Journal Article Annotations
2020, 4th Quarter
Annotations by R. Garrett Key, MD
PUBLICATION #1 — Palliative Medicine
The investigators found evidence supporting the efficacy of music in reducing patient reported pain scores in the ICU with an apparent optimal exposure threshold of 20-30 minutes twice daily. The study offers support for a minimally invasive, low risk, nonpharmacologic intervention that could be used not only in ICU but across a wide variety of settings. The ubiquity of technology to play music to patients allows for easy adoption of this treatment modality which could potentially improve outcomes without little or no additional cost.
Strength and weaknesses:
Strenths of the article include adherence to PRISMA methodology, inclusion of only RCTs, and assessment for risk of bias (ROB) using the Cochrane ROB Tool for RCTs. Subgroup analyses were done to identify potential critical elements in study design that would influence results with evaluation for the effect of music duration, selection by patient/provider, provider background, timing of intervention (i.e. procedure vs. rest), and the presence or absence of co-analgesia.
The main weakeness in the review is the heterogeneity in study design: there was little consistency between RCTs in how the intervention was applied. Although a large number of indivuals were included in the study (n=1173), most of the included trials had relatively small sample sizes and limited power. Pooled results suggested effect, although a number of included studies had results with a null finding within the 95% CI when viewed individually.
C-L psychiatrists are often asked to assess and treat patient in ICU settings with complex pain and high delirium risk. We need to expand our nonpharmacologic armamentarium to reduce reliance on opioids and other pharmacologic analgesics in order to optimize patient comfort and thereby improve morbidity and outcomes. Further inquiring with patients and primary teams as to how music may help modulate the pain experience could be fruitful.
Type of study (EBM guide):