Music Therapy for Pain Management in Adults with Sickle Cell Disease

1. Samuel Rodgers-Melnick, MT-BC Music Therapist-Board Certified, UH Connor Integrative Health Network Master of Public Health Student, Case Western Reserve University September 6, 2019 Music Therapy for Pain Management in Adults with Sickle Cell Disease

4. Music Therapy “The clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship by a credentialed professional who has completed an approved music therapy program.” (American Music Therapy Association, 2017) Goals include: • Improving pain management • Providing a means of coping and self-expression • Increasing disease knowledge • Improving self-management skills • Improving quality of life

5. Survey of Music use in Adults with SCD Acute Pain Music Therapy Intervention ChronicPain Music Therapy Intervention

6. MUSIQOLS: A Pilot StudyMUSic therapy toImproveQualityOfLifeinSickle cell diseasePurpose • Investigate the effects of a 6-part music therapy protocol on • Pain • Mood • Quality of life • Coping skills • Self-efficacy • Determine feasibility (delivery, acceptability, and usefulness) of the music therapy intervention

7. Methods Design • Mixed methods intervention study • Music therapy (MT) vs. Wait List Control (WLC) Participants • 24 adults (18+) with sickle cell disease (SCD) • No significant visual/hearing impairment • Fit chronic SCD pain criteria (Dampier et al., 2017) • Access to mobile device • English speaking • Attended at least 50% of SCD clinic visits in last 12 months

8. 2 weeks Pain diary 2 weeks Pain diary 6 sessions MT 2 weeks Pain diary Post-test Interview 2 weeks Pain diary No intervention Randomized 1) Music Therapy (MT) 2) Wait List Control (WLC) Pretest Self-Efficacy PROMIS-29 ASCQ-Me Coping Skills Post-test Recruitment 24 adults SCD + chronic pain Study Diagram

9. Music Therapy Intervention – 6 parts • Education • Breathe • Relaxation (PMR) • Imagery • Active Music Making • Conclusion Photo credit – The Plain Dealer

10. 12 28 25 1 24 12 3 12 12 Withdrawn Music Therapy Wait List Control Declined Assessed Analyzed Randomized Consented Analyzed ResultsParticipantFlow Chart

11. No significant demographic differences between study groups Demographics

12. Significant Quantitative Results • No significant differences between changes in: • Other PROMIS-29 measures • ASCQ-Me Emotional Impact, Pain Impact, Sleep Impact • a Raw scores were converted to t-scores using healthmeasures scoring service • b Student t-test of change scores (post – pre)

13. Feasibility Study • 89% consent rate, only 1 withdrawal • All pre- and post-test study measures and interviews completed • High pain diary completion rates • Average 70% completed at baseline • Average 66% completed at follow-up Intervention • All MT participants attended all 6 music therapy sessions • All MT participants reported achieving goals for therapy • All interventions accessible via participants’ devices • 81% of MT participants reported using interventions at least every other day • Interviews revealed high degree of usefulness and acceptability

14. Qualitative Analysis Music therapy can transfer a person to a difference place “It takes my mind off my pain. It puts me in a whole new dimension. Like for them couple of minutes, I don’t hurt. I be in a whole ‘nother world.’” Improved coping skills “I noticed when I use some of the music therapy techniques, Ican handle the pain a little better than usual…overall, it had made an impact on my ability to cope with my pain.” “Sometimes people don’t know that they have options or things that can help them feel better, other than taking pain medicine.So just knowing that you know a way to make it feel better without having to be all drowsy and sluggish and stuff from your pain meds, then you’ll kind of be like ‘Okay, I can cope”

15. Qualitative Analysis continued… Reduced need for pain medication “it gave me tricks to use to lessen the pain so I don’t think about it. It’s not there. I got other tricks to go to to kind of get rid of the pain, other than just taking medicine all the time. So it was very helpful that way.” Improved ability to perform daily tasks “Once you start learning how to manage things yourself, doing certain things become easier…I would be able to like do more chores around the house like faster, ‘cause I’d be listening to this, or breathing and just my mind on something else while I’m cleaning up, and I wouldn’t really think about me and my bad knees popping while I’m trying to sweep”

16. Conclusion Music therapy is feasible for home use in adults with SCD and chronic pain • Intervention may be useful for other chronic pain populations • Protocol provides framework for future music therapy research Music therapy may assist adults with SCD in: • reducing pain interference • improving sleep • improving social functioning • improving perceived ability to manage symptoms More research is needed to determine effectiveness Future studies to include more rigorous control condition

17. Acknowledgements Study Team Coretta Jenerette, PhD, RN, AOCN, CNE Evanilda Souza de Santana Carvalho Douglas Y. Rowland, PhD Lucas Lin Jeffrey A. Dusek, PhD Nitya Bakshi, MD Jane A. Little, MD Research Assistants Cara Smith, MT-BC Kristina Gam The Kulas Foundation Sickle Cell Team Tara Alin, CNP Santina Ciarallo, CNP Maranda Lumpkin Tiffany Cousino, LISW Rene Crooker, RN Brandi Griffin, RN Pain Diary Team Lakshmananan Krishnamurti, MD Ashley Griffin Kolanda Sanders Deforia Lane, PhD, MT-BC Seneca Block, MA, MT-BC Tracey L. Baker (transcriptionist) Sara Debanne, PhD

18. For more information Email: Samuel.RodgersMelnick@UHhospitals.org Website: www.uhconnorintegrativehealthnetwork.org

19. References Dampier, C., Palermo, T. M., Darbari, D. S., Hassell, K., Smith, W., & Zempsky, W. (2017). AAPT diagnostic criteria for chronic sickle cell disease pain. The Journal of Pain, 18(5), 490-498. Rodgers-Melnick, S. N., Matthie, N., Jenerette, C., Griest Pell, T. J., Lane, D., Fu, P., ... & Little, J. A. (2018). The Effects of a Single Electronic Music Improvisation Session on the Pain of Adults with Sickle Cell Disease: A Mixed Methods Pilot Study. Journal of Music Therapy, 55(2), 156-185.