Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Pain is the most prevalent complaint for the more than 155 million patients accessing emergency care in the United States. Appropriate and timely management of pain is a measure of quality emergency care. However, the opioid crisis has created a need for multimodal and alternative approaches to successful pain management. Models for integrating such approaches in emergency departments (ED) are understudied. Therefore, we chose to investigate the impact of live preferential music (LPM) in the management of acute musculoskeletal pain.

Methods: This prospective, randomized, double-blind intervention study was designed with block randomization clustered by day of the week to live preferred music versus usual care. To ensure blinding, patients were deceived that the study focus was on pain assessment without disclosure that there was an intervention. A total of 2,262 patients were screened, and 272 patients (94 interventions, 128 usual care controls, and 50 declined-music intervention) were recruited from two free-standing EDs. All subjects received analgesics per prescription, had vital signs measured, and completed baseline and follow-up Pain Intensity Number Scale (0-10) scores via PAINReportIt. We calculated morphine equivalents for pain medications in the ED.

Results: The mean age of the 222 patients in the per-protocol analytic sample was 48.3 years (95% confidence interval, 45.9-50.7); 64% were female, 29% Black; and their triage acuity was 4% emergent Emergency Severity Index (ESI) 2, 52% urgent ESI 3, and 44% less urgent ESI 4. There were absolute reductions in current pain intensity from baseline in both the control (–1.21) and intervention (–1.34) groups (difference –0.14, 95% CI, –0.48 to 0.76). However, the difference was not significant in posttest pain intensity when controlling for baseline pain intensity (P = .29). Qualitative analysis reflected patient-reported reduction in the perception of pain as a common theme. Vital signs and morphine equivalents were similar between groups.

Conclusion: This study demonstrated that live preferential music interventions are feasible to study rigorously in the ED. Patients were enrolled using deception and were not informed of the study’s focus on music or their potential exposure to music. However, they were told initially that they would be part of a pain assessment study. Although significant between-group differences were not observed, the general theme of patient-reported reduction in the perception of pain suggests that a more highly powered study might detect significant effects in pain reduction with LPM. Variation in clinician care strategies and evolving federal guidelines for pain management may have influenced study processes and outcomes.