CDA Essentials 2018 • Volume 5 • Issue 7

S upporting Y our P ractice Culturally Adapted Musical Intervention For Patient-Centred Health Care Refusal, avoidance, and postponement of needed treatments happen frequently in health care systems. 1–4 The patient’s low engagement in care has been attributed to several socio- demographic and contextual factors including the patient’s age, sex, ethnic group status, personality, medical and mental conditions, type and complexity of care, as well as the type of health care setting. 5–10 Clinical diagnostic procedures, treatments and care settings with fear- evoking characteristics such as imaging rooms, CT scan machines, blood tests, colonoscopy and surgical procedures, and dental clinics are good examples of environments and contexts that can cause medical and dental anxiety or phobia. Treatment phobia shapes individuals’ disruptive behaviour patterns and leads to preoperative anxiety, which is associated with state treatment anxiety and increased postoperative pain. 11,12 Improved anxiety regulation and pain control is critical for maintaining health and well- being, empowerment of positive health care behaviours, and optimal care management. 13,14 Music has been used in several clinical settings to engage patients in self-regulation of anxiety and pain control. 15 Growing clinical evidence attests that music exerts anxiolytic effects on patients undergoing invasive medical procedures or cancer experience. It may be used as an adjunctive intervention in many conditions such as musculoskeletal disease, cardiovascular disease, and dementia, by influencing the activity of brain/emotion networks, initiating corresponding physiological responses, and contributing to psychological well- being and engagement in self-care activities. 15–22 Although the underlying mechanisms through which music produces its impact are not yet completely understood, cognitive and emotional pathways have been proposed as key mediators. Activities that distract attention help attenuate pain or decrease anxiety. 23–25 Recent neuroscience research has also demonstrated the power of music to induce pleasure and modulate arousal. 26–29 Experimental research indicates that the subjective pleasantness of music contributes to its analgesic effects, 30 consistent with neuroimaging studies showing how positive emotions reduce the brain response to acute pain. 31 The neural impulses produced by music affect the autonomic nervous system, modulate activity in brainstem structures, and initiate the reflexive brainstem and endocrine system responses, which provoke changes in blood pressure, heart rate, and anxiety level by releasing a series of hormones such as corticotropin-releasing hormone and norepinephrine. 32,33 Pleasant emotions induced by music further inhibit pain-related reflex responses of the spinal cord. 34 The magnitude and kind of response to music depend on several factors related to the individual’s characteristics, the type of music, and preferences for the music. According to previous studies, preferred music can play a role in the effectiveness of musical interventions. 35,36 For example in elders with dementia, preferred music can control agitated The views expressed are those of the authors and do not necessarily reflect the opinions or official policies of the Canadian Dental Association. Full article available at jcda.ca/h13 More Online Elham Emami PhD Nathalie Gosselin PhD Pierre Rainville PhD Robert Durand DMD,MSc,FRCD(C) elham.emami@ mcgill.ca The following is based on a Meeting Report article originally published on JCDA.ca —CDA’s online, open access scholarly publication that features articles indexed in Medline, Journal Citation Reports and Science Citation Index. Research Summary 37 Issue 7 | 2018 |