research on an article

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Synopsis and Appraisal of a Study Exploring Music and Hypnotic Suggestion to Manage

Chronic Pain

Studentfirstname Studentlastname

College of Nursing, Resurrection University

NUR4440: Research in Nursing

Professor Carina Piccinini

April 13, 2020

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Synopsis and Appraisal of a Study Exploring Music and Hypnotic Suggestion to Manage

Chronic Pain

The purpose of this paper is to summarize and appraise a research study that investigated

the effects of music and hypnotic suggestion on patients enduring chronic pain. The Center for

Disease Control and Prevention (CDC, 2016) highlighted that over 60% of drug overdose deaths

involve opioids initially prescribed for pain relief. Therefore, the CDC recommends a shift

toward non-opioid treatment that include many multimodal and multidisciplinary therapy

options. Besides reducing the cost of drug treatment and possible addiction or death, mental

stability and overall quality of life for patients in chronic pain chronic pain would be improved

for patients in chronic pain if it was managed with safer options. Although further research is

being conducted to fully understand the long-term effect of music and hypnosis on chronic pain,

currently they are both considered a method in multidisciplinary therapy.

Summary of the Study

There is a movement in medicine to look at more non-pharmacological treatments for

chronic pain due to possible dependency and the serious side effects risk. With so much interest

in the practice of mind-body interventions, there has already been evidence that shows hypnosis

and music are effective separately for patients in pain, but there is no research on combining the

two interventions for a better outcome. This study addresses that gap by testing the interventions

together.

Johnson et al. (2017) conducted a quasi-experimental study to explore the possible

combined effect of hypnotic suggestion and music to improve components of chronic pain, pain

bothersomeness, anxiety, depression, and distress. Interventions and data collection took place

in the homes of the participants.

Commented [CP1]: This answers “Why is this important to study?” It’s not just testing out a new intervention…it goes beyond that to fatalities through the pharmacological methods that have led to an opioid crisis and finding solutions for chronic pain management. The CDC and other healthcare related organizations are great sources of information on the importance of topics.

Commented [CP2]: What is known (we need new non- pharm methods, music and hypnosis work separately), not known (do music and hypnosis work better in combo?), and gap in knowledge (to test the combo). This information is found in the introduction to every research article. DO NOT use the discussion/conclusions section of an article for this information! It will be WRONG

Commented [CP3]: Study being summarized/appraised is correctly cited. Specific research design stated. Setting of study stated.

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The researchers acquired their samples through a nonrandom snowball sample, where

participants were first referred by physicians from an integrative cancer center in Texas. Later,

patients self-enrolled—a volunteer/convenience sampling method—due to difficulties with

enlisting participants through referral. Twelve participants originally enrolled under the inclusion

criteria of anyone over the age of 18 who was English or Spanish speaking, diagnosed with

cancer or other serious illness, and rated their pain > 4 on an 11-point numerical rating scale.

Two participants were lost to follow up, with a final sample size of 10. The average age of the

participants was 58.3 years, with most of the participants being white (75%), women (67%),

married (58%) and an associate’s degree or higher (55%).

At the beginning of the study for baseline data, each participant completed a

demographic form, the Hospital Anxiety and Depression Scale (HADS), and numeric rating

scales (NRS) to assess pain, pain bothersomeness, and distress. The HADS has a score range of 0

to 42, with higher scores indicating more depression and anxiety. The NRS for the three

variables required participants to rate on a scale of 0 to 10, with 0 representing “none” and 10

representing “worst possible.” Participants were then asked to rate and document their pain daily

upon waking up, as well as before and after the intervention, for two weeks.

The three-part recorded audio intervention was provided to patients for self-

administration. First, participants listened to a 5-minute hypnotic suggestion. Then, they listened

to 15 minutes of string orchestra music (Fantasia on a Theme of Thomas Tallis by Ralph Vaughn

Williams). Finally, they listened to a post-hypnotic suggestion to continue the pain relief attempt.

Researchers called participants once per week for two weeks to discuss progress and remind

participants to record their pain and do the intervention consistently. Data on the same three

numeric ratings scales and HADS were submitted after the second week of the intervention. The

Commented [CP4]: Sampling method stated and explained. Inclusion criteria listed. Exclusion criteria listed. Loss to follow up explained. Selected demographics reported with stats.

Commented [CP5]: Measurement instruments defined with context to values. When measurements were taken (in this case by the participants with timing noted).

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participants were also asked to complete an NRS for Treatment Satisfaction with a range of 0 to

11, with 0 representing “not satisfied at all” and 11 representing “totally satisfied.” The

researcher concluded the study with Study Completion/Dropout interviews, which was

qualitative data to verify treatment fidelity.

Appraisal

The combined snowball and volunteer/convenience sampling method may have attracted

participants that were predisposed to the effects of complementary and alternative medicine

(CAM) methods, creating a potential placebo effect on the intervention. There was no exclusion

criteria; however, a scale to measure the participants’ attitudes toward CAM and including it in

the statistical analysis would have reduced bias considerably. The participants in the sample had

multiple conditions, including musculoskeletal conditions (5), cancer (4), fibromyalgia (2), mood

disorders (3) and inflammatory conditions (3). With the wide range of illnesses, it would be

difficult to draw conclusions about the effect of the intervention on a particular illness or

disorder. For these reasons, the sampling method was not appropriate for an experimental study,

and the lack of exclusion criteria was problematic.

An NRS has been validated for pain in two previous studies, but the authors did not

mention if it has been tested for pain bothersomeness or distress. It is unknown if the scale is

reliable and valid for at least two major variables in this study, bringing into question

measurement error for them. The Treatment Satisfaction NRS has been tested for reliability and

validity in one previous study, and the HADS demonstrated internal consistency reliability with

Cronbach’s alpha scores of 0.83 and 0.84 in previous studies.

Researchers called participants once per week to remind them to adhere to the protocol,

but timing of the calls was not reported. The authors failed to report complete compliance data

Commented [CP6]: The intervention is described, with additional post-intervention measurement tools stated and described.

Commented [CP7]: Analysis of sampling method and inclusion/exclusion criteria. Rationales are fully developed.

Commented [CP8]: Validity/reliability of measurement tools stated and analyzed.

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for collection and the intervention, but they did report that 9 of the 11 participants listened to the

audio recording multiple times a day. Due to this, treatment fidelity was compromised by

introducing a “dosing” variable that was not controlled for in the analysis.

The researchers concluded that their findings supported their hypothesis that the

combination of hypnotic suggestion and music help in the reduction of chronic pain in

participants. Each participant reported a reduction in their pain from 6.6 to 5.4, pain

bothersomeness from 7.5 to 5.4, distress from 5.9 to 4.9, anxiety from 7.2 to 6.5, and depression

from 6.1 to 4.1. The conclusion in a reduction in pain is technically correct, but no statistical

significance was calculated or reported in this study, so eliminating chance differences is

impossible. The limitations acknowledged by the authors (small sample size and not controlling

for usual care with pain medication), plus the fact that a majority of participants used the

intervention multiple times a day, means that the conclusions are not fully supported.

Conclusion

The conclusions of this study were not fully supported, but other studies cited in the

article indicate that an effect is evident. Acceptability of the combined intervention was high in

this study, and the limited medical-related cost and lack of complications imply that the

intervention is possible to recreate and practice in many hospitals, clinics, and home settings.

The practice of including hypnotic suggestion and music (possibly of the patient’s choosing and

not the prescribed classical music that some participants in this study complained about) could be

beneficial to a wide range of pain sufferers with no side effects. The study, if nothing else,

implied that patients who are invested in the idea of non-pharmacological pain reduction would

experience the benefit from the intervention. Nurses can use this study and others like it to

further explore the option of hypnosis/music recordings that they can offer to chronic pain

Commented [CP9]: Treatment fidelity explained and analyzed.

Commented [CP10]: Conclusions analyzed with regard to results and lack of p values, with consideration of limitations noted by the authors.

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sufferers, in hopes of lessening the chronic effects on their acute problems. Patients can self-

administer, reducing the burden of nursing-driven interventions on busy bedside caregivers.

Commented [CP11]: Careful balancing between lack of conclusive evidence and relative safety and low-cost of intervention. Specific ideas for nursing implications end the paper.

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References

Center for Disease Control and Prevention. (n.d.). Module 2: Treating chronic pain without

opioids. Retrieved from

https://www.cdc.gov/drugoverdose/training/nonopioid/508c/index.html

Johnson, A. J., Kekecs, Z., Roberts, R. L., Gavin, R., Brown, K., & Elkins, G. R. (2017).

Feasibility of music and hypnotic suggestion to manage chronic pain. International

Journal of Clinical & Experimental Hypnosis, 65(4), 452–465.

https://doi.org/10.1080/00207144.2017.1348858