Creative Arts

Music therapy, art therapy, movement/dance therapy, or any therapeutic interventions involving the creative arts have rarely been evaluated in controlled trials, despite case studies (47) and uncontrolled investigations (48) describing their benefits for pain management in children. Most of the published studies comparing a creative arts intervention to a control have evaluated live or recorded music as a form of distraction for children undergoing acute procedural pain. Engaging in any task demanding attention, such as listening to music, probably limits a child's capacity to process pain, reduces pain sensitivity (49), and may thereby assist the child to habituate to repeated painful stimuli (50).

There is no evidence, however, that music functions as a better distraction than other stimuli or activities that engage attention, and it has not been established that music has any other pain-relieving or desensitizing effects. Almost any kind of auditory stimulus, including conversation, a cat's purr, or even street noise, will distract a child to some extent; an appropriate placebo is thus essential in evaluating a musical intervention. Yet, as discussed in the next Subheading, few studies have included such a control condition.

2.3.1. Procedural Pain

Four reports of music distraction studies are discussed. Fowler-Kerry and Lander (51) evaluated this intervention in a controlled trial of 200 children aged 4.5-6.5 years subjected to injection pain. One group of children listened to music played over headphones before and during injection; a second received a verbal suggestion that the experimenter would help the child during the injection; a third was given music distraction plus suggestion; a placebo control group was given headphones without music, and a second control group received no intervention. Pain was assessed using a 4-point visual analog scale, the psychometric properties of which were not reported. The music distraction group reported less pain on this scale than the suggestion-only group, and there was no incremental effect on pain when suggestion was added to music distraction. The use of a validated scale and the inclusion of an auditory distraction condition (e.g., white noise) would have improved this otherwise strong study design.

In a more recent study (52), investigators played lullabies to one group of children aged 3-6 years receiving immunizations; a control group received no intervention. The lullaby group showed less distress, but there were no differences in reported pain or in physiological response. The total number of subjects was 99, but it was unfortunately not stated whether the groups were randomly assigned, whether the observers rating distress were blinded, or which measures they used. Nonrandom assignment increases the likelihood that chance differences between groups may affect the observed variation in distress; nonblinded assessment may introduce an unknown level of subjective bias into the observer ratings.

In a third study, 20 children aged 0-7 years listened to live music while undergoing intravenous starts, venipunctures, injections, and heel sticks and were compared with a control group of 20 children matched for age and type of procedure who did not receive the intervention (53). The music group showed less behavioral distress than the controls both before and after the procedures; however, both groups exhibited the same level of distress when the needle was actually inserted. As with the previously discussed study, the investigators did not report employing random assignment or blinding of observers rating distress in the children. A further methodological flaw was that the nurses and intravenous therapists were instructed to "maintain their normal modes of consolation or distraction" in the control group; these "normal modes" may have varied across providers and patients.

The fourth study (54) is a rare example of music distraction compared to other auditory stimuli. In the study, 121 neonates undergoing unanesthetized circumcision were randomly assigned to one of six groups; one group heard classical music, a second heard recorded intrauterine sounds, a third was given a pacifier only, the fourth group was given music and a pacifier, and the fifth group received intrauterine sounds and a pacifier. The sixth group was the control (no intervention). No significant differences between groups in pain reduction were recorded during the procedure, as indexed by behavioral and physiological measures.

In sum, music therapy may be considered a promising intervention for procedural pain if the 1995 Task Force criteria are loosely applied, but studies using other auditory stimuli as placebos and controlling for the effects of other factors, such as anxiety, are needed if this modality is to be judged an EST. However, there have been no controlled studies on the effectiveness of music therapy in chronic pediatric pain or any well-controlled studies of the other creative arts on any type of childhood pain.

Listening to the Binaural Beat

Listening to the Binaural Beat

When you were a kid were you fascinated by those dog whistles that you could blow, not hear but all the dogs in the vicinity would come running? The high pitch was something that only they could here, and though it seemed the dogs didn't seem to arrive in droves as they did in the movies, it was enough for perhaps your pet dog to prick up his ears before sliding back into sleep.

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