A pilot protocol for conditioning music-cued relaxation responses in patients undergoing total shoulder arthroplasties.

Background: Orthopedic patients undergoing shoulder arthroplasties-to treat chronic joint pain-frequently experience significant pain. Music therapy (MT) has demonstrated non-pharmaceutical benefits for reducing postoperative pain and associated perioperative anxiety. However, a study of approaches and timing is needed to enhance patient care. Objective: This qualitative study examined the effects of a conditioned MT intervention on pre/postoperative pain and anxiety among patients undergoing shoulder surgery. As part of a larger quantitative randomized controlled trial, this paper specifically evaluated qualitative participant journal comments from two music groups. Methods: Eligible adult surgery patients were consented and randomized to Live MT, Recorded MT, or Control (standard of care). Those in the two music groups received an original intervention comprising an induction song, autogenic muscle relaxation, and directed cognitive visualization over prescribed sedative guitar playing. In addition to practice recordings, a music therapist treated the Live group. Participants experienced multiple contacts with the study process, allowing for preparation, education, practice, and pre/postsurgery treatment. Journals were provided to the participants to record responses to the intervention. Comments were analyzed by the researchers and recurring themes identified. Results: From 69 MT participants, 319 comments were collected as data points. Four themes identified areas of impact: (1) The MT intervention contained qualities and components that were perceived as beneficial for relaxation and calming. (2) Participants personalized their visualization experience with the music, which cued memories and associations of soothing or reflection. (3) Music therapists were a supportive presence, in addition to the healthcare team. (4) Through practice, aspects of the music intervention became internalized as a self-help tool. Theme 1, referencing general relaxation, was further divided into three subthemes-(1a) pain management, (1b) anxiety management, and (1c) sleep hygiene-which were found to be interrelated. Pre/postsurgery comparisons were made between the Live and Recorded groups. Conclusions: Given opportunities for repeated practice, the MT intervention was effective in supporting relaxation. The effects included improved pain and anxiety management, as well as increased sleep and personalized patient experience. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT02692768.