One of the big responsibilities of music therapists in pediatric hospitals is to help work on pain management. There are multiple different types of pain that children may experience: procedural and postsurgical pain, pain from sickle cell disease, hemophilia, cystic fibrosis, cancer related pain, and trauma related pain (Bradt, 2013). Music therapy can’t replace the typical pain medications but can be used in conjunction to help manage the pain. Bradt states that a child's understanding of pain depends on the cognitive development of the child. These different stages can affect how you may implement music therapy with a child. Children in the preoperational stage (ages 2-7) have a more passive attitude towards pain. Children in the concrete operational stage (ages 7-12) begin to understand the negative emotions that come with pain. Children in the formal operational stage (above 12 years of age) possess the capability to reflect on pain in a more abstract way (22). Children tend to perceive most of their treatment as out of their control, “three categories of control-enhancing techniques have proven to be effective in the pediatric setting: behavioral, decisional, and cognitive control” (22). The biggest emotional things that children experience related to pain are anxiety/fear and depression.
There are various scales used to rate the amount of pain a child is feeling. Some examples include The Visual Analogue scale (VAS), Graphic rating scales and multidimensional pain scales. The VAS is “a 100-mm line, the length of which represents the continuum of an experience such as pain” (26). Graphic ratings scales involve the use of numeric ratings, word graphics, pain thermometers, and/or facial scales. Multidimensional pain scales are geared at mearing various dimensions of the pain experience. A music therapy assessment of pain will often assess more than the pain itself. It will also assess the patient's emotional state, developmental level, cognitive understanding, musical preferences, etc. “The assessment should also include information about the musical qualities of the pain. Many attributes of pain can be easily translated into musical parameters” two examples of this would be pulse (how fast is the pain) and timbre (instruments that have a sharp sound/dull sound).
There are various different types of music therapy methods that are designed to help with pain management. Those methods include Receptive music therapy, improvisational music therapy, Re-creative music therapy, and compositional music therapy. Some examples of interventions within each of these methods are as follows (31):
Receptive MT
Music Guided Imagery: Use of imagery supported by music to help children relax, find refuge from pain, escape hospital environments, and be empowered in the healing process.
Vibroacoustic Therapy: Use of sound in the audible range to produce mechanical vibrations that are applied directly to the body, resulting in relaxation and analgesic effects.
Improvisational MT
Tonal Intervallic Synthesis: The purposeful use of tones and timbres that resolve dissonance into consonance to influence circulation, release, integration, pain, and physical perception.
Improvised music for Integration: The use of drumming, toning, and chanting in an improvisatory style to help the child integrate the hurt.
Re-creative MT
Singing songs: Singing favorite songs to shift the child's focus away from the pain, improve perceived level of control, normalize sterile hospital environment and encourage interaction with others.
Compositional MT
Songwriting: the use of songwriting to give the child the opportunity to articulate their feelings and direct them into a creative form, provide cognitive reframing, and to enhance the child's understanding of pain and/or procedure.
Bradt states that inadequate treatment of pain in the hospital can have a severely negative impact on a child and create long-term negative effects, “Music therapists play an important role in assuring that children's pain management needs are adequately addressed” (53). Music Therapy can be an amazing tool for children to help contextualize and deal with their pain.
-Sara Demlow, MT Intern
Sources:
Bradt, J. (2013). Guidelines for music therapy practice in pediatric care. Gilsum, NH: Barcelona.