Background & Aims
Sickle cell disease (SCD) is a genetic condition linked to a single mutation in the ? globin gene, leading to the production of hemoglobin S. It is characterized by the occurrence of painful bone vaso-occlusive crises (VOC), the management of which is still notoriously limited. VOC pain is multifactorial, with both biological and psychological components. Several studies suggest the benefit of relaxation techniques, especially musical listening, in the management of SCD pain. The objective of our study was to evaluate the effect of web app-based music intervention on severe VOC pain in SCD.
Methods
MUSICODREP is a pilot single-center prospective randomized open-label controlled study carried out in SS/S?° sickle cell patients hospitalized for severe VOC. All patients received usual care for VOC (including intravenous opioid self-administration), and were randomized in a 1:1 ratio between an experimental arm receiving a web app-based music intervention and a control arm without music. Music intervention sessions were administered by a trained staff three times a day until hospital discharge. Student t-test was used to compare the primary endpoint which was the mean daily intravenous morphine intake within the first 3 days of hospitalization.
Results
A total of 39 patients were included, with 20 assigned to the experimental arm and 19 to the control arm. Our study revealed a non-significant decrease in the daily intravenous morphine intake in the music intervention group vs. control group (mean ± standard deviation: 62.6±21.5 mg vs 78.7 ±36.7 mg respectively; p=0.13). Pre-specified secondary endpoints (total amount of morphine intake during hospitalization, mean daily Visual Analogue Scale (VAS) over the first 3 days, mean VAS during hospitalization, length of hospitalization, depression or anxiety scores) did not differ between the two groups. In an exploratory study, the music intervention demonstrated significant benefits for patients on long-term level II analgesics (p=0.03), patients experiencing more than 1 VOC per year (p=0.046), and patients not receiving hydroxyurea treatment (p=0.03).
Conclusions
Our small-scale pilot study failed to demonstrate a significant effect of a web app-based music therapy intervention combined with usual care on severe VOC pain, possibly related to a lack of power due to loss of information, which reduces the ability of the study to detect real effects. Nevertheless, an exploratory analysis suggested a potential benefit of music therapy for the most symptomatic and severe SCD patients. Music intervention is an inexpensive technique, simple to implement and devoid of pharmacological side-effects. These preliminary data deserve to be confirmed by a higher-powered multicenter study targeting high-risk SCD patients.
References
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[3] Rodgers-Melnick SN, Matthie N, Jenerette C, Griest Pell TJ, Lane D, Fu P, Margevicius S, Little JA. The Effects of a Single Electronic Music Improvisation Session on the Pain of Adults with Sickle Cell Disease: A Mixed Methods Pilot Study. J Music Ther. 2018 Jun 7;55(2):156-185.
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Presenting Author
Morabito Antonio
Poster Authors
Antonio Morabito
MD
Hôpital Avicenn
Lead Author
Jaehyo Suhl
Lead Author
Nanthara Sritharan
Lead Author
Nacira Darghal
Lead Author
Coralie Bloch-Queyrat
Lead Author
Vincent Lévy
Lead Author
Marilucy Lopez-Sublet
Lead Author
Robin Dhôte
Lead Author
Stéphane Guetin
Lead Author
Jean Jacques Mourad
Lead Author
Sylvain Le Jeune
Lead Author
Topics
- Treatment/Management: Interventional Therapies – Other