopkins last year, Meyer, Nurs '12 (DNP), decided to try a different approach. Tasked with reviewing patient satisfaction surveys at the community hospital where she worked, she found that the hospital had received low marks when it came to pain management. Just two-thirds of patients felt the staff had done everything they could to alleviate their pain; less than half reported that they were satisfied with their pain relief. Working as a clinical nurse specialist at the time, she says, "I really saw that as a reflection of what the nurses—independent of physician orders—could be doing for patients. And that's what led me to think about complementary therapies that would be completely within the nurses' autonomous practice, to implement without a physician order, that may help the patient experience more comfort."

Looking for an affordable solution, and one that would be manageable for nurses to incorporate into their other duties, Meyer settled on music, long recognized as a complementary therapy. Even Florence Nightingale made reference to the therapeutic effects of music, in her 1860 Notes on Nursing, writing that "wind instruments, including the human voice, and stringed instruments, capable of continuous sound, have generally a beneficent effect" on the sick. Although research is divided on whether music actually reduces pain, Meyer says, certain genres of music have been shown to lower blood pressure, heart rate, and respiratory rate, which Meyer hoped would also induce comfort and improve feelings of well-being for patients. She provided individual CD players and headphones for patients, and had nurses encourage their use when patients received medication or when they simply felt uncomfortable.

The results surprised Meyer. One hundred percent of the patients in the group who had listened to music reported that they were either "satisfied" or "very satisfied" with the hospital's pain management efforts. And 87 percent of patients in the music intervention group felt their pain care was complete, compared to only 52 percent of patients who did not listen to music. Another benefit of the project, Meyer says, is that the nurses who participated indicated that they would be much more likely to use this kind of therapy in the future, after seeing evidence that it worked and that it wouldn't take them away from their other duties and responsibilities.

"There are very elegant but simple ways to improve the patient's experience," says Meyer, who now works as a director of nursing practice at the Center for Nursing Evidence-Based Practice, Research, and Innovation in Boise, Idaho. "And this was the presence of nurses, their encouragement to use the simple intervention of listening to music. Just a little extra, and that was the impact, at least in a small group of patients—none of them felt dissatisfied with their pain care."