Discussion
Pain, anxiety, pain
The results of this randomized controlled trial suggest that perioperative music listening is associated with significant reduction in anxiety and pain catastrophizing following elective cesarean delivery. There was good to excellent satisfaction and positive feedback with perioperative music listening.Our finding that parturients who received music listening had significantly reduced postoperative anxiety is consistent with the results of two meta-analyses studying music listening during cesarean delivery [To our knowledge, this is the first study that showed that perioperative music listening was associated with significant reduction in pain catastrophizing including the total scores and all sub-scores on magnification, rumination and helplessness. Pain catastrophizing is characterized by the tendency to magnify the threat, feeling of helplessness, combined with inability to avoid negative thoughts in the context of anticipated or actual pain [Despite the significant reduction in pain catastrophizing, music listening was not associated with significant reduction in acute pain scores. This finding differed from a meta-analysis conducted by Masoud et al., which showed reduced postoperative pain with exposure to music listening [Based on the high satisfaction scores and positive feedback obtained in this study, music listening was well accepted amongst the parturients. This may have been enhanced by allowing parturients to choose their music. Of interest, the diverse genres of music selected by the parturients suggest that a standardized playlist or music selected by a therapist may be limited; patient choice could be more important. Though this could be challenging in previous studies, allowing parturients to select their own music is presently feasible given the availability of streaming services providing an encompassing library of music genres. Allowing parturients the freedom to choose their own music also upholds the principle of patient autonomy and can be empowering.We acknowledge several limitations to this study. First, we did not continue with longer follow-up and hence did not collect data on persistent pain to determine if the beneficial effects of perioperative music listening persisted, as we believe that exposure to other factors in the ward environment may influence the parturients’ anxiety and pain, hence confounding the results. Second, we only included parturients who were healthy, had no significant co-morbidities, and who were undergoing elective cesarean delivery. Those with significant co-morbidities and undergoing emergency cesarean delivery may experience higher levels of anxiety, perhaps due to the additional uncertainties about their overall outcome. Therefore, our study results may not be generalizable to all obstetric populations. Future studies should examine the efficacy of perioperative music listening on pain and anxiety on these specific obstetric groups.