The effect of a music-based caregiving intervention on pain intensity in nursing home patients with dementia. A cluster-randomized controlled study.

ABSTRACT: Treatment of chronic pain in patients with dementia is challenging because they have reduced ability to report pain and are particularly vulnerable to side effects of analgesics. Different types of music-based therapy have been recommended and are used as an alternative to analgesics, but the evidence is lacking. Therefore, we performed a cluster-randomized controlled study (RCT) to reduce pain intensity using music-based caregiving (MBC) over 8 weeks in nursing home patients with dementia and chronic pain. We also investigated if the amount of MBC and different chronic pain syndromes would impact on the effect. Of the 645 patients, 498 patients from 36 wards in 12 nursing homes were screened for dementia and pain. Using the Clinical Dementia Rating Scale and the Mobilization-Observation-Behavior-Intensity-Dementia Pain Scale (range 0-10), 279 (71% females, 42% severe dementia) nursing home patients were randomized to intervention group (n = 134, 18 wards) or control group (n = 145, 18 wards). The main outcome was change in pain intensity before and after the intervention. The study did not reveal any effect of MBC on pain intensity when compared with the control group (B = -0.15, 95% CI [-0.72 to 0.43]). No significant difference was found within the intervention group analyzing the impact of intervention time (B = 0.73, 95% CI [-0.55 to 2.02]) or chronic primary vs secondary pain syndromes (B = 0.45, 95% CI [-0.05 to 0.96]). Our data from this first RCT on music and pain intensity in patients with dementia and chronic pain did not find an effect of MBC on pain.

[Therapeutic use of music in nursing homes]. / Bruk av musikk som terapeutisk hjelpemiddel i sykehjem.

BACKGROUND: There is growing interest in the therapeutic use of music in nursing homes. The difficulties inherent in medical treatment of this population warrant further studies of music as a therapeutic modality. MATERIAL AND METHODS: This is a review of articles on the use of music and music therapy in geriatrics. Findings from a nursing home project, "Music in the late stages of life", have been compared with those reported in the literature, particularly from meta-analyses and systematic reviews. The distinction between music therapy, music medicine and individualised music has been taken into account. RESULTS AND INTERPRETATION: The evidence base for using music therapeutically in nursing homes is still insufficient. There is a lack of consensus about criteria for the use of different types of music therapy, and most studies have methodological limitations or are insufficiently defined. Approaches to measurement and evaluation vary. Meta-analyses have tried to overcome this problem by emphasizing effect size. A widely shared conclusion is that music can supplement medical treatment. The cost is low, there are few side effects, and music gives a high level of patient satisfaction. Clinical experience and analyses of effect size indicate that music has a specific potential in nursing homes. It can enhance well-being and alleviate symptoms like agitation, anxiety, depression, and sensomotor symptoms in neurodegenerative diseases; it may also contribute in palliative care at the end-of-life stage.

[Can music therapy for patients with neurological disorders?]. / Kan musikkterapi hjelpe pasienter med nevrologiske sykdommer?

Recent developments in brain research and in the field of music therapy have led to the development of music-based methods specifically aimed at relieving symptoms of Parkinson's disease and other neurologic disorders. Rhythmic auditory stimulation uses external rhythmic auditory cues from song, music or metronome to aid patients improving their walking functioning and has been shown to be effective both within sessions and as a result of training over time. Melodic intonation therapy and related vocal techniques can improve expressive dysphasia and aid rehabilitation of neurologic disorders, particularly Parkinson's disease, stroke and developmental disorders.