Listening to music may ease cancer patients' pain

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(Reuters Health) - Listening to music at home may reduce cancer patients’ pain and fatigue and ease symptoms like loss of appetite and difficulty concentrating, according to research in Taiwan.

In the study, breast cancer patients assigned to 30 minutes of music listening five times a week had “noticeably” reduced side effects of cancer and its treatment over 24 weeks, researchers report in the European Journal of Cancer Care.

The patients said the music helped their physical and psychological wellbeing because it distanced them from negative thoughts about cancer.

“Music therapy is convenient, does not involve invasive procedures, and can easily be used by people in the comfort of their homes,” said senior study author Kuei-Ru Chou of Taipei Medical University.

“Home-based music interventions can also be used with no cost,” Chou told Reuters Health by email. “Healthcare services have become expensive in the present time.”

The researchers recruited 60 breast cancer patients and randomly assigned half of them to a group that would listen to music at home on an MP3 player provided by the study team with a selection of classical, parlor, popular, Taiwanese and religious music to choose from. The other patients were also given a player and the same instructions about how often to listen, but their selections were various types of ambient music, mainly consisting of environmental sounds, which research has shown does little to reduce pain or symptoms, the study team notes.

Before the women had surgery, and after six, 12 and 24 weeks of music listening, all patients rated the severity of 25 physical symptoms on a five-point scale, as well as rating five categories of fatigue on a separate five-point scale, and the level of pain they felt on a 100-point scale.

The average symptom severity scores of the music therapy group had dropped by five points at the six-week assessment, seven points at 12 weeks and nearly nine points after 24 weeks. Pain scores and overall fatigue scores fell at each assessment as well.

For those listening to music, physical and mental fatigue had also dropped at six weeks but not later.

In contrast, pain and symptom severity scores in the control group increased and remained higher than at the start of the trial.

Based on the results, music therapy may not relieve long-term physical and mental fatigue, the study authors caution. And future studies should use objective measures of pain and fatigue, in addition to the subjective measures used in this study, Chou said.

The researchers are also interested in learning how and why music therapy reduces symptoms and pain. Because listening to music promotes endorphins, dopamine and serotonin in the brain, the chemicals may spark joy and positive emotions that distract patients from the negative emotions, the study authors speculate.

Music could affect functions of the cardiovascular, respiratory, muscular, skeletal, nervous and metabolic systems as well, relieving muscle tension and pain, they add.

“From the neurophysiological point of view,” said Tereza Alcantara-Silva of the Federal University of Goias in Brazil, music-evoked emotions can modulate activity in a variety of brain areas.

“Music plays a major role in self-regulation of emotional contexts,” said Alcantara-Silva, who wasn’t involved in the study, by email. “Music therapy can bring several benefits to cancer patients, helping them to find ways to deal with stress, fear, and loneliness.”

SOURCE: bit.ly/2Idu5cY European Journal of Cancer Care, online June 5, 2019.

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Experimental mobile app helps manage migraines

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(Reuters Health) - A smartphone-based relaxation app could help migraine sufferers reduce the number of headaches they get each month, a small study suggests.

Using the app twice a week was associated with an average of four fewer headache days per month, according to the report in Nature Digital Medicine.

“Migraine is now the second most disabling condition in terms of disability-adjusted years lost,” said lead author Dr. Mia Minen of NYU Langone Health in New York City.

Migraines affect about 1 in 6 adults in the U.S., with women most at risk.

“Previous research has shown that the best treatment for preventing migraine is a combination of migraine medication and behavioral therapy,” Minen told Reuters Health by email. However, “patients have significant difficulty accessing these safe, top evidence-based treatments.”

Minen and colleagues created RELAXaHEAD, an app based on the technique of progressive muscle relaxation, a proven method of migraine prevention, the authors note. The study team analyzed whether patients recruited from a neurology clinic would use the app regularly and whether they’d have fewer headache days.

During the study, 51 patients in their 30s and 40s who typically had 13 or more headache days per month were asked to complete a daily headache diary and to do progressive muscle relaxation with the app for 20 minutes a day for 90 days. Nearly one third of the participants were considered to have severe migraine disability when they enrolled, meaning they had missed considerable amounts of work, school and family activities due to the headaches.

On average, participants used the app on 22 days per month, for about 11 minutes per day. Roughly half used it once per week and a third used it two or more times per week. Overall, those who used the app twice per week had four fewer headache days the following month, and those who used it once per week had two fewer headaches days. Use of the app tended to drop over time.

Patients with higher depression scores were less likely to use the daily headache diary, and those with higher anxiety scores were more likely to use it.

“The number of mobile health apps available in the iOS and Google Play stores has ballooned, and recent studies show that most people download an app but then rarely use it,” Minen said. “Importantly, we were able to get a considerable number of study participants to use the app.”

The researchers have received inquiries about the app from patients with migraines outside the NYU Langone system, she noted. Although it was created as a research tool, Minen’s team is exploring ways to expand access to the app or include it in office visits. They’re also studying whether the app can help healthcare providers who don’t know where to refer patients with migraines who want behavioral therapy.

“I would encourage people who live with migraines to consider a behavioral treatment,” said Alice Pressman of Sutter Health in Walnut Creek, California, who wasn’t involved in the study.

“The great thing about starting a (behavioral therapy) BT is that you don’t have to stop your other treatments if you feel they are effective,” Pressman said by email. “BTs can be used as add-ons with no added side effects.”

However, an in-person a mindfulness-based stress reduction program targeting migraines that was offered at her center was difficult for some patients to attend due to time and location, Pressman said, so an online program may help. At the same time, patients should know that apps are still new and not fully studied.

“Research here is important to enable therapeutically effective and safe smartphone apps. Lots of apps are offered that are not based on any scientific evidence,” said Thomas Dresler of the University of Tuebingen in Germany, who wasn’t involved in the study.

“There are a lot of migraine apps out there, but customers need to know that the availability of an app per se does not guarantee effectiveness, safety or the developers’ adherence to specific quality standards,” Dresler said by email.

SOURCE: bit.ly/2X9Iwa1 Nature Digital Medicine, online June 4, 2019.

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Traumatic injuries linked to later social dysfunction

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(Reuters Health) - Nearly half of trauma patients, even those without brain injuries, experience social deficits that make it harder for them to interact with friends and stay involved in the community, a recent study suggests.

Traumatic brain injuries have long been linked to an increased risk of a wide range of short-term and long-term physical and mental health problems that can dramatically reduce quality of life, researchers note in the journal Surgery. But doctors don’t yet have a clear picture of what type of social impairments may follow other types of traumatic injuries.

“Social functioning is considered a critical determinant of quality of life,” said lead study author Dr. Juan Herrera-Escobar of Brigham and Women’s Hospital and Harvard Medical School in Boston.

Broadly speaking, social function includes the ability to participate in organized and informal activities with friends, relatives, and people in the community or the workplace. Serious injuries can lead to physical and emotional issues that contribute to social deficits, and long hospital stays that keep patients away from their daily routines for weeks on end can make matters worse.

For the current study, researchers followed 805 adults hospitalized for moderate to severe traumatic injuries. During the year after the injury, 364 of them, or 45%, reported experiencing social dysfunction.

In the study, researchers assessed social function 6 months and 12 months after injuries. Each time, they asked patients how often physical or emotional challenges interfered with social activities in the previous four weeks.

Compared to patients who reported no social dysfunction, those who did tended to be younger and were more likely to be African American and have no more than a high school education. Patients with social dysfunction were also more likely to have had longer hospital stays, required mechanical ventilation in the hospital and have previous psychiatric illness.

People with a history of a major psychiatric illness, for example, were almost three times more likely to experience social dysfunction. Low education, meanwhile, more than doubled the risk of social dysfunction.

In addition, people with social dysfunction were over 16 times more likely to have post-traumatic stress disorder (PTSD) than those without social dysfunction, and about five and a half times more likely to have not returned to work after their accident.

It’s possible that people with lots of social support from family and friends or from patient support groups might have fewer challenges with social dysfunction after their injuries, Herrera-Escobar said by email.

“A strong family environment fosters resilience, which has been associated with better long-term outcomes after trauma,” Herrera-Escobar added. “We also believe that getting appropriate and timely treatments (rehabilitation, mental health services, etc.) for physical and mental health conditions can also help improve their social outcomes.”

The study lacked data on social functioning before patients’ injuries, and it’s possible that some people had impairments beforehand, the study team notes.

Even so, the results underscore the importance of considering social function in trauma care from the start instead of waiting to address this until after patients go home from the hospital, said Dr. Tim Platts-Mills, an emergency medicine researcher at the University of North Carolina at Chapel Hill who wasn’t involved in the study.

Pain management and treating people for depression, PTSD and other psychiatric issues may help minimize the social dysfunction, Platt-Mills said by email.

“The best approach is not to wait six weeks and then conclude that there is a problem,” Platt-Mills said. “A better approach is to work with the patient’s clinical team to try to address these problems early on.”

SOURCE: bit.ly/2Xb9NsA Surgery, online May 17, 2019.

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