Relief of postoperative pain with jaw relaxation, music and their combination

The aim of this randomized controlled trial was to determine the effect of jaw relaxation, music and the combination of relaxation and music on postop erative pain after major abdominal surgery during ambulation and rest on po stoperative days 1 and 2. Opioid medication provided for pain, following ab dominal surgery, does not always give sufficient relief and can cause undes ired side effects. Thus, additional interventions such as music and relaxat ion may provide more complete relief. Previous studies have found mixed res ults due to small sample sizes and other methodological problems. In a rigo rous experimental design, 500 subjects aged 18-70 in five Midwestern hospit als were randomly assigned by minimization to a relaxation, music, relaxati on plus music, or control group. Interventions were taught preoperatively a nd tested postoperatively. The same amount of time was spent with subjects in the control group. Pain was measured with the visual analogue sensation and distress of pain scales. Demographic and surgical variables, and millig rams of parenteral or oral opioids in effect at the time of testing were no t significantly different between the groups, nor did they correlate with p ain scores. Controlling for pretest sensation and distress, orthogonal a pr iori contrasts and multivariate analysis of covariance indicated that the t hree treatment groups had significantly less pain than the controls, (P = 0 .028-0.000) which was confirmed by the univariate analysis of covariance (P = 0.018-0.000). Post hoc multivariate analysis revealed that the combinati on group had significantly less sensation and distress of pain than the con trol group on all post-tests (P = 0.035-0.000), and the relaxation and musi c groups had significantly less on all tests (P = 0.022-0.000) except after ambulation At post ambulation those using relaxation did not have signific antly less pain than the controls on both days and those using music did no t on day 1, although there were some univariate effects. A corresponding si gnificant decrease in mastery of the interventions from pre to post ambulat ion suggests the need for reminders to focus on the intervention during thi s increased activity. Physicians and nurses preparing patients for surgery and caring for them afterward, should encourage patients to use relaxation and music as adjuvants to medication for postoperative pain. (C) 1999 Inter national Association for the Study of Pain. Published by Elsevier Science B .V.