Music therapy has been used historically as a therapeutic tool to impact emotions and physiology. A literature review identified 49 peer-reviewed studies from 1990-2012 investigating the effects of music therapy on variables like anxiety, pain, vital signs, and biochemical markers. The studies represented a variety of clinical settings and populations. The review found that music therapy reduced anxiety and sedative requirements in 42 studies, impacted vital signs in 30 studies, reduced pain and analgesic use in 22 studies, and influenced mood and biochemical markers in some studies. The evidence suggests music therapy may be useful as an adjuvant therapy in many clinical contexts by positively influencing physiological stress and pain responses.

1. ROLE OF ADJUVANT
MUSIC THERAPY
Dr.T.Varun Raju
Senior Laparoscopic & GI Surgeon
OMNI Hospitals
Kukatpally Hyderabad

2. Historical aspects
 Long before acoustics came to be understood in Europe as
a subject of study, the ancient Arab, Greek and Indian
civilizations were already familiar with the therapeutic
role of sounds and vibrations and the later day concepts
pertaining to them.
 As Plato (428 BC-348 BC), one of the world's most
influential philosophers, stated in the Republic (written
around 380BC): “Music moulds character, when modes of
music change, the fundamental laws of the state change
with them." He also wrote that "Music is medicine to the
soul“ and "Justice is to the soul as health is to the body.

3. Historical aspects
 During the time of the RENAISSANCE AND BEYOND (1580-1750
AD), the PHYSICIAN used music to effect desired emotional and
physiological changes.
 During the ROMANTIC ERA (2nd half of 18th C. – early 20th C.),
the PHYSICIANMUSICIAN used music listening, active music-
making, and live musical performances in their work with patients
of all ages and disabilities.
 TWENTIETH CENTURY ~ BIRTH OF MUSIC THERAPY AS A
PROFESSIONAL HEALTH CARE DISCIPLINE.
 Rapid urbanization resulted in large mental hospitals. One attempt
to turn these mental asylums into active treatment centres was
through music played by hospital and community musicians.

4. Historical aspects
 Furthermore, with the return of World War II veterans traumatized by their
horrific war experiences, and their remarkable responses to music, there was
a growing interest in the therapeutic and rehabilitative value of music – both
live and recorded (thanks to Edison's invention of the phonograph in 1877).
 At the same time, an increasing number of publications were presenting the
case for music therapy and for training music therapists who were able to use
specific music skills in the assessment and treatment of patients of all ages and
presenting a wide range of disabilities.

5. Historical aspects
 The need for specially trained music therapists was realized
in 1944 with the establishment of the first training program at
Michigan State University. In 1950 the first Association for
Music Therapy was founded in the United States, and in
2010, the American Music Therapy Association celebrated 60
years of development and growth.
 Music Therapy has become a recognized professional health
care discipline.
 For information on the state of music therapy throughout the
world, go to www.voices.no {World Forum for Music
Therapy}.

6. Historical aspects
 Music Therapists draw from ancient healing traditions and
from evidence –based research on the behavioural and
cognitive effects of music (behaviour-oriented music
therapy), the physiological effects of music (medical model of
music therapy) and the psychological effects (insight-oriented
music therapy ~ psychodynamic,analytical).
 “Music therapy is a systematic process of intervention
wherein the therapist helps the client to promote health,
using music experiences and the relationships that develop
through them as dynamic forces of change.” (1998, p.20)
(Kenneth Bruscia, a key player and prolific writer )

7. Research,Education,Publications, Associations
 1. The earliest known reference to music therapy appeared in
1789 in an unsigned article in Columbian Magazine titled "Music
Physically Considered."
 2. (1806). Atlee and Mathews were both students of Dr.
Benjamin Rush, a physician and psychiatrist who was a strong
proponent of using music to treat medical diseases.
 3. Interest in music therapy continued to gain support during the
early 1900s leading to the formation of several short-lived
associations.
 4.In 1903, Eva Augusta Vescelius founded the National Society
of Musical Therapeutics. In 1926, Isa Maud Ilsen founded the
National Association for Music in Hospitals.
 And in 1941, Harriet Ayer Seymour founded the National
Foundation of Music Therapy.

8. Research,Education,Publications, Associations
 5. In the 1940s, three persons began to emerge as innovators
and key players in the development of music therapy as an
organized clinical profession.
 6. E. Thayer Gaston, known as the "father of music therapy,"
was instrumental in moving the profession forward in terms of
an organizational and educational standpoint.
 7. The first music therapy college training programs were also
created in the 1940s. Michigan State University established the
first academic program in music therapy (1944) and other
universities followed suit, including the University of Kansas,
Chicago Musical College, College of the Pacific, and Alverno
College.

9. Research,Education,Publications,
Associations
 The National Association for Music Therapy (NAMT) was
founded at a meeting in New York City on June 2, 1950.
 NAMT operated from 1950-1997 and saw the creation of a
board-certification program (1985), a critically-acclaimed
Senate Hearing on Aging (1991), and the growth of music
therapy from a few dozen practitioners to thousands.
 The American Association for Music Therapy (AAMT) was
established in 1971. Many of the purposes of AAMT were
similar to those of NAMT, but there were differences in
philosophy, education and approach.

10. Research,Education,Publications,
Associations
 .CBMT has been fully-accredited by the National Commission
for Certifying Agencies since 1986 and is committed to
maintaining certification and recertification requirements that
reflect current music therapy practice. To date, there are over
5,000 certificants who hold the credential Music Therapist-Board
Certified (MT-BC). CBMT and AMTA are separate, independent
organizations.
Currently, AMTA is the intellectual home of and serves over 5,000
music therapists. It publishes two research journals as well as a
line of publications, serves as an advocate for music therapy on
the state and federal levels, promotes music therapy through
social media streams, and provides research bibliographies,
podcasts, scholarships, and newsletters to its members.

11. Music therapy as an adjuvant therapeutic tool
in medical practice: an evidence-based
summary
TA Mattei*, AH Rodriguez
 Department of Neurosurgery, University of Illinois, College of
Medicine at Peoria, Peoria, Illinois, USA
Corresponding author Email:
tobias.a.mattei@osfhealthcare.org

12.  Materials and methods
A literature search was conducted using the following
criteria: supportive, peer-reviewed, scientific music
therapy research on human subjects, available in the
English language, dating from 1990 until 2012 and
listed on the PubMed/Medline database in the form
of randomised and non-randomised clinical trials,
meta-analyses and systematic reviews. A multi-word,
multi-search approach was used, utilising various
combinations of terms such as ‘music’, ‘therapy’,
‘anxiety’, ‘pain’, ‘symptoms’, ‘patient’, ‘anxiolytic’,
‘analgesic’, ‘vitals’, ‘heart rate’ and ‘blood pressure.

13. All articles that met the criteria were then
systematically categorised twice based on
two separate categories: variables under
investigation (e.g. anxiety, pain, analgesic
use, vital signs and biochemical markers)
and level of evidence provided by the
research study according to its design (non-
randomised or randomised controlled
clinical trial, meta-analysis or systematic
review).

14. Results
Forty-nine studies met the proposed search criteria,
consisting of six systematic reviews, three meta-
analyses, 33 randomised and seven non-randomised
clinical trials. The primary variables targeted by these
studies included anxiety/sedative requirements (42
studies), vital signs (30 studies), pain/analgesic use
(22 studies), mood/depression (five studies) and
biochemical markers related to pain, fear and anxiety
(seven studies).

15. Results
The authors found that music therapy has already been
investigated scientifically in a broad array of clinical settings
in several medical fields including family medicine,
paediatrics, internal medicine, nursing, gastroenterology,
cardiology, pulmonology, haematology and oncology,
otolaryngology, urology, obstetrics and gynaecology, surgery,
anaesthesiology, interventional radiology, neurology and
psychiatry.

16. Conclusion
The results of this review suggest that music therapy
may be useful as an adjuvant therapy in medical
practice in a broad variety of clinical settings, from
the general clinical exam room to specific scenarios
involving interventional procedures and surgical
operations. This review provides a useful evidence-
based summary for both generalists and specialists
about the current scientific evidence of the beneficial
effects of music therapy as an adjuvant tool in
medical practice.

17. Conclusion
Moreover, as music therapy represents a very inexpensive
and safe therapeutic tool, which has been shown to positively
influence several physiological variables related to anxiety,
stress response and pain, the presented scientific evidence
is intended to increase awareness among the medical
community of the possible benefits of the widespread
application of music therapy throughout modern medical
practice.

18. References
1. Misic P, Arandjelovic D, Stanojkovic S, Vladejic S, Mladenovic J. Music Therapy. Eur Psychiatry
2010 Jan;839.
2. Bradt J, Dileo C, Grocke D, Magill L. Music interventions for improving psychological and physical
outcomes in cancer patients. Cochrane Database Syst Rev 2011 Aug(8):CD006911.
3. Bradt J, Dileo C. Music for stress and anxiety reduction in coronary heart disease patients.
Cochrane Database Syst Rev 2009 Apr(2):CD006577.
4. Evans D . The effectiveness of music as an intervention for hospital patients: a systematic review.
J Adv Nurs 2002 Jan;37(1):8-18.
5. Galaal KA, Deane K, Sangal S, Lopes AD. Interventions for reducing anxiety in women undergoing
colposcopy. Cochrane Database Syst Rev 2007 Jul(3):CD006013.
6. Klassen JA, Liang Y, Tjosvold L, Klassen TP, Hartling L. Music for pain and anxiety in children
undergoing medical procedures: a systematic review of randomized controlled trials. Ambul Pediatr
2008 Mar–Apr;8(2):117-28.
7. Nilsson U . The anxiety- and pain-reducing effects of music interventions: a systematic review.
AORN J 2008 Apr;87(4):780-807.
8. Loomba RS, Arora R, Shah PH, Chandrasekar S, Molnar J. Effects of music on systolic blood
pressure, diastolic blood pressure, and heart rate: a meta-analysis. Indian Heart J 2012: May–
Jun;64(3):309-13.
9. Rudin D, Kiss A, Wetz RV, Sottile VM. Music in the endoscopy suite: a meta-analysis of
randomized controlled studies. Endoscopy 2007 Jun;39(6):507-10.
10. Tam WW, Wong EL, Twinn SF. Effect of music on procedure time and sedation during
colonoscopy: a meta-analysis. World J Gastroenterol 2008 Sep;14(34):5336-43.

19. References
 11. Aragon D, Farris C, Byers JF. The effects of harp music in vascular and thoracic surgical patients. Altern Ther
Health Med 2002 Sep–Oct;8(5):52-4, 56–60.
 12. Binek J, Sagmeister M, Borovicka J, Knierim M, Magdeburg B, Meyenberger C. Perception of gastrointestinal
endoscopy by patients and examiners with and without background music. Digestion 2003;68(1):5-8.
 13. Bringman H, Giesecke K, Thörne A, Bringman S. Relaxing music as premedication before surgery: a randomised
controlled trial. Acta Anaesthesiol Scand 2009 Jul;53(6):759-64.
 14. Buffum MD, Sasso C, Sands LP, Lanier E, Yellen M, Hayes A. A music intervention to reduce anxiety before
vascular angiography procedures. J Vasc Nurs 2006 Sep;24(3):68-73.
 15. Chan MF, Chan EA, Mok E, Kwan Tse FY. Effect of music on depression levels and physiological responses in
community-based older adults. Int J Ment Health Nurs 2009 Aug;18(4):285-94.
 16. Chan YM, Lee PW, Ng TY, Ngan HY, Wong LC. The use of music to reduce anxiety for patients undergoing
colposcopy: a randomized trial. Gynecol Oncol 2003 Oct;91(1):213-7.
 17. Chlan L, Evans D, Greenleaf M, Walker J. Effects of a single music therapy intervention on anxiety, discomfort,
satisfaction, and compliance with screening guidelines in outpatients undergoing flexible sigmoidoscopy. Gastroenterol
Nurs 2000 Jul–Aug;23(4):148-56.
 18. Cooke M, Chaboyer W, Schluter P, Hiratos M. The effect of music on preoperative anxiety in day surgery. J Adv
Nurs 2005 Oct;52(1):47-55.
 19. Han L, Li JP, Sit JW, Chung L, Jiao ZY, Ma WG. Effects of music intervention on physiological stress response
and anxiety level of mechanically ventilated patients in China: a randomised controlled trial. J Clin Nurs 2010
Apr;19(7–8):978-87.
 20. Hatem TP, Lira PI, Mattos SS. The therapeutic effects of music in children following cardiac surgery. J Pediatr (Rio
J) 2006 May–Jun;82(3):186-92.

20. Western Michigan University
ScholarWorks at WMU
Music Therapy and Quality of Life: The Effects of
Musical Interventions on Self-Reported and
Caregiver-Reported Quality of Life in Older Adults
with Symptoms of Dementia
Alisha Snyder

21. Pain Manag Nurs. 2014 Mar;15(1):406-25. doi:
10.1016/j.pmn.2012.08.010. Epub 2012 Oct 26.
Music as an adjuvant therapy in control of pain and symptoms in
hospitalized adults: a systematic review.
Cole LC1, LoBiondo-Wood G2.
 Abstract
 The objective of this review is to evaluate the evidence
regarding the use of music as an adjuvant therapy for pain
control in hospitalized adults.
 The search terms music, music therapy, pain, adults, inpatient,
and hospitalized were used to search the Cochrane Library,
Cinahl, Medline, Natural Standard, and Scopus databases from
January 2005 to March 2011.
 (A systematic review conducted by the Cochrane Collaboration
has extensively covered the time frame from 1966 to 2004.)

22.  Seventeen randomized controlled trials met criteria for review
and inclusion.
 Seven of the research studies were conducted with surgical
patients, three with medical patients, one with medical-
surgical patients, four with intensive care patients, and two
with pregnant patients.
 The combined findings of these studies provide support for
the use of music as an adjuvant approach to pain control in
hospitalized adults.
 The use of music is safe, inexpensive, and an independent
nursing function that can be easily incorporated into the
routine care of patients.

23. J Music Ther. 2015 Spring;52(1):1-77. doi: 10.1093/jmt/thv004.
Epub 2015 Apr 15.
A systematic review of music-based interventions for
procedural support.
Yinger OS1, Gooding LF2.
 BACKGROUND:
 Individuals undergoing medical procedures frequently
experience pain and anxiety. Music-based interventions have
the potential to help alleviate these symptoms.
 OBJECTIVE:
 This review investigated the effects of music-based
interventions (music therapy and music medicine) on pain
and anxiety in children and adults undergoing medical
procedures.

24.  METHODS:
 This systematic review examined randomized controlled trial
music intervention studies to manage patient-reported pain
and/or anxiety during medical procedures.
 All studies were published in English and peer-reviewed
journals. Quality and risk of bias were assessed using criteria
from the Checklist to Evaluate a Report of a
Nonpharmacological Trial (CLEAR-NPT).

25.  RESULTS:
 Fifty studies met inclusion criteria, the majority of which (84%) had a
high risk of bias. It was not possible to perform a meta-analysis
because studies varied greatly in terms of medical procedure and
intervention type. Results varied across studies, with approximately half
(48%) indicating less anxiety for music intervention participants; fewer
studies (36%) reported less pain for music intervention participants.
 CONCLUSIONS:
 There is a need to clearly define and differentiate between music
therapy and music medicine interventions in procedural support
research.
 Further research is necessary to determine which patients would
benefit most from music interventions during medical procedures, and
which interventions are most beneficial.
 To improve research quality and reduce risk of bias, when designing
studies investigators need to carefully consider factors related to
design, including randomization, treatment allocation concealment,
blinding outcome assessors, and intention-to-treat analysis.
 In addition, more detailed intervention reporting is needed when
publishing results.

26. The Effect of Music on the Human Stress Response
Myriam V. Thoma,1,2 Roberto La Marca,2 Rebecca
Brönnimann,2 Linda Finkel,2 Ulrike Ehlert,2 and Urs M.
Nater3,*
Robert L. Newton, Editor
Background
 Music listening has been suggested to beneficially impact health via
stress-reducing effects.
 However, the existing literature presents itself with a limited number of
investigations and with discrepancies in reported findings that may
result from methodological shortcomings (e.g. small sample size, no
valid stressor).
 It was the aim of the current study to address this gap in knowledge
and overcome previous shortcomings by thoroughly examining music
effects across endocrine, autonomic, cognitive, and emotional domains
of the human stress response.

27. Methods
 Sixty healthy female volunteers (mean age = 25 years) were
exposed to a standardized psychosocial stress test after having
been randomly assigned to one of three different conditions
prior to the stress test: 1) relaxing music (‘Miserere’, Allegri)
(RM), 2) sound of rippling water (SW), and 3) rest without
acoustic stimulation (R).
 Salivary cortisol and salivary alpha-amylase (sAA), heart rate
(HR), respiratory sinus arrhythmia (RSA), subjective stress
perception and anxiety were repeatedly assessed in all subjects.
 We hypothesized that listening to RM prior to the stress test,
compared to SW or R would result in a decreased stress
response across all measured parameters.

28. Results
 The three conditions significantly differed regarding cortisol
response (p = 0.025) to the stressor, with highest concentrations
in the RM and lowest in the SW condition.
 After the stressor, sAA (p=0.026) baseline values were reached
considerably faster in the RM group than in the R group.
 HR and psychological measures did not significantly differ
between groups.

29. Conclusion
 Our findings indicate that music listening impacted the
psychobiological stress system.
 Listening to music prior to a standardized stressor
predominantly affected the autonomic nervous system (in
terms of a faster recovery), and to a lesser degree the
endocrine and psychological stress response.
 These findings may help better understanding the beneficial
effects of music on the human body.

31. Arq Bras Cardiol. 2009 Nov;93(5):534-40.
Music therapy effects on the quality of life and the blood pressure of
hypertensive patients.
Zanini CR1, Jardim PC, Salgado CM, Nunes MC, Urzêda FL,
Carvalho MV, Pereira DA, Jardim Tde S, Souza WK. Brasil.
 BACKGROUND:
Arterial Hypertension (AH) is a mass disease, with
consequences for the cardiocirculatory system, since its
complications raise the rates of morbidity and mortality.
Controlling blood pressure (BP) reduces complications and
may preserve the quality of life (QOL) of patients.
Studies show positive effects of music therapy as an adjuvant
in the treatment of several diseases.
 OBJECTIVE:
to evaluate the effect of music therapy on the QOL and BP
control of hypertensive patients.

32. METHODS:
 This was a controlled clinical study that evaluated patients of
both genders, aged over 50 years, with stage 1 hypertension, in
use of medication and enrolled in multidisciplinary service for
treatment of hypertension.
 They were divided into an experimental group (EG) and a
control group (CG).
 The EG, in addition to the conventional treatment, participated
in weekly music therapy sessions for twelve weeks.
 The CG received the standard treatment of the service.
 Before and after the intervention, the SF-36 questionnaire was
applied in both groups, and the BP of each patient was
measured.
 The voice, an important element of communication, reflecting
the patient's physical, mental and emotional state, was the main
resource used.

33.  STATISTICS:
 Student T-test and Wilcoxon test were considered significant
at p <0.05.
 RESULTS:
 The groups were initially similar in gender, age, education,
and the assessed QOL.
 In the initial and final comparison of EG patients, we
observed a significant improvement on the QOL (p <0.05)
and BP control (p <0.05), with no change in adhesion.
 CONCLUSIONS:
 Music therapy has contributed to an improvement on the
QOL and BP control of patients, suggesting that this activity
may represent a therapeutic approach to help strengthen the
programs of multidisciplinary care of hypertensive patients.

35. INFLUENCE OF MUSIC THERAPY ON HYPERTENSIVE PATIENTS
WITH EARLY POST-INFARCTION ANGINA. September 2016
Mitrovic, P.; Stefanovic, B.; Paladin, A.; Radovanovic, M.;
Radovanovic, N.; Rajic, D.; Matic, G.; Subotic, I.; Vasiljevic, Y.;
Bulatovic, V.
 Objective:
 Most studies have shown that early post-infarction angina
(EPA) implies an unfavorable long-term prognosis among
patients with acute myocardial infarction (AMI).
 Unrelieved anxiety combined with hypertension (HTA) can
produce an increase in sympathetic nervous system activity
leading to an increase in cardiac workload.
 The purpose of this study was to evaluate the effectiveness of
music therapy for reduction of anxiety and pain in patients with
HTA and EPA.

36.  Design and method:
The effectiveness of music in reducing anxiety and pain during
EPA attacks was tested using a two-group pretest-posttest
experimental design with 220 patients with HTA and EPA.
Patients were randomly assigned to receive 30 min of sedative
music (N = 110) or treatment as usual (N = 110).
Anxiety, pain sensation, and pain distress were measured with
visual analogue scales at start of chest pain episodes and 30
min later.

37.  Results:
Repeated measures MANOVA indicated significant group
differences in anxiety, pain sensation, and pain distress from
pretest to posttest (p = 0.0018).
Post hoc dependent t-tests and univariate repeated measures
ANOVA (p = 0.0184) indicated that in the sedative music,
anxiety, pain sensation, and pain distress all decreased
significantly (p = 0.0118), while in the treatment as usual
group, no significant differences occurred.
Independent t-tests indicated significantly less posttest
anxiety, pain sensation, and pain distress in the sedative music
group than in treatment as usual groups (p = 0.0208).

38.  Conclusions:
 Sedative music was more effective than treatment as usual
in decreasing anxiety and pain in patients with HTA and EPA.
 Patients with HTA should have beneficial of using sedative
music as an adjuvant to medication during EPA episodes.

40. The Therapeutic Effect Of Indian Classical Music on
Physiological And Psychological Parameters Of
Hypertension in Geriatric Patients
Manasi M Godbole and Anita Basavaraj
Hypertension. 2014;64:A628
 Aim:
To evaluate the effect of Indian classical music as evidence
based treatment for hypertension and anxiety level reduction.

41.  Method:
Pre-selected 60 geriatric patients (60-85years) were randomly
assigned to Study Group(SG){n=30}and Control
Group(CG){n=30}.
The SG, in addition to conventional treatment, received 20
minutes of pre-recorded Indian classical music therapy for 4
sessions.
The CG received standard treatment alone.
Blood pressure (BP), pulse rate (PR) and respiratory rate (RR)
were taken before and after each session.
Psychological assessment was done at the start and at the
conclusion of final session.

42.  Results:
Comparing pre and post parameters of all the sessions, the
intervention resulted in a statistically significant reduction in BP
and RR in both groups and significant reduction in PR only in
the SG.
Further analysis revealed a more statistically significant
reduction in BP, PR and RR and anxiety levels in the SG as
compared to CG after music session.

43.  Conclusion:
This study indicates the use of Indian classical music as an
innovative therapeutic approach in modern era for prevention
or in conjunction with antihypertensive medications for blood
pressure management in geriatric patients.

45. Format: AbstractSend to
Indian J Surg. 2014 Oct;76(5):363-70. doi:
10.1007/s12262-012-0705-3. Epub 2012 Aug 1.
 Effect of the Raga Ananda Bhairavi in Post Operative Pain Relief
Management.
 Kumar TS1, Muthuraman M2, Krishnakumar R2.
 Abstract
 Music is considered as an universal language and has influences the
human existence at various levels.In recent years music therapy has
evolved as a challenge of research with a clinical approach involving
science and art. Music therapy has been used for various therapeutic
reasons like Alzheimer's disease,Hypertension and mental disorders to
name a few. We conducted a study to establish the effect of the
classical ragam Anandhabhairavi on post operative pain relief

46.  . A randomized controlled study involving 60 patients who were to undergo
surgery was conducted at PSG Institute of Medical Sciences and
Research,Coimbatore.
 30 patients selected at random and were exposed to the ragam
Anandhabhairavi which was played in their room pre operatively (from the
day they got admitted for surgery) and 3 days post operatively.
 The control group did not listen to the music during their stay in the hospital.
An observation chart was attached in which the requirement of analgesics
by the patient was recorded.
 On completion of the study and on analysis,the ragam Anandhabhairavi had
a significant effect in post operative pain management which was evidenced
by the reduction in analgesic requirement by 50 % in those who listened to
the ragam.A significant p value of <0.001 was obtained.
 KEYWORDS:
 Analgesic requirement; Anandhabhairavi; Music therapy; Pain management;
Post operative pain