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J Pain Symptom Manage. 2016 Aug;52(2):196-204. doi: 10.1016/j.jpainsymman.2016.01.008. Epub 2016 Apr 15.

Trajectories of Terminally Ill Patients' Cardiovascular Response to Receptive Music Therapy in Palliative Care.

Author information

1
Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany. Electronic address: marco.warth@hochschule-heidelberg.de.
2
Center of Pain Therapy and Palliative Care Medicine, Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany.
3
School of Therapeutic Sciences, SRH University Heidelberg, Heidelberg, Germany.

Abstract

CONTEXT:

Relaxation interventions are frequently used to promote symptom relief in palliative care settings, but little is known about the underlying mechanisms.

OBJECTIVES:

The present analysis aimed at examining the psychophysiological pathways of terminally ill patients' cardiovascular response to a live music therapy vs. prerecorded mindfulness exercise.

METHODS:

Eighty-four patients of a palliative care unit were randomly assigned to either of the two interventions. Multilevel modeling was used to analyze trajectories of physiological change. Vagally mediated heart rate variability (VM-HRV) and blood volume pulse amplitude (BVP-A) served as indices of autonomic nervous system response. Participants' gender, age, baseline scores, self-rated pain, and assignment to treatment were entered to the models as predictors.

RESULTS:

Both VM-HRV and BVP-A showed significant linear and quadratic trends over time, as well as substantial heterogeneity among individuals' trajectories. Baseline scores, pain, and treatment significantly accounted for random variation in VM-HRV intercepts. BVP-A levels were significantly higher in women than in men. Moreover, assignment to treatment significantly accounted for differences in the linear slopes of peripheral blood flow.

CONCLUSION:

Higher levels of VM-HRV in the music therapy group highlight the importance of a therapeutic relationship for the effectiveness of relaxation interventions in end-of-life care settings. Music therapy caused significantly stronger reductions of vascular sympathetic tone and, therefore, may be indicated in the treatment of pain and stress-related symptoms in palliative care. Initial self-ratings of pain moderated patients' physiological response and need to be taken into account in clinical practice and future theory building.

KEYWORDS:

Music therapy; cancer; mindfulness; multilevel analysis; pain; palliative care; randomized controlled trial

[Indexed for MEDLINE]

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