被動式音樂應用在疑似或確診癌症病人診斷性切片檢查及手術之疼痛緩解──系統性文獻回顧與統合分析

The Pain-Relief Efficacy of Passive Music-Based Interventions in Cancer Patients Undergoing Diagnostic Biopsies and Surgery: A Systematic Review and Meta-Analysis

背景：音樂是常使用於住院病人的非藥物性疼痛緩解策略。 目的：透過系統性文獻回顧及統合分析，檢視被動式音樂對疑似或確診癌症病人在診斷性切片檢查及手術 疼痛的緩解效應，並找出具臨床實證的應用策略與建議。方法：在Cochrane Library/Trials、PubMed、PsycINFO、CINHAL、台灣期刊論文索引系統五個中英文資料 庫，搜尋2016年以前的隨機對照性試驗研究，以modified Jadad scale 3分以上者列為統合分析之題 材，使用comprehensive meta-analysis進行資料處理及分析。 結果：共12篇研究納入分析，發現被動式音樂對診斷性切片檢查及手術疼痛具有緩解效應，整體效果量 （Hedges’s g）為小至中度-.42（p = .02）；次群組分析顯示：麻醉方式、介入環境、頻次及音樂治療師 是顯著影響疼痛緩解效應的調節因子。 結論：實務應用 本統合分析證實被動式音樂能有效減緩疑似或確診癌症病人，接受診斷性切片檢查或手術疼痛。建 議未來可將之應用在全身麻醉手術前後，於等候室或病房環境、每日提供2–3次、由音樂治療師執 行或指導的方案，乃為被動式音樂介入緩解疼痛的重要關鍵。

Background: Music-based intervention is commonly used as a non-pharmacological strategy to reduce pain in hospitalized patients. Purpose: To conduct a systematic review and meta-analysis to examine the effects of passive music-based interventions on pain relief in cancer patients undergoing diagnostic biopsies and surgeries and to identify the moderating variables in order to identify clinically validated interventional strategies and related suggestions. Methods: Studies using an RCT (randomized clinical trial) design that were published before 2016 were collected from the following databases: Cochrane Library/Trials, PubMed, PsycINFO, CINHAL, and Index to Taiwan Periodical Literature System. The high-quality studies, defined as those earning a modified Jadad scale score > 3, were then analyzed using comprehensive meta-analysis software. Results: The passive music-based interventions had a small-to-moderate overall effect (g = -.42, p = .02) on pain relief in the subjects undergoing diagnostic biopsies and surgery in the analyzed studies (n = 12). Subgroup analysis identified the moderating variables affecting pain reduction as the type of anesthesia administered and the settings, frequency, and music therapist that were used in the intervention. Conclusion/Implications for Practice: Passive music-based interventions have a significant pain reduction effect and may be used as an effective, non-pharmacologic intervention for cancer patients undergoing diagnostic biopsies and surgery. Delivering 2-3 intervention sessions daily, using a certificated music therapist to deliver/guide the sessions, holding the sessions in waiting-room or ward settings, and administering a general anesthesia were identified as the crucial factors impacting the effectiveness of music intervention on pain relief.