Pain is a common symptom among pediatric patients who have leukemia. Pain can be linked to invasive medical procedures or the disease itself. Although pain related to cancers causes distress, invasive procedures done during diagnosis and treatment are the most common source of pain among pediatricians. More pain can result from the negative effects of treatment. Pain can be difficult to assess and manage pediatric populations. Challenges associated with pain assessment and management in children is the main reason as to why they are, in most cases, not treated. Studies indicate that if the pain is not adequately treated, it can have adverse effects on both the psychological and physical wellbeing of children.
Pain among pediatrics is, in most cases, managed or treated using pharmacological or non-pharmacologic methods or the two combined. Pharmacological treatments such as opioids and NSAIDS, among others, are used. Existing evidence indicates that these drugs are effective in managing pain. However, these drugs may not be affordable or available to some individuals. As a result, a child has to be restrained when undergoing a painful procedure, which can cause more injury. Even in situations where these drugs are available, studies show that they do not effectively improve pain experience, and children keep complaining of pain even after they are administered. As a result, multiple studies propose non-pharmacologic interventions in managing pediatric pain. It is, therefore important to understand if non-pharmacologic pain interventions are effective among children experiencing pain. Therefore, the question that needs to be addressed is, “Is music therapy compared to pharmacologic interventions effective in reducing pain among pediatrics suffering from leukemia?”
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Method
The search terms used for the current review were pediatrics pain, music therapy, pediatric leukemia, and pharmacologic pain interventions for children . These terms were used to generate several search strings to produce the desired results. The search was conducted in several databases, which included PubMed, Google Scholar, Medline, and CINAHL Plus with full text, and EMBASE. Numerous articles were generated, and only those that explicitly addressed the research question were selected for this review.
Themes
Three major themes emerged from the studies reviewed. These themes are:
Music as a distractor has a positive impact on pain
The major theme addressed in the articles reviewed is the impact of music therapy on pain in children with health conditions such as leukemia. Music is considered an effective therapy in relieving pain caused by invasive procedures such as lumbar puncture and bone marrow aspirations, especially in children who have cancer (Pfaff et al., 1989). Findings indicate experience a lot of anxiety, distress, and high levels of pain during medical procedures such as lumbar puncture (Xie et al., 2016). Compared to their past experiences without music and control groups, children who receive music therapy report reduced pain and distress during invasive procedures (Thanh Nhan Nguyen et al., 2010). They focus on music and, as a result, experience little pain and make it easier for health care staff to conduct medical procedures on them. This shows that distraction through music can help children endure pain. However, although findings indicate that interventions based on music have a positive effect on pain levels, the findings are not easy to translate into practice because they lack a theoretical framework that explains how music therapy alters targeted results and provides guidance on music therapy content (Burns, 2012). Also, Thanh Nhan Nguyen et al. (2010) propose in their findings that although music therapy is effective, it should be combined with pharmacological treatment.
Music Making versus Music Listening
Evidence from the studies reviewed shows that patients preferred music listening to music-making. In addition, music listening was found to be effective compared to music-making. Forty-four percent of cancer patients prefer music listening compared to 17 percent who are interested in music-making (Burns et al., 2005). Findings show that children who listen to music on devices such as iPod report less pain and more satisfaction. Most patients who prefer music listening are, in most cases, young. This is the reason why listening to music before, during, and after invasive medical procedures is effective for children. According to evidence, young patients, especially children, prefer an intervention, prefer interventions that need less cognitive or physical demands to prevent more anxiety or pain from an already distressing situation. Therefore, healthcare providers need to consider the preferences of patients when it comes to the administration of music therapy to ensure the effectiveness of the intervention. In the case of children, all the studies reviewed used listening to music as an intervention, and their findings found the intervention to be effective.
Familiar versus Unfamiliar Music
The patient’s preference is important in music therapy. Studies that intentionally used unfamiliar music on pediatric patients reported fewer improvements in pain levels compared to those that used music that is familiar to patients. Instead of using standardized music that is not familiar to patients, healthcare staff who wish to have a significant clinical effect on pain levels in pediatric patients should use music that patients prefer. Findings indicate that listening to familiar music has a more positive impact on subjective wellbeing (Kemper et al., 2008). This can help children remain calm and experience less anxiety too. Therefore, the studies show children suffering from conditions such as leukemia should be allowed to listen to the music of their choice for a significant positive effect on pain levels during invasive medical procedures.
Conclusion
It is imperative to effectively manage pain in the pediatric population suffering from leukemia to minimize anxiety, pain, and improve their general wellbeing. Evidence shows that non-pharmacological interventions such as music therapy can effectively help reduce pain as well as anxiety and distress during invasive procedures related to cancer treatment. However, there are two factors that clinicians should consider when giving music therapy to ensure effectiveness. These factors are the patient’s familiarity with the music being used and the patient’s preference for whether to listen or make music. Although studies show that non-pharmacological interventions are effective in reducing pain levels among pediatric patients, it is not clear if they are superior to pharmacological treatments. This calls for more research to clearly establish if non-pharmacological interventions are more effective than pharmacological treatments in reducing pain levels.
Literature Review Matrix
Author/date | Theoretical/ Conceptual Framework | Research Questions(s)/ Hypothesis | Methodology & Indicate Quantitative Or Qualitative | Analysis & Results | Conclusions | Implications For Future Research | Implications For Practice |
Xie, Anwei; Shan, Yuying; Niu, Mei′e; Chen, Yi; Wang, Xiya (2017) | practice-level nursing theory | Aims and objectives To describe experiences and nursing needs of school-age Chinese children undergoing lumbar puncture for the treatment of acute lymphoblastic leukaemia . Background Lumbar puncture is an invasive procedure, causing psychological changes and physical discomfort in patients. In a previous study, it was proved that distraction intervention, such as music therapy , relieves pain and anxiety. | qualitative study | distraction intervention, such as music therapy | Results While undergoing lumbar puncture for the treatment of acute lymphoblastic leukaemia, the school-age children experienced complex psychological feelings (fear, tension, helplessness, sadness and anxiety). They also experienced physical discomfort. | The experiences described in this study contribute to a better understanding of the needs of acute lymphoblastic leukaemia children undergoing lumbar puncture. | The study provided valuable information to medical care staff that develops future nursing assessments |
| Nguyen TN; Nilsson S; Hellström A; Bengtson A | This study uses conceptual level framework | The aim of this study was to evaluate if music medicine influences pain and anxiety in children undergoing lumbar punctures | quantitative and qualitative study | Descriptive statistics using variables of heart rate, resp rate, O2 sat and BP were used and well as interview questions. THe results show improved pain perception with the use of music during a lumbar puncture. | The use of music in pediatric patients with leukemia during lumbar puncture reduces pain and anxiety. | Since the results were statistically significant, it raises implications for future research to strengthen data since there was few research done on the topic. | With significant results, the study definitely raises implications for clinical practice. More research can strengthen the study. |
MEDINA CÓRDOBA, Camila Alejandra; PÉREZ VILLA, Marjorie 2019 | This study uses a middle range conceptual theory | To evaluate the non pharmacological measures implemented by the nurses management of pain manifested by pediatric patients diagnosed with Acute Lymphocytic Leukemia during hospitalization. | Longitudinal analytical study, Qualitative | Pain scales were used to analyze pain. The study concludes that music reduces pain perception in the child with ALL. | The study concludes that music as a non pharmacological method in the treatment of pain in children with Acute Lymphocytic Leukemia improves pain perception. | The study raises implications for future research for the purpose of strengthening data and addressing limitations of the study. Perhaps adding quantitative data such as measured vital signs will add to the data. | The study raises implications for clinical practice if more data can be done to validate and strengthen the study. In that case, it would be a good method to use as evidence based practice. |
Kemper, K. J., Hamilton, C. A., McLean, T. W., & Lovato, J. (2008). | This study uses a middle range conceptual theory | What is music’s effect on pediatric oncology patients? | Prospective cohort study, Quantitative | Parental questionnaires were used in addition to monitoring patient HR | The study concludes that music therapy improved pain in children with leukemia. | The study raises implications for future research since this is beneficial, yet requires use of quantitative data to strengthen results. | The study raises implications for future research since a non pharmacological approach can be a beneficial nursing intervention with positive results. |
(Kemper et al.,2008) | Theoretical framework | How does specially designed music that improves HRV and subjective feelings of well-being in healthy adolescents affect pediatric oncology outpatients? | Quantitative Study | Descriptive statistics using VAS pain scale | The study concluded that music can impact pain and related stress during procedures. | The implications for future research in this study is useful and generates quantitative studies that will aid the healthcare professional in the management of pain utilizing the VAS pain scale system. | The data implications will optimize future use of non-pharmacological applications in the nursing/healthcare profession as the superior method rather than the use of opioid pain medication |
Burns, Debra S, PHD, MT-BC (2012) | Theoretical Framework | The research question that is intended to be answered in the study is whether lack of regular, effective screening by qualified health care providers has led to an increased rate of STIs among the older population. The | Quantitative /qualitative/Integrative | Systematic Approach using various research techniques | The study concluded the results in the use of music-related interventions, which makes it almost impossible to translate the findings of this research to the clinical practices. | The implications for the future is not useful at this time will require further research on the subject matter | The data implications can be used in further research studies for non pharmacological interventions for both quantitative and qualitative research |
Vohra S, and Nilsson, S 10/13/2011 | EBP | Can music be an effective alternative pain management in children with leukemia | Quantitative and qualitative | Descriptive statistics using pain level, HR, RR, and O2 saturation as variables in pain management | The findings from the research confirmed patients experienced less pain and fear | The study can serve as a foundation for future research on music as a non-pharmacological pain intervention in predicting patient suffering from leukemia | The result confirmed positive experience which can be incorporated into future nursing practice in pain management of pediatric oncology patients. |
Valerie K. Pfaff , Karen E. Smith & Darryl Gowan 06/2010 | Middle range conceptual theory | Is music therapy a viable pain reduction alternative in children with leukemia undergoing bone marrow aspiration | Quantitative research study | Observational methods were used to evaluate distress related to pain during the procedure | Data analysis indicated strong trends for reductions in anticipatory fear and pain experienced | The study did not show significant reduction in total observed behavioral distress, however, implication for future research will be of significance in pain management in pediatric oncology patients. | The study can be further researched to assist nurses in non pharmacological interventions for stress and pain reduction in the pediatric setting |
References
Burns, D. S. (2012). Theoretical rationale for music selection in oncology intervention research: An integrative review. Journal of Music Therapy , 49 (1), 7-22. https://doi.org/10.1093/jmt/49.1.7
Burns, D. S., Sledge, R. B., Fuller, L. A., Daggy, J. K., & Monahan, P. O. (2005). Cancer patients’ interest and preferences for music therapy. Journal of Music Therapy , 42 (3), 185-199. https://doi.org/10.1093/jmt/42.3.185
Kemper, K. J., Hamilton, C. A., McLean, T. W., & Lovato, J. (2008). Impact of music on pediatric oncology outpatients. Pediatric Research , 64 (1), 105-109. https://doi.org/10.1203/pdr.0b013e318174e6fb
Pfaff, V. K., Smith, K. E., & Gowan, D. (1989). The effects of music-assisted relaxation on the distress of pediatric cancer patients undergoing bone marrow aspirations. Children’s Health Care , 18 (4), 232-236. https://doi.org/10.1207/s15326888chc1804_6
Thanh Nhan Nguyen, Nilsson, S., Hellström, A., & Bengtson, A. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. Journal of Pediatric Oncology Nursing , 27 (3), 146-155. https://doi.org/10.1177/1043454209355983
Thanh Nhan Nguyen, Nilsson, S., Hellström, A., & Bengtson, A. (2010). Music therapy to reduce pain and anxiety in children with cancer undergoing lumbar puncture: A randomized clinical trial. Journal of Pediatric Oncology Nursing , 27 (3), 146-155. https://doi.org/10.1177/1043454209355983
Xie, A., Shan, Y., Niu, M., Chen, Y., & Wang, X. (2017). Experience and nursing needs of school-age children undergoing lumbar puncture during the treatment of acute lymphoblastic leukaemia: A descriptive and qualitative study. Journal of Clinical Nursing , 26 (21-22), 3328-3335. https://doi.org/10.1111/jocn.13680
