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Lars Heslet Professor ICU 4131 National University Hospital Rigshospitalet Copenhagen Denmark

Lars Heslet Toronto February 07. The Musical Brain. Lars Heslet Toronto February 07. Music as medicine. Ancient cultures Treatment of disease with music in ancient cultures in India, Greece and China,

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Lars Heslet Professor ICU 4131 National University Hospital Rigshospitalet Copenhagen Denmark

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    1. Lars Heslet Toronto February 07 Lars Heslet Professor ICU 4131 National University Hospital Rigshospitalet Copenhagen Denmark

    2. Lars Heslet Toronto February 07 The Musical Brain

    3. Lars Heslet Toronto February 07 Music as medicine Ancient cultures Treatment of disease with music in ancient cultures in India, Greece and China, & most extensively applied in Arab cultures healing centers with sound of string instruments and water. Modern times Scientists have documented that music affects our endocrine system, host defense, autonomous nerve system and counter regulation of stress. Music reduces anxiety and improves quality of sleep. The sense of hearing is unaffected by sleep sedation and anesthesia.

    4. Lars Heslet Toronto February 07 The Musical Brain

    5. Lars Heslet Toronto February 07 The Musical Brain

    6. Lars Heslet Toronto February 07

    7. Lars Heslet Toronto February 07 Brains perception of tones is complex and ”hemispheric” specialized

    8. Lars Heslet Toronto February 07 Music = Tones + Melody

    9. Lars Heslet Toronto February 07 Music as medicine - Introduction

    10. Lars Heslet Toronto February 07 Thorgaard P et al. Designed sound and music environment in postanaesthesia care units--a multicentre study of patients and staff. Intensive Crit Care Nurs. 2005 Aug;21(4):197-8.

    11. Lars Heslet Toronto February 07 Thorgaard P et al. Designed sound and music environment in postanaesthesia care units--a multicentre study of patients and staff. Intensive Crit Care Nurs. 2005 Aug;21(4):197-8.

    12. Lars Heslet Toronto February 07 Purpose Effect of a specially designed music environment on feeling and wellbeing of lightly sedated patients in Cardiac Catheter Laboratory undergoing invasive procedures. Method 193 patients randomly assigned to music group, listened to music during the procedure (99) or to a non-music group (94) Patients interviewed by questionnaire. Result - Music group 91% of the patients defined the sound environment as pleasant - compared to 56% in the non-music group. - Number of patients with 'no opinion' on the sound environment lower in the music group than in the non-music group (8% vs 42%).

    13. Lars Heslet Toronto February 07 Music in the Card Lab - a controlled trial (II)

    14. Lars Heslet Toronto February 07 Conclusion Specially designed music positive effect on the wellbeing of patients and their opinion on the sound environment during invasive cardiac procedures. It is suggested specially designed music should be a part of the sound environment in the Cardiac Catheter Laboratory.

    15. Lars Heslet Toronto February 07 Music in therapy – Pain therapy

    16. Lars Heslet Toronto February 07 Acute pain

    17. Lars Heslet Toronto February 07 Effect of music on acute pain – A Metaanalysis (I) Objective To evaluate the effect of music on acute pain intensity, pain relief, and analgesic requirements. Selection criteria Only randomized controlled trials were included that evaluated the effect of music on any type of pain in children or adults. Trials that reported results of concurrent non-pharmacological were excluded

    18. Lars Heslet Toronto February 07 Effect of music on acute pain – A Meta analysis (II)

    19. Lars Heslet Toronto February 07 Chronic non-malignant pain

    20. Lars Heslet Toronto February 07 Effect of music on chronic nonmalignant pain (I) Chronic non-malignant pain (CNMP) persists in spite of traditional interventions. Most CNMP patients have moderate effect of conventional analgesics and frequent adverse effects and affective psychological disorders with loss of personal “power”. Previous most studies of music intervention have focused on decreasing pain and anxiety related to acute pain postoperative and procedural pain. However, the effect of music on power, pain, depression, and disability in working age adults with chronic non-malignant pain has not been investigated.

    21. Lars Heslet Toronto February 07 Effect of music on chronic nonmalignant pain (II) Method Randomized controlled clinical trial in chronic non-malignant pain randomly assigned to researcher-provided music, subject-preferred music or control group. Pain, depression, disability and “power” measured with NRS. Results The music groups had more “power” and less pain, depression and disability than the control group. No statistically significant differences between the two music interventions. The model predicting both a direct and indirect effect for music was supported. Conclusion Nurses can teach patients how to use music to enhance the effects of analgesics, decrease pain, depression and disability, and promote feelings of “power”

    22. Lars Heslet Toronto February 07 Effect of music on chronic nonmalignant pain (III) Statistical analysis

    23. Lars Heslet Toronto February 07 Music in stress and host defense

    24. Lars Heslet Toronto February 07 Objective To study the effect of music on the immune defense and metastatic cancer in rats exposed to sound stress (noise) Injected with sarcoma cells. Number of metastases evaluated after 8 days Music counteracted the effect of noise stress on the immune system and cancer metastases. Music reduced the number of metastases even in unstressed animals Music and immune defense (I)

    25. Lars Heslet Toronto February 07 Music and immune defense (II)

    26. Lars Heslet Toronto February 07 Music and immune defense (III)

    27. Lars Heslet Toronto February 07 Music and immune defense (IV)

    28. Lars Heslet Toronto February 07 Music and immune defense (V) Music counteracted the negative stress effect on the immune defense, by increasing the number of killer cells (CD 16)? and reducing the cortisol level. Stress in itself increased number of metastases. Music, however, reduced number of metastases in the animals exposed to stress. Music even reduced number of metastases in unstressed animals

    29. Lars Heslet Toronto February 07 Conclusion: Music as medicine

    30. Lars Heslet Toronto February 07 Music processing in the brain is complex – involves several CNS centers. Music has a harmonizing effect on the mind, e.g. as a daily ”musical break or musical meditation” and further dampens the worrying ambient noise of daily hospital activity with alarms and irrelevant conversation Music coordinates the function of the neocortex and integrates the 2 hemispheres (corpus callosum) & affects the emotional brain. Music has a number of specific biological effects in disease and in health

    31. Lars Heslet Toronto February 07 Reduces sensation of both acute, procedural and chronic pain. Has a de-stressing effect both in acute and in chronic stress & anxiety reducing effect Has a positive effect on immune defense – the effect is mostly documented in animal studies. Systematic use of special designed music acts as drugs but without adverse effects and Music may be used as an adjuvant therapeutic measure in concert with analgesics sedatives and anxiolytics The effect of music has probably only a short and temporal effect but considering its price, and lack of adverse effects an important effect The type of ”medical music”, however, is probably important

    32. Lars Heslet Toronto February 07

    33. Lars Heslet Toronto February 07

    34. Lars Heslet Toronto February 07 Music and designed sound environement

    35. Lars Heslet Toronto February 07 The Sound sources used

    36. Lars Heslet Toronto February 07 Music in therapy – other effects

    37. Lars Heslet Toronto February 07 Stress og Music

    38. Lars Heslet Toronto February 07 Stress induced by ”white noise”

    39. Lars Heslet Toronto February 07 Kronisk stress og musik Musik påvirker signalstofferne i hjernen. Alzheimerpatienter ? musikeffekten øget mængde melatonin ? afslappet og rolig sindstilstand. Melatonin er det hormon der signalerer søvn. Forhøjet binyrebarkhormon – Cortisol – ses ved kronisk stress. Musik har en påvirkning af kronisk stress bedømt ved Cortisolmålinger i spyt. Stress ? betydende stigning i Cortisol indholdet i spyt allerede indenfor 15 minutter. Musik medførte det en betydelig reduktion i Cortisol koncentrationen. Musik reducerer stress, angst og får BT og puls til at falde i forbindelse med kirurgi i lokalbedøvelse. Ved en lodtrækningsundersøgelse med musik og ikke-musik under bedøvelse blev blodtryksmønstret undersøgt. Efter bedøvelsen mindst stigning i hjertefrekvens og blodtryk i musikgruppen sammenlignet med ikke musikgruppen.

    40. Lars Heslet Toronto February 07 Den musikalske hjerne The brain prosesses music at several levels. The biomusical science has focused on teh interplay between music and the brain the socalled ”musical brain”. A slow paced rythm in classical music ? changes the electropencephalographic waves to alpha & theta level Nyere undersøgelser: musikalske stimuli øger aktiviteten i den nye hjerne (neocortex) knyttet til indlæring og koordination og styrke forbindelsen mellem de to hjernehalvdele. Undersøgelser tyder på at musik kan styrke evnen til at løse opgaver som stiller krav til højere mentale funktioner.

    41. Lars Heslet Toronto February 07 Music in the ICU Patients listening to music induces wellbeing, relaxation, reduced anxiety and stress. Nurses are affected by music patients music sessions i relation to a modified behavior with conversation with a lower voice. Ambient noise with e.g. alarms is stressing Music played via loudspeakers in the ceiling applied to the ambient noise improves the sound environment

    42. Lars Heslet Toronto February 07 Music and reduction of anxiety in breast cancer patients waiting a randomized trial 20 patients in 2 groups (music vs no music) 20-minute music-based intervention in a preoperative holding area before performing the biopsy Measurements blood pressure, heart rate and respiratory rate (RR) Self completion of Standardized Stress Questionnaire* Result Stress Questionnaire and RR lower in the music-group (p< 0.05) *State trait Anxiety Inventory (STAI)

    43. Lars Heslet Toronto February 07 Effect of music for mood disturbances in hematopoietic stem cell transplantation (HSCT) A controlled trial of 69 patients undergoing autologous HSCT Randomized to Music or no intervention Results Level of mood was improved dramatically already after the 1rst musical session The positive effect continued every day during the hospital admittance period. Results were found to be both clinical important and statistical significant (p<0.01)

    44. Lars Heslet Toronto February 07 Oplevelse af lydmiljøet Patienter under opvågning efter operation

    45. Lars Heslet Toronto February 07 Hjertepatienter: Ønsker du musik ? vs. Synes du om lydmiljøet ?

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