Music Therapy for Pain Management for People With Advanced Cancer: A Randomized Controlled Trial
Corresponding Author
Joke Bradt
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Correspondence: Joke Bradt
Search for more papers by this authorAmy Leader
Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorBrooke Worster
Division of Supportive Oncology, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorKate Myers-Coffman
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorKarolina Bryl
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorJacelyn Biondo
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorBrigette Schneible
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCarrie Cottone
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorPreethi Selvan
Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorFengqing Zhang
Department of Psychological and Brain Sciences, College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCorresponding Author
Joke Bradt
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Correspondence: Joke Bradt
Search for more papers by this authorAmy Leader
Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorBrooke Worster
Division of Supportive Oncology, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorKate Myers-Coffman
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorKarolina Bryl
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorJacelyn Biondo
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorBrigette Schneible
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorCarrie Cottone
Department of Creative Arts Therapies, College of Nursing and Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorPreethi Selvan
Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorFengqing Zhang
Department of Psychological and Brain Sciences, College of Arts and Sciences, Drexel University, Philadelphia, Pennsylvania, USA
Search for more papers by this authorFunding: This work was supported by the National Institute of Nursing Research of the National Institutes of Health (Award Number R01NR016681).
ABSTRACT
Objective
To improve mechanistic understanding, this randomized controlled trial examined anxiety, mood, emotional support, and pain-related self-efficacy as mediators of music therapy for pain management in people with advanced cancer.
Methods
People with advanced cancer who had chronic pain were randomized (1:1) to 6 weekly individual music therapy or social attention control sessions. We measured mediators and pain outcomes (pain interference and pain intensity) using self-report measures at baseline, session 4, and post-intervention. We included outcome expectancy/treatment credibility, music reward, adult playfulness, and baseline pain interference and pain intensity as moderators.
Results
Participants (n = 92) had a mean age of 56 years. Most were female (71.7%), white (47.8%) or Black (39.1%), and had stage IV cancer (75%). Self-efficacy was found to be a significant mediator of music therapy for pain intensity (indirect effect ab = 0.79, 95% CI 0.01–1.82) and pain interference (indirect effect ab = 1.16, 95% CI 0.02–2.51), while anxiety, mood, and emotional support were not. The mediating effect of pain-related self-efficacy was significantly moderated by baseline pain interference but not by the other moderators.
Conclusions
The findings suggest that the impact of music therapy on chronic pain is mediated by self-efficacy. This knowledge can help optimize music therapy interventions for chronic pain management for people with advanced cancer by capitalizing on teaching music-based self-management strategies.
Trial Registration: ClinicalTrials.gov identifier: NCT03432247
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data underlying this article cannot be shared publicly due to the privacy of individuals who participated in the study and protected health information collected. The data will be shared on reasonable request to the corresponding author.
References
- 1B. T. Valeberg, T. Rustoen, K. Bjordal, B. R. Hanestad, S. Paul, and C. Miaskowski, “Self-Reported Prevalence, Etiology, and Characteristics of Pain in Oncology Outpatients,” European Journal of Pain 12, no. 5 (2008): 582–590, https://doi.org/10.1016/j.ejpain.2007.09.004.
- 2T. Meuser, C. Pietruck, L. Radbruch, P. Stute, K. A. Lehmann, and S. Grond, “Symptoms During Cancer Pain Treatment Following WHO-Guidelines: A Longitudinal Follow-Up Study of Symptom Prevalence, Severity and Etiology,” Pain 93, no. 3 (2001): 247–257, https://doi.org/10.1016/S0304-3959(01)00324-4.
- 3P. M. Barnes, B. Bloom, and R. L. Nahin, “Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007”, National Health Statistics Reports, no. 12 (2008): 1–23.
- 4J. Bradt, N. Potvin, A. Kesslick, et al., “The Impact of Music Therapy Versus Music Medicine on Psychological Outcomes and Pain in Cancer Patients: A Mixed Methods Study,” Supportive Care in Cancer 23, no. 5 (2015): 1261–1271, https://doi.org/10.1007/s00520-014-2478-7.
- 5 American Music Therapy Association, What Is Music Therapy?, accessed May 30, 2015, http://www.musictherapy.org/about/musictherapy/.
- 6J. Bradt, C. Dileo, K. Myers-Coffman, and J. Biondo, “Music Interventions for Improving Psychological and Physical Outcomes in People With Cancer,” Cochrane Database of Systematic Reviews 10, no. 9 (2021), https://doi.org/10.1002/14651858.CD006911.pub4.
- 7E. A. Garza-Villarreal, V. Pando, P. Vuust, and C. Parsons, “Music-Induced Analgesia in Chronic Pain Conditions: A Systematic Review and Meta-Analysis,” Pain Physician 20, no. 7 (2017): 597–610, https://doi.org/10.36076/ppj/2017.7.597.
- 8M. A. Lumley, J. L. Cohen, G. S. Borszcz, et al., “Pain and Emotion: A Biopsychosocial Review of Recent Research,” Clinical Psychologist 67, no. 9 (2011): 942–968, https://doi.org/10.1002/jclp.20816.
10.1002/jclp.20816 Google Scholar
- 9M. L. Chen, H. K. Chang, and C. H. Yeh, “Anxiety and Depression in Taiwanese Cancer Patients With and Without Pain,” Journal of Advanced Nursing 32, no. 4 (2000): 944–951, https://doi.org/10.1046/j.1365-2648.2000.t01-1-01560.x.
- 10P. D. Thielking, “Cancer Pain and Anxiety,” Current Pain and Headache Reports 7, no. 4 (2003): 249–261, https://doi.org/10.1007/s11916-003-0045-x.
- 11A. Poulos, M. Gertz, V. Pankratz, and J. Post-White, “Pain, Mood Disturbance, and Quality of Life in Patients With Multiple Myeloma,” Oncology Nursing Forum 28 (2001): 1163–1171.
- 12D. B. Ferreira, R. Koifman, and A. Bergmann, “Quality of Life in Brazilian Women With Breast Cancer: Association With the Social Environment,” supplement, Journal of Epidemiology and Community Health 65, no. S1 (2011): A241, https://doi.org/10.1136/jech.2011.142976i.13.
- 13C. Murillo, T.-T. Vo, S. Vansteelandt, et al., “How Do Psychologically Based Interventions for Chronic Musculoskeletal Pain Work? A Systematic Review and Meta-Analysis of Specific Moderators and Mediators of Treatment,” Clinical Psychology Review 94 (June 2022): 102160, https://doi.org/10.1016/j.cpr.2022.102160.
- 14M. K. Nicholas, “The Pain Self-Efficacy Questionnaire: Taking Pain Into Account,” European Journal of Pain 11, no. 2 (2007): 153–163, https://doi.org/10.1016/j.ejpain.2005.12.008.
- 15R. A. Sela, E. Bruera, B. Conner-Spady, C. Cumming, and C. Walker, “Sensory and Affective Dimensions of Advanced Cancer Pain,” Psycho-Oncology 11, no. 1 (2002): 23–24, https://doi.org/10.1002/pon.551.
- 16D. Duck-Hee Kang, T. McArdle, and Y. Suh, “Changes in Complementary and Alternative Medicine Use Across Cancer Treatment and Relationship to Stress, Mood, and Quality of Life,” Journal of Alternative & Complementary Medicine 20, no. 11 (2014): 853–859, https://doi.org/10.1089/acm.2014.0216.
- 17S. W. Jane, S. L. Chen, D. J. Wilkie, et al., “Effects of Massage on Pain, Mood Status, Relaxation, and Sleep in Taiwanese Patients With Metastatic Bone Pain: A Randomized Clinical Trial,” Pain 152, no. 10 (2011): 2432–2442, https://doi.org/10.1016/j.pain.2011.06.021.
- 18A. S. Cephas, S. Stephenie, and A. Millstein, “Embracing Technological Possibilities in the Telehealth Delivery of Interactive Music Therapy,” Nordic Journal of Music Therapy 31, no. 3 (2022): 214–227, https://doi.org/10.1080/08098131.2022.2040579.
- 19D. Watson, L. A. Clark, and A. Tellegan, “Development and Validation of Brief Measures of Positive and Negative Affect: The PANAS Scales,” Journal of Personality and Social Psychology 54, no. 6 (1988): 1063–1070, https://doi.org/10.1037/0022-3514.54.6.1063.
- 20W. Guy, ECDEU Assessment Manual for Psychopharmacology (Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, National Institute of Mental Health, Psychopharmacology Research Branch, Division of Extramural Research Programs, 1976).
- 21G. J. Devilly and T. D. Borkovec, “Psychometric Properties of the Credibility/Expectancy Questionnaire,” Journal of Behavior Therapy and Experimental Psychiatry 31, no. 2 (2000): 73–86, https://doi.org/10.1016/s0005-7916(00)00012-4.
- 22E. Mas-Herrero, J. Marco-Pallares, U. Lorenzo-Seva, R. J. Zatorre, and A. Rodriguez-Fornells, “Individual Differences in Music Reward Experiences,” Music Perception 31, no. 2 (2013): 118–138, https://doi.org/10.1525/MP.2013.31.2.118.
10.1525/mp.2013.31.2.118 Google Scholar
- 23R. T. Proyer, “Development and Initial Assessment of a Short Measure for Adult Playfulness: The SMAP,” Personality and Individual Differences 53, no. 8 (2012): 989–994, https://doi.org/10.1016/j.paid.2012.07.018.
- 24M. S. Fritz and D. P. MacKinnon, “Required Sample Size to Detect the Mediated Effect,” Psychological Science 18, no. 3 (2007): 233–239, https://doi.org/10.1111/j.1467-9280.2007.01882.x.
- 25J. Bradt, M. Norris, M. Shim, E. J. Graceley, and P. Gerrity, “Vocal Music Therapy for Chronic Pain Management in Inner-City African Americans: A Mixed Methods Feasibility Study,” Journal of Music Therapy 53, no. 2 (2016): 178–206, https://doi.org/10.1093/jmt/thw004.
- 26S. B. Hanser, S. Bauer-Wu, L. Kubicek, et al., “Effects of a Music Therapy Intervention on Quality of Life and Distress in Women With Metastatic Breast Cancer,” Journal of the Society for Integrative Oncology 4, no. 3 (2006): 116–124, https://doi.org/10.2310/7200.2006.014.
- 27S. van Buuren and K. S. Groothuis-Oudshoorn, “MICE: Multivariate Imputation by Chained Equations in R,” Journal of Statistical Software 45, no. 3 (2011): 1–67, https://doi.org/10.18637/jss.v045.i03.
- 28K. J. Preacher and A. F. Hayes, “SPSS and SAS Procedures for Estimating Indirect Effects in Simple Mediation Models,” Behavior Research Methods, Instruments, & Computers 36, no. 4 (2004): 717–731, https://doi.org/10.3758/bf03206553.
- 29R. M. Baron and D. A. Kenny, “The Moderator–Mediator Variable Distinction in Social Psychological Research: Conceptual, Strategic, and Statistical Considerations,” Journal of Personality and Social Psychology 51, no. 6 (1986): 1173–1182, https://doi.org/10.1037/0022-3514.51.6.1173.
- 30A. F. Hayes, “Beyond Baron and Kenny: Statistical Mediation Analysis in the New Millennium,” Communication Monographs 76, no. 4 (2009): 408–420, https://doi.org/10.1080/03637750903310360.
- 31A. F. Hayes, “An Index and Test of Linear Moderated Mediation,” Multivariate Behavioral Research 50, no. 1 (2015): 1–22, https://doi.org/10.1080/00273171.2014.962683.
- 32J. Bradt, M. Norris, M. Shim, E. J. Gracely, and P. Gerrity, “Vocal Music Therapy for Chronic Pain Management in Inner-City African Americans: A Mixed Methods Feasibility Study,” Journal of Music Therapy 53, no. 2 (2016): 178–206, https://doi.org/10.1093/jmt/thw004.
- 33M. Y. Low, C. Lacson, F. Zhang, A. Kesslick, and J. Bradt, “Vocal Music Therapy for Chronic Pain: A Mixed Methods Feasibility Study,” Journal of Alternative & Complementary Medicine 26, no. 2 (2019): 113–122, https://doi.org/10.1089/acm.2019.0249.
- 34S. N. Rodgers-Melnick, L. Lin, K. Gam, et al., “Effects of Music Therapy on Quality of Life in Adults With Sickle Cell Disease (MUSIQOLS): A Mixed Methods Feasibility Study,” Journal of Pain Research 15 (2022): 71–91, https://doi.org/10.2147/JPR.S337390.
- 35L. L. White, M. Z. Cohen, A. M. Berger, K. A. Kupzyk, and P. J. Bierman, “Self-Efficacy, Symptom Management, Integrative Review, Symptom Distress, Cancer,” Oncology Nursing Forum 46, no. 1 (2019): 113–128, https://doi.org/10.1188/19.ONF.113-128.
- 36R. Marks, J. P. Allegrante, and K. Lorig, “A Review and Synthesis of Research Evidence for Self-Efficacy-Enhancing Interventions for Reducing Chronic Disability: Implications for Health Education Practice (Part I),” Health Promotion Practice 6, no. 1 (2005): 37–43, https://doi.org/10.1177/1524839904266790.
- 37R. H. Dworkin, D. C. Turk, J. T. Farrar, et al., “Core Outcome Measures for Chronic Pain Clinical Trials: IMMPACT Recommendations,” Pain 113, no. 1–2 (2005): 9–19, https://doi.org/10.1016/j.pain.2004.09.012.
- 38G. A. Hanvey, A. Padron, E. L. Kacel, et al., “Accrual and Retention of Diverse Patients in Psychosocial Cancer Clinical Trials,” Journal of Clinical and Translational Science 6, no. 1 (2022): e45, https://doi.org/10.1017/cts.2022.380.
- 39T. Bebi, R. Horovitz, K. Blum, et al., “How Granularity of Data Matters in Understanding and Accelerating Racial Diversity in U.S. Clinical Trials,” supplement, Journal of Clinical Oncology 40, no. S28 (2022): 88, https://doi.org/10.1200/JCO.2022.40.28_suppl.088.
10.1200/JCO.2022.40.28_suppl.088 Google Scholar
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