Music and medicine are deeply connected. But what kind of music should your surgeon really be listening to?

BY RAHUL PARIKH

iStockphoto/lisagagne/Salon

PopRX is a new weekly column about the intersection of pop culture and medicine.

In 1889 Nietzsche wrote, “Without music life would be a mistake.” As someone who regularly spends a chunk of change on Radiohead and Bright Eyes, I completely agree. I’m not the only doctor who finds nirvana in Nirvana. There’s a reason hospital dramas always feature surgeons listening to — and arguing about — music in the operating room. It’s because music and medicine are deeply connected.

The fascinating links go back as far back as ancient Greece. Apollo, the God of healing, was often depicted with a harplike instrument called a lyre. Some doctors have doubled as musicians. In the 1950s, a group of doctors at the Mayo Clinic started the Notochords (named after the primitive spine in a developing fetus), playing with Duke Ellington and Jack Benny. More recently, NPR ran a story about an orchestra of doctors from Albert Einstein Medical Center in New York.

Surgeons have a particularly profound relationship to music. As Siddhartha Mukherjee noted in his book “The Emperor of All Maladies,” music and medicine “go hand in hand. Both push manual skill to the limit; both mature with practice; both depend on immediacy, precision and opposable thumbs.” A 2008 study, in fact, tested whether musical prowess has any impact on performance during laparoscopic procedures (special scopes that surgeons use to perform minimally invasive procedures). Non-surgeons who had experience playing music performed better at suturing using this equipment than did non-musical participants. There’s perhaps no better example of the facility of the musician-surgeon than Theodor Billroth, a 19th century virtuoso who pioneered surgical techniques to dissect abdominal tumors from the body and whose talent on violin and piano forged a close friendship with Brahms.

But surgeons don’t have to play instruments to enjoy music in the operating room. It’s a regular, enjoyable part of the daily routine and one way a surgeon creates a comfortable atmosphere in a sometimes tense setting. Atul Gawande, contributor to the New Yorker and author of “The Checklist Manifesto,” operates to Modest Mouse, Arcade Fire, the Decemberists and other alternative bands. (He does own a Fender ’62 Stratocaster replica at home, but he says he’s rusty.)

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Salon.com The truth about music in the operating room 3/8/11 11:29 AM

So is operating to music a good idea? Lest you go into a panic the next time you hear Lady Gaga while they’re administering the laughing gas, the answer seems to be yes.

It’s a bit of a tricky thing to prove. It’s far from ethical to take a group of surgeons and measure their performance on and off music while they cut into real patients. But studies have offered some insight into the effects of music on surgical performance. One is from the Journal of the American Medical Association and dates back to the grunge rock era, 1994. In this study, researchers took 50 surgeons and measured blood pressure, heart rate and other physiological markers while they performed a series of subtraction problems. Each volunteer performed this task while listening to self-selected music and, later, music selected by the researchers (“Pachelbel’s Canon in D,” which is supposedly included in a lot of “stress reduction” musical compilations).

It turns out that when surgeons listened to music of their own choosing they had very steady vital signs and performed the subtraction task better than when they listened to Pachelbel. That’s encouraging, though it’s important to note that the surgeons who participated listened to music regularly both in and out of the operating room. So if you’re a surgeon and you think investing in an iPod will make you better with a scalpel and sutures, first ask yourself whether you care for music to begin with.

What about the rest of the operating room team? Anesthesiologists are, of course, indispensable to surgery. Does music help or hurt them? In a study out of the U.K., where 70 percent of anesthesiologists say they’ve been subjected to music in the operating theatre (as the Brits call it), 63 percent of those surveyed said that they enjoyed the sounds of music while they worked. Those in another survey who did not said it was because they felt music reduced their vigilance and impaired communication with other staff members. Not surprisingly, the most distracting tunes were ones they hated the most. On the other hand, another study contradicted any deleterious effect of music on anesthesiologists’ performance: That study measured psychomotor performance, and it didn’t change when subjects were listening to self-chosen music, Pachelbel, white noise or no music at all. Finally, surveys of other O.R. team members (nurses, techs, etc.) indicate that music enhances teamwork and communication among members, though, again, most of those surveyed listened to music regularly on their own time.

The next logical question to ask is: What kind of music should your surgeon be listening to while he or she closes your grapefruit of a hernia or bypasses your clogged coronaries? A study from 1976 suggested that rock (sorry, disco), with its varying rhythm and intensity was best. Other surveys have shown that the preferred genre in the operating room is classical, followed by folk, rock, jazz and blues. But, like the JAMA study I mentioned above, most studies hint that music’s positive effects have more do with the personal preference of the surgeon or the O.R. team than any particular genre of it.

A couple of last points: First, there is a body of evidence that music also helps patients going to surgery, including reducing anxiety before and after an operation; it may help patients cope better with pain, leading to their requiring less pain medicine. Finally, here’s an interesting B-side to this story: Take a listen to a 2001 album called “A Chance to Cut Is a Chance to Cure” by a San Francisco music group named Matmos. The two members of the group, Drew Daniel and Martin Schmidt, took their recording equipment to the hospital and sampled the sounds of surgery, creating electronica out of them. Highlights include “California Rhinoplasty” and “Lasik.” Let the sounds of cauterized flesh and dripping anesthetic be music to your ears.

– Rahul Parikh

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 More and more people are hearing about our Surgical Serenity Headphones and choosing to use them.  People remember reading about them and know  that they will use them if they are told that they need surgery.  That’s exactly what happened with a customer today and she  will be “practicing” with them over the next few weeks so that she automatically relaxes and calms down when she hears this particular music.

For people who don’t happen to live in Louisville, KY, they are readily available online!  Surgical Serenity Headphones are also being test and several key hospitals around the country and just this week I talked with two more hospitals about research and testing.  There are so many interesting studies that people people are devising for me; studies that look not only at the headphones ability to decrease the amount of pain medication, but also comparing our headphones to acupuncture, and another looking at whether people wearing our headphones and listening to our proprietary music perhaps leave the hospital sooner, thus getting back to their homes and lives sooner as well as allowing the hospital to see more patients.  Lots of good information to be gathered.

As a matter of fact, I’ve sold so many lately that my inventory is getting low so I’ll be ordering another 100 or so soon.  The price on the new ones may have to go up so if you want some, now would be an excellent time!  Surgical Serenity Headphones.

Nearly one-quarter of all Americans avoid dentists because they’re afraid, according to American Dental Association surveys. And the fear comes in many forms.

In an attempt to win back fearful patients, dentists like Dr. Eda Ellis in New York offer spa-like services. WSJ’s health columnist Melinda Beck reports.

There’s fear of pain, fear of needles, fear of drills, fear of blood, fear of gagging, fear of feeling helpless or having personal space violated, fear of being lectured for not brushing or flossing adequately and fear of being admonished for staying away so long.

“I even hate that sucky thing that vacuums up your saliva,” says Carolyn Moody, a Bridgewater, N.J., mother of three who avoided dentists for 10 years. Now she makes sure to bring her iPod. “As soon as I hear that drill, even from another room, my fists clench, my body stiffens and my heart starts pounding,” she adds.

Of course, delaying cleanings and checkups only compounds dental problems. Neglected plaque creates cavities; cavities can lead to root canals; root canals require crowns and eventually implants or dentures or worse, a mouthful of toothless gums. Some oral-health problems also send bacteria into the bloodstream, raising the risk of heart attack, diabetes and dementia.

Now, many dentists are taking pains to win frightened patients back. Some practices let patients virtually sleep through the procedure. Others focus on maximizing soothing distractions while minimizing pain as well as the typical sounds and smells of dentistry that can trigger unpleasant memories.

Dental schools are also paying more attention to communication skills. At New York University College of Dentistry, third-year students practice interviewing patients—played by actors—with a variety of dental problems and phobias.

“You can’t just say, ‘Open up—you have nothing to fear,’ ” says psychologist Hillary Broder, who teaches the course. “You have to establish a rapport and find out what makes them anxious and reassure them that that’s not going to happen.”

“There is usually something that triggers that phobia, like a bad experience when they were a child,” says David Hershkowitz, associate chairman of the school’s department of Cariology and Comprehensive Care. He tells students, “Once you know the trigger point, you can do away with the fear.”

To be sure, not all dentists want to treat anxious patients. “There’s a fair number of dentists who are more phobic of the phobic patients than the phobic patients are of dentistry. They’re difficult to work on and you can’t work at your normal pace says George Kivowitz who has dental practices in New York City and Newtown, Pa. But he finds that kindness and communication can go a long way toward calming patients. “I promise that if I see an area of decay, I don’t have to prove it to you by peeling you off the ceiling.”

Other dentists aren’t eager to work with anxious patients, others have built their practices around treating them. “I have some who go into a full-blown panic attack, shaking uncontrollably, when I merely look in their mouths with a mirror. That’s my flock,” says Manhattan dentist Louis Siegelman.

Feeling Groggy

For some such patients, being asleep or close to it may be the only way to endure dental procedures—even routine cleanings. “You have to meet the patients where they are,” says Dr. Siegelman.

The mildest and most common form of sedation, nitrous oxide—or “laughing gas”—has been used in dentistry since the frontier days and is still considered effective for reducing pain and relieving anxiety. About 35% of dentists offer it. But some patients can’t tolerate wearing a mask over their nose during the dental work, and in rare cases, it can make people more jittery and anxious instead of less.

Oral conscious sedation, in which patients take a tranquillizer such as Halcion or Versed before the visit, puts them into a relaxed and sleepy state although they can still respond to the dentist’s commands. Patients may have little memory of the dental work, but are so groggy they must be accompanied to and from the dentist’s office.

Intravenous sedation gives patients an even greater feeling of being “out,” and can be very useful for extensive gum or implant surgery. It also works quickly and can be increased or counteracted quickly, if necessary. But it does require a needle. The patient’s heart rate, blood pressure and oxygen intake must be monitored in case of cardiac arrest or other problems. And the dentist needs additional training and certification as well as higher malpractice insurance to cover the added risk. General anesthesia, in which the patient is unconscious and unable to respond to commands, is mainly used for oral surgery. That requires even more specialized training.

Costs of sedation, which range from about $50 for nitrous oxide to $350 for IV drugs, are rarely covered by insurance. But some dentists throw it in for free if a patient is having extensive work. Anxious patients often need considerable dental repairs, particularly if they’ve been fugitives from dentistry for years, and many opt to have it all done at once while they are under sedation.

Minimizing Pain

New techniques and tools have made many aspects of dentistry less off-putting than they used to be.

Some dentists and hygienists offer lidocaine spray, gel or patches to numb patients’ teeth and gums even for routine cleanings. Many also wear magnifying loupes that allow them to give patients more personal space. “We can stand about 18 inches away now, rather than six or 12 inches,” says Dr. Hershkowitz.

Electric drills are quieter than older models that were driven by compressed air. In some cases, ultra-quiet lasers can be used instead of drills, but they have many limitations and don’t eliminate the need for anesthesia.

Devices that emit low-dose electrical pulses to block pain pathways right through the skin can be used in place of anesthesia for some procedures.

Unfortunately for the needle phobic, much dental work still requires an injection of local anesthetic—but there, too, there are innovations. For one thing, dental needles used to be sterilized and re-used, getting blunter and more painful to inject each time. Now, needles are used only once.

Numbing gel can also minimize the pain of the stick, but what hurts most about dental injections is the pressure of 1.7 milliliters of fluid pushing into dense tissue. One computerized device called The Wand controls the flow, volume and pressure of the injection and looks more like a pen than a needle. Dr. Kivowitz says that manually delivering an injection very slowly can minimize pain just as well. “Do they ever love it? No,” he says. “But if they understand what you’re doing, it helps a lot.”

He also notes that many anesthetics contain adrenaline, which makes them last longer but can send a patient’s heart racing and trigger panic attacks. It pays to warn patients of the possibility in advance, he says: “Any unexpected thing that happens in the chair just adds to the phobia.”

Maximizing Distractions

Taking a cue from pediatric practices, some dentists offer an array of entertainment options to keep patients’ minds off the drilling and filling, from flat-screen TVs to headphones to virtual-reality goggles for watching 3-D movies.

Some also boast spa-like comforts, such as massaging chairs, warm neck rolls, paraffin wax treatments for hands and reflexology, the traditional Chinese foot massage.

“Mondays and Wednesdays are ‘spa-days.’ We’re very busy then,” says dentist Eda Ellis at Central Park Dental Spa in New York, which also has a waterfall and aromatherapy candles in the waiting room. “Patients love it. THey say, ‘Wait, it’s over so fast?’ ” she says.

What can patients do themselves to alleviate their anxiety? Bring your own distractions—a riveting book, a music player full of transporting tunes or favorite movies if your dentist is equipped to play them.

“Some of my patients have done yoga and they are somewhere else in their minds while I’m working,” says Dr. Hershkowitz who has a private practice in Stony Brook, N.Y.

Behavioral psychotherapists can teach ways to overcome anxiety. Some people find that hypnosis helps them relax, and some hypnotherapists can provide sessions by phone before dental visits.

Don’t try to self-medicate. Drinking alcohol before a dental visit is an especially bad idea. An over-the-counter pain reliever may take the edge off pain, but some forms increase bleeding. Be sure to tell the dentist about any medications you are taking.

Tell the dentist and the staff about your fears. And shop around until you find a practice that is empathetic.

In the meantime, take very good care of your teeth and gums. The healthier they are, the more pleasant every dental visit will be.

—Take a video visit to a New York dental spa, at WSJ.com/Health.

Write to Melinda Beck at HealthJournal@wsj.com

J Oral Maxillofac Surg. 2010 Aug 11. [Epub ahead of print]

Musical Intervention Reduces Patients’ Anxiety in Surgical Extraction of an Impacted Mandibular Third Molar.

Kyoung Kim Y, Kim SM, Myoung H.

Primary Researcher.

PMID: 20708320 [PubMed - as supplied by publisher]

This post appeared recently on another blog (http://ordinarilyuninteresting.blogspot.com/2010/02/its-business-time.html) and pertained so specifically to music with dental surgery, I thought that my readers might enjoy reading it:  “I had to get up early–0500h–in order to travel to the Big City and get a tooth implant. For those of you who don’t know, a tooth implant is a titanium screw that is placed in the jawbone as an anchor for a permanent tooth approx four months after the implant is embedded. It is the best solution for those looking to replace a missing tooth, the other options being a bridge or no treatment. Bridges are usually fine and have been used for decades, are usually lower cost, but the downside is that you have to ruin two perfectly good teeth in order to install a bridge.

So I didn’t go with the bridge, because I am a relatively young guy and I don’t want to give up two more teeth–bridges can result in root canals in a long-term run–and my doctor recommended the implant. He’s a nice guy, great with oral surgery. Did my wisdom teeth (third molars). The only problem I had with the implant was that I needed some bone grafting done in order to anchor the implant firmly. These days they grow bone tissue in test tubes, so I didn’t not have to give up any of my bone for the procedure.

I was a bit scared at first, because I remember when I had my wisdom teeth removed. I had all four teeth growing in, two of them impacted, so I had to have two of them pulled and two of them cut out. It wasn’t pretty. I remember waking up after the surgery int he recovery room thinking I was at some kind of party or social event at which I had imbibed too much alcohol. The feeling after being aroused from the anesthesia is remarkably like being intoxicated. The nurses had a hard time getting me to lay back down. I then spent the next two weeks recovering from my procedure, spending lots of time with my mouth open over the toilet as blood and ooze drained from my cavities, suffering pain unimaginable when my codeine ran out or I had to eat–I remember lots of chocolate malts. What a way to spend spring break.

So this time I was a bit unnerved about the whole ordeal. Getting my mouth opened up and having some bone and titanium implanted into my jaw didn’t sound like a lot of fun. So I get to the Big City and get into the office and they talk me through the thing and let me choose my anesthesia and I’m looking around at all the tools and stuff laying around the small operating area and I want to ask lots of questions–not out of worry, but curiosity. I don’t ask those questions, though, because I’d rather these nurses concentrate on making everything go smoothly as possible. I wake up about two and a half hours later in the recovery room, this time completely ready for the wave of intoxication to wash over me. There is is. I lay back down, knowing that I got little enough sleep the night before and that I’ve got time here, and now, to get more rest without feeling guilty. I just had a major operation done. So I lay back down, listen to the girl crying next to me–her first time, I assume–and just let the anesthesia work its magic.

My mom drives me home after that; I’m not allowed with all the drugs in my system. I brought my mp3 player and listened to soothing music to facilitate more rest, in case the pain kicked in early. Last time we didn’t have any drugs and I was in howling torture by the time we got home. Not this time. They gave me some really great pain killing stuff at the hospital. Injected it directly into my mouth.

And I sleep most of the rest of the day, nearly completely pain free. Yesterday I went out to a client’s house and hooked up her computer and configured the printer with no problems. I slept early last night and woke up in some pain, but I took ibuprofen for comfort, no Darvocet. “  Whenever you can manage dental pain with a little ibuprofen and no narcotics, THAT’S a successful music-amplified anesthesia!  Get you headphones here:  www.surgicalheadphones.com. 

Tomorrow I’m traveling to Versailles, KY to speak to a group of 25-30 dentists about our Surgical Serenity Headphones and their value in dentistry! Ever since the headphones went on the market last March (www.surgicalheadphones.com) people have been saying “Oh, those would be great in a dentist’s office!”

Yes, the dentist chair is one of the most un-favorite places to find oneself. In dentistry, the headphones would serve multiple purposes. In addition to the relaxation effect that invariably is elicited, there’s also the fact that having on headphones will block and muffle the sound of the drill, one of the most unpleasant parts of the dental procedure.

As with so many procedures, just knowing that you have multiple choices for pain management is a huge plus, and with music, there’s no novocaine numbness to wear off and no gases or narcotics to put into your bloodstream!

The benefits far outweigh the disadvantages, which are………..none!