Many
operations can be done painlessly and while the patient is awake with a nerve
block, but the injection to block pain signals can be slightly painful and
anxiety-inducing for some.
Sedative drugs like midazolam are often used to soothe these patients, but this
class of drugs, benzodiazepines, can interfere with breathing and blood flow and
can actually cause hallucinations and hostility.
Plus,
benzodiazepines are addictive schedule IV drugs.
Instead, a University of Pennsylvania trial found that relaxing music -
specifically, the soothing sounds of Marconi Union's Weightless - reduced
patients' anxiety levels as well the drugs did, although the patients were less
'satisfied' with the experience.
Pre-surgery anxiety is understandable, and common, affecting more than half of
patients ,but nervousness can actually make the operation itself more
dangerous.
Anxiety kicks the nervous system into high gear, which makes us more prone to
high blood pressure, constricting blood vessels, heart arrhythmia and higher
body temperature, which can lead to higher complication risks in surgery.
Previous studies have also shown that patients who are anxious before a surgery
- however minor - begins may have a harder road to recovery.
The
go-to fix for most anesthesiologists and surgeons has long been to give a
patient a pill or IV benzodiazepine (or benzo) a highly effective class of
sedatives.
These
drugs work fast by amplifying the effects of a neurotransmitter called GABA,
which slows down other fast-talking neurotransmitters in over-active, anxious
brains.
Quieting these neurotransmitters and slowing down the brain's anxious activity
for a quick tranquilizing effect.
But
sometimes benzos backfire, causing agitation, aggression anxiety and
irritability.
And
even when they work as they should, the sedative effect depresses breathing and
heart rate, which help patients feel calm, but can be dangerous during surgery,
so they have to be monitored constantly.
Midazolam itself is fast-acting and quick to wear off, but people can form
tolerances for and dependencies on benzos, putting them at risk for addiction.
And
amid the opioid epidemic, doctors and patients alike are increasingly looking
for alternatives to addictive drugs when they aren't absolutely necessary.
Music
is among the top contenders for non-pharmacological ways to ease pain and
anxiety.
To
see just how well easy listening measures up to a drug buzz, University of
Pennsylvania researchers randomly gave 80 patients midazolam injections three
minutes before having a nerve block placed, and gave the other 77 noise-cancelling
headphones playing Weightless three minutes before the procedure.
They
assessed the patients' anxiety levels on a standardized scale and found that, on
average, had the same reduction in anxiety after listening to Weightless as the
midazolam patients did after getting the injection.
And
of course the music had no side effects.
But
it wasn't an entirely perfect replacement.
Patients and doctors alike said that it was harder to communicate when using
music instead of drugs, which the researchers guess probably had to do with the
noise-cancelling headphones.
Although their anxiety reductions were aligned after the three-minute period but
before the nerve block was given, musically-calmed patients didn't feel as
'satisfied' with the experience as their drugged peers.
Their
anxiety levels also didn't stay as low after the nerve block was given.
The
researchers attributed this to the fact that the participants didn't get to
choose their own music, although the disparity in satisfaction levels may have
somewhat more complicated sources.
Music
does act on neurotransmitters, thwarting the stress hormone, cortisol, while
boosting the 'feel-good' hormone, dopamine.
This
isn't as direct an interference on the brain activity that comes with anxiety as
boosting GABA with benzos is.
It
might be an imperfect substitute for drugs, but it is an alternative.
The
researchers write that future studies should experiment with other genres of
music or ways of 'delivering' it - by not using headphones that block out
anything a doctor tries to say - to improve its effectiveness.
Via Daily Mail