Kratki znanstveni prispevek ◆ Short Scientific Article https://doi.org/10.26493/2712-3987.19(39)127-142 THE EFFECTS OF MUSIC LISTENING ON PAIN PERCEPTION AND COPING WITH BREAST CANCER Vpliv poslušanja glasbe na zaznavanje bolečine in spoprijemanje z rakom dojke Brigita Vilč University of Zagreb, Faculty of Education and Rehabilitation Sciences brigita.vilc@erf.unizg.hr Renata Martinec University of Zagreb, Faculty of Education and Rehabilitation Sciences renata.martinec@erf.unizg.hr Damir Miholić University of Zagreb, Faculty of Education and Rehabilitation Sciences damir.miholic@erf.unizg.hr Abstract: In patients with breast cancer, pain is often a significant factor that can deter- mine the success of coping with the disease and overall quality of life. For this reason, in addition to analgesics, the use of various complementary approaches is also recom- mended, of which music listening can reduce the perception of pain. On this basis, this study aimed to assess the influence of music listening in a clinical setting on music expe- rience, pain perception and, therefore, daily functioning during the postoperative peri- od in breast cancer patients. For the evaluation, a qualitative thematic analysis was con- ducted using a semi-structured interview. The results show that music listening evokes positive emotions, relieves physical pain, improves daily functioning during hospitaliza- tion and facilitates coping with the diagnosis of breast cancer. It can be concluded that music is easily applicable in the clinical setting without harmful consequences and that it can serve as a distraction medium from feelings of pain to feelings of pleasure and sat- isfaction. Keywords: breast cancer, postoperative pain, music listening, coping with disease Izvleček: Pri bolnicah z rakom dojke je bolečina pogosto pomemben dejavnik, ki lah- ko vpliva na uspešnost spoprijemanja z boleznijo in splošno kakovost življenja. Zato se poleg analgetikov priporoča tudi uporaba različnih komplementarnih pristopov, med katerimi lahko poslušanje glasbe zmanjša zaznavanje bolečine. Na teh osnovah je za- snovana raziskava z namenom ocenitve vpliva poslušanja glasbe v kliničnem okolju na doživljanje glasbe, zaznavanje bolečine in s tem na vsakodnevno delovanje v pooperativ- nem obdobju pri bolnicah z rakom dojke. Za evalvacijo je bila izvedena kvalitativna te- matska analiza z uporabo polstrukturiranega intervjuja. Rezultati kažejo, da poslušanje glasbe vzbuja pozitivna čustva, lajša fizično bolečino, izboljšuje vsakodnevno delovanje © Authors g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 128 med hospitalizacijo in olajša spoprijemanje z diagnozo rak dojke. Zaključimo lahko, da lahko glasbo brez težav uporabljamo v kliničnem okolju brez škodljivih posledic in da lahko služi kot sredstvo za preusmerjanje pozornosti od občutkov bolečine k občutkom ugodja in zadovoljstva. Ključne besede: rak dojke, pooperativna bolečina, poslušanje glasbe, soočanje z boleznijo INTRODUCTION Breast cancer in its early stages typically manifests as a lump in the breast or axilla and may be accompanied by other symptoms, such as the appearance of bloody discharge from the breast, inverted nipples, changes in the skin of the breast (e.g. ulcerations), inflammatory processes in the breast and more (Šamija et al., 2006). Due to the complex symptomatology and symbolic re- presentation of the breast, women affected by breast cancer may experience problems with physical functioning, identity crises related to the need to re- define their gender/sexual role, misunderstandings in relationships and redu- ced ability to work. For these reasons, according to the results of some studi- es, women with breast cancer are more likely to experience depression, anxiety, shame, anger, body image disturbances and other unwanted psycho-emotio- nal reactions that disrupt physical, psychological, and social balance and, con- sequently, their quality of life (Martinec, 2013; Michael et al., 2000; Bjerkeset et al., 2020). In addition, the duration and intensity of pain are significant fa- ctors that can influence the success of coping with the diagnosis, therapy, and psychological distress (Dupoiron et al., 2022). Unfortunately, according to the results of various studies, 41 percent to 74 percent of individuals with breast cancer suffer from chronic pain (Gärtner et al., 2009; Ilhan et al., 2017; Ha- mood et al., 2018). Pain can be caused by tumour infiltration into the tissue, the spread of metastases into the surrounding tissue and as a result of therape- utic procedures such as surgery, chemotherapy, or radiotherapy (Majerić Ko- gler et al., 2011). The International Association for the Study of Pain (2020) defines pain as ‘an unpleasant sensory and emotional experience associated with or resem- bling that associated with actual or potential tissue damage’. The World He- alth Organization (2018) has developed guidelines for pain management, sta- ting that effective pain management is possible for 70–90 percent of persons with malignant disease. However, data shows that this is only the case for 40 percent of people affected. If there is no tendency to reduce postoperative pain, this may lead to increased morbidity and mortality as well as higher treatment costs (Apfelbaum et al., 2003). Table 1 contains a classification of pain according to the mechanism of its occurrence and duration. Pain is divided into acute and chronic pain accor- Brig ita V ilč , Ren ata M a rtin ec , D a m ir M ih o lić ◆ TH E EFFEC TS O F M U SIC LISTEN IN G O N PA IN PERC EPTIO N A N D C O PIN G W ITH BREA ST C A N C ER 129 ding to its duration. Acute pain is a ‘physiological reaction to chemical, ther- mal or mechanical stimuli caused by surgery, injury or acute illness’ (Majerić Kogler et al., 2011). The duration of acute pain is limited to the healing peri- od. According to Sapunar and Puljak (2011), acute pain serves an ‘adaptive-pro- tective function by making the injured or inflamed area and the surrounding tissue hypersensitive to all types of stimuli and avoiding any external influen- ce’. Chronic pain has no protective character and is the result of a persistent pathological disorder. Pain is considered chronic if it persists for 3–6 months after healing. The causes of chronic pain can lie in damage to the central or peripheral nervous system or in pathological processes within the structures of the body. From a pathophysiological point of view, a distinction can be made between organic and psychogenic pain. Organic pain is differentiated according to its cause, including nociceptive somatic and visceral pain and neuropathic pain. Nociceptive pain is caused by the activation of pain receptors, known as noci- ceptors. Nociceptors are membrane proteins located in the skin, muscles, jo- ints, and visceral organs and are triggered by stimuli that threaten the body’s homeostasis. When peripheral nociceptors stimulate joints, muscles, bones, and connective tissue, this is referred to as nociceptive somatic pain. When in- ternal organs are injured, this is referred to as nociceptive visceral pain. Neuro- pathic pain can occur due to mechanical injuries, viral infections, chemothe- rapy, metabolic disorders, and autoimmune diseases (Sapunar & Puljak, 2011). Psychogenic pain, on the other hand, has no organic cause (Majerić Kogler et al., 2011). In psychogenic pain, there is no objective tissue damage, but it arises due to psychological factors or affective states. Table 1 Classification of Pain (Majerić Kogler et al., 2011) Mechanism of Onset Organic Pain Nociceptive Pain • Somatic Pain• Visceral Pain Neuropathic Pain • Central Neuropathic Pain • Peripheral Neuropathic Pain Psychogenic Pain Duration Acute Pain Chronic Pain • Chronic Malignant Pain• Chronic Non-Malignant Pain g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 130 Acute postoperative pain is felt by individuals directly after surgery and can last up to 7 days (Kvolik & Ikić, 2011). If it lasts longer than three months, the acute postoperative pain turns into a chronic condition. Zemba et al. (2001) explain the effects of surgical procedures on the occurrence of pain and attri- bute it to tissue damage – nociceptive pain as well as inflammatory pain, whi- ch is the result of tissue inflammation in the surgical area. According to Ma- jerić Kogler (2014), successful treatment of postoperative pain must take into account ‘individual differences in the subjective experience of pain intensity during the same surgical procedures’, which means that psychological states, the presence of fear, the anticipation of painful conditions, and the occurren- ce of depression and anxiety can negatively influence the intensity and durati- on of pain. Therefore, the subjectivity of pain perception can change the actu- al intensity of pain experienced. Successful postoperative treatment requires a multidisciplinary approach that includes pharmacological and complementa- ry non-pharmacological treatment methods (Jukić, 2011). Multimodal balanced analgesia is nowadays a significant approach in the treatment of acute postoperative pain. It involves using pharmaceutics with different mechanisms of action to achieve a stronger analgesic effect with fewer side effects. For example, non-opioid and opioid analgesics are combi- ned (Cousins & Power, 2003). Possible routes of administration include oral, intravenous, spinal, transdermal, and epidural administration of drugs. Pain relief is influenced not only by physiological aspects of the body, but also by distraction from pain, relaxation, and suggestion (Prstačić et al., 1992; Mel- zack, 2003). On this basis, the modern treatment and rehabilitation paradigm for oncology patients includes holistic and multidisciplinary approaches to pain management, primarily using complementary therapies (Fingler, 2011). For example, current research suggests that therapies such as music therapy, progressive muscle relaxation, acupuncture, reflexology, massage, aromathe- rapy, meditation, guided imagery, mindfulness, neuromuscular taping, etc. can be effective in reducing and controlling pain, as well as reducing stress and improving well-being in breast cancer patients (Tola et al., 2021; Hikmat et al., 2022). MUSIC THERAPY AND THE BENEFITS OF MUSIC IN ONCOLOGICAL SETTINGS Music is a synergy of rhythm, melody, harmony, tempo, form, style, and colour. Music allows each person to find a subjective, intuitive, and non-verbal experi- ence, memories, and mental images. The American Music Therapy Associati- on (2005) defines music therapy as a formal branch of health care that uses the medium of music to positively impact the physical, emotional, cognitive, and social aspects of individuals of all ages. In addition, music therapy interventi- Brig ita V ilč , Ren ata M a rtin ec , D a m ir M ih o lić ◆ TH E EFFEC TS O F M U SIC LISTEN IN G O N PA IN PERC EPTIO N A N D C O PIN G W ITH BREA ST C A N C ER 131 ons contribute to overall well-being, stress management, pain relief, expressi- on of feelings, improved cognition and memory, and improved communicati- on. Music therapy can be used in both active and receptive forms, as active or receptive music therapy. Active music therapy includes playing musical instruments, singing, im- provisation, composing, and other techniques in which the music therapist uses various methods to address individual needs through musical performan- ce. Receptive music therapy includes listening to live or recorded music under the supervision of a music therapist (van der Heijden et al., 2015), listening to music during relaxation, and listening to music during guided imagery (Stark, 2012). Listening to music encompasses a wide range of variations, including: (a) somatic listening, in which music, vibrations, and sounds are used to directly affect the client’s body; (b) listening to support analgesic effects, where music is used to support the action of analgesics, reduce or control pain, and decrease pain-related anxiety; (c) listening for body relaxation, in which music is used to relax the body and reduce stress and psychophysical tension; and (d) listening to evoke memories, where music is used to trigger memories of past events and life experiences in clients (Bruscia, 2014). According to Matsota et al. (2013), music can reduce anxiety and discom- fort, promote a positive attitude towards hospitalization, and serve as a distra- ction from hospital sounds. The role of music therapy in the preoperative pha- se helps to reduce anxiety, fear, and stress. The authors van der Heijden et al. (2015) conducted a meta-analysis of research on the effects of music therapy in the perioperative period in paediatric surgery patients. They concluded that music therapy reduces pain, anxiety and stress in children undergoing surge- ry, highlighting the non-invasiveness of music therapy as a significant benefit. The contribution of music therapy for post-operative pain is to reduce the side effects caused by post-operative pain and increase the functionality of the indi- vidual after surgery. The long-term benefits of music therapy as a complemen- tary intervention are reduced medication use, lower treatment costs, improved mood, faster recovery, and greater satisfaction with medical care during hospi- talization (Matsota et al., 2013; Poulsen et al., 2019). Binns-Turner et al. (2011) conducted a study on the effects of music the- rapy in the perioperative period on anxiety, hemodynamic profile (heart rate and blood pressure) and pain in women undergoing mastectomy. The study included 30 participants, who were divided into an experimental and a con- trol group. The participants in the experimental group listened to music via music playback devices and headphones before, during and immediately af- ter the surgery. In contrast, the participants in the control group did not lis- ten to music and received the usual medical care. The music selected for liste- ning was chosen by the researchers and categorized into four different genres with a total duration of 4 hours. The results of the study showed that variables such as blood pressure, anxiety and pain were statistically significantly redu- g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 132 ced in the participants who listened to music compared to those in the con- trol group. Although there was a difference in heart rate, this was not statisti- cally significant. Li et al. (2011) investigated the impact of music therapy on anxiety in a sample of 120 women who had undergone radical mastectomy. The music was played through music playback devices and headphones. The researchers crea- ted a music database from which the participants could select music according to their preferences. From the first day after surgery until the third hospitali- zation for chemotherapy, music was listened to twice a day for 30 minutes, in the morning and in the evening. The research results showed a statistically sig- nificant reduction in anxiety in the experimental group compared to the con- trol group. Receptive music therapy can also be used in other treatments as part of conventional medical care and rehabilitation. For example, Prstačić et al. (1992) examined the effects of multi-convergent therapy on pain reduction during kinesiotherapy exercises in women who had undergone a mastectomy. The study included 4 participants aged between 40 and 55 years, and Beetho- ven’s Moonlight Sonata was used as the musical template with kinesiotherapy exercises. The therapeutic programme was conducted at five time points, each lasting 20 minutes (10 minutes without music and 10 minutes with music). The visual analogue self-assessment scale for pain (VAS) was used as the assessment tool, and the comparative results indicated a reduction in pain in each parti- cipant after performing the kinesiotherapy exercises with music. The authors of the study highlighted the benefit of using music under these conditions in terms of motivating and energizing the participants involved in the research. Köhler et al. (2020) conducted systematic review and meta-analysis of 30 stu- dies and pointed out that music therapy overall had positive effects on a bro- ad range of outcomes in cancer patients and can therefore be offered in vario- us treatment phases. Based on the previous results and a review of recent research, it can be concluded that music therapy is most used to relieve stress and anxiety, reli- eve pain, alleviate depression and helplessness, and improve immune functi- on. Due to its effects on psychophysiological states and pain management, mu- sic therapy is also recognized as a complementary, evidence-based method for breast cancer patients that can be combined with other medical treatments or other complementary interventions (Babikian et al., 2013; Lyman et al., 2018; Kievisiene et al., 2020; Sun et al., 2023). AIM OF THE STUDY The quality of life of breast cancer patients depends on many different factors, of which the duration and intensity of pain are significant factors that can de- termine the success of coping with the diagnosis, therapy, and psychological Brig ita V ilč , Ren ata M a rtin ec , D a m ir M ih o lić ◆ TH E EFFEC TS O F M U SIC LISTEN IN G O N PA IN PERC EPTIO N A N D C O PIN G W ITH BREA ST C A N C ER 133 distress. It has been shown that, in addition to analgesics, various non-phar- macological complementary therapies – such as receptive music therapy – can help to reduce pain perception and consequently improve the physical, psycho- social, and behavioural dimensions of those affected. On this basis, this study aimed to assess the influence of music listening on music experience, pain perception and daily functioning during the posto- perative period in breast cancer patients. METHODS In this study, thematic realistic analysis was used as a form of qualitative the- matic analysis to gain insights into participants’ experiences, meanings, feelin- gs, and interpretations of reality (Braun & Clarke, 2006). In addition, latent thematic analysis was used to understand participants’ statements and what shapes their thoughts, attitudes, and emotions. In this approach, data are col- lected based on observations and noting down participants’ statements during interactions with the interviewers (Čorkalo Biruški, 2015), followed by the fol- lowing steps: (1) familiarising with data, (2) generating initial codes, (3) sear- ching for themes, (4) reviewing themes, (5) defining and naming themes, and (6) producing the report (Braun & Clarke, 2006). SAMPLE The study was conducted on a sample of 32 participants aged between 29 and 83 years with localized malignant processes in the breast and axilla. The parti- cipants were included in the music listening programme after surgery during the entire hospitalization (which on average lasted 3-5 days). STUDY DESIGN In this study a qualitative research methodology was used which included the following: – defining the problem areas, objectives, and research questions, – creation of an information brochure for participation (Calls for Participa- tion in the Research), – creation of a Researcher-Participant Agreement to obtain consent from participants to take part in the research and to ensure compliance with et- hical guidelines, – planning how the researchers would record their observations, g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 134 – designing questions for semi-structured interviews and planning schedule and locations for conducting the research. The protocol for using the music listening programme involved selecting music by each participant according to their preferences that was done the day before surgery (the most frequently selected music was the local pop music ge- nre). The music was played through music playback devices and headphones twice a day for 30 minutes in the morning and in the evening on each day of hospitalization, except on the first postoperative day, when music listening was only possible once in the evening due to the duration and sequence of surgical procedures in the morning. If the participants wanted to, they could listen to music for longer than the recommended time. None of the participants expres- sed their reluctance to listen to music during the research. The participants lis- tened to the music while lying in bed. RESEARCH QUESTIONS For the evaluation, a qualitative thematic analysis was conducted by using a se- mi-structured interview that included three research questions: – How do the participants experience music, and what meaning does it have for them? – How do the participants describe the contribution of music to their pain management? – What changes in their daily functioning do participants notice after mu- sic listening? DATA COLLECTION As the method of data collection, a semi-structured interview was used, whi- ch included pre-defined questions but also provided the opportunity to ask ad- ditional questions if they were deemed relevant based on the participants’ pre- vious statements. The questions of the semi-structured interview were defined in accordance with the research questions and categorized into the following areas: the experience and meaning of music during hospitalization and in da- ily life, the impact of music on pain perception and relief, and changes in daily functioning during hospitalization. The duration of the interviews varied de- pending on the willingness of participants to share their experiences and tho- ughts and generally lasted 25–30 minutes, although some interviews lasted up to 45 minutes for certain participants. The interviews were conducted on the last day of hospitalization. Brig ita V ilč , Ren ata M a rtin ec , D a m ir M ih o lić ◆ TH E EFFEC TS O F M U SIC LISTEN IN G O N PA IN PERC EPTIO N A N D C O PIN G W ITH BREA ST C A N C ER 135 RESULTS AND DISCUSSION The results of the qualitative thematic analysis of the data related to the defi- ned research questions are presented in Tables 2, 3, and 4. Table 2 Results related to the research question ‘How do the participants experience music, and what meaning does it have for them?’ CATEGORY: EXPERIENCE AND MEANING OF MUSIC Themes Codes Reflections Contribution of music in daily life Positive emotions induced by music • Love • Beauty • Calmness • Relaxation • Fulfilment • Freedom • Comfort • Enlightenment • Joy • a unique world • a world where everything else disappears • a world where a person can find themselves • a nicer place • an oasis of peace Facilitating everyday activities • Household chores • Leisure time Contribution of music during hospitalization Intensifying positive emo- tions • Love • Joy • Excitement • Satisfaction • Strength • Hope • Comfort Eliciting memories • Recalling close living and deceased family members, as well as their youth and time spent with friends Emotions induced during music listening • Tears • Tears of joy • Relaxation • Calmness • Mood • Enlightenment • Enjoyment • Caring from another person • Immersion • Elevation • Against feelings of sorrow and abandonment • Against depressive states • Reducing the fear of pain Experiencing the power of music • Immersing in music • Losing oneself in music • Creating a unique world with music • Surrendering to music • Journeys to better places through music • Music transports to another time • Music as a means of self-absorption • Music as a piece of the past and a piece of the future • Music as a medium of self-dedication – ’something we have all forgotten’ g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 136 Table 3 Results related to the research question ‘How do the participants describe the contribution of music to their pain management? CATEGORY: MUSIC LISTENING AND PAIN MANAGEMENT Themes Codes Reflections Pain perception Contribution of music to coping with physical pain • Reduction of continuous pain through music • A distraction from pain • Secondary importance of pain with music • Shifting focus from physical pain to music • Shifting focus from physical discomfort to a sense of pleasure • Engagement with music • Concentration on music Table 4 Results related to the research question ‘What changes in their daily functioning do participants notice after music listening?’ CATEGORY: MUSIC LISTENING AND DAILY FUNCTIONING Themes Codes Reflections Contribution of music to coping with pain and functioning during hospita- lization Self-perception during hospita- lization • Relief from postoperative pain during physical activities while listening to music (e.g. more comfortable lying in bed) • Music as a sedative, lullaby, aids in falling asleep • Enhancing the comfort of hospitalization Coping with a breast cancer diagnosis • Music as a motivator to fight the disease • The contribution of music to the subconscious and subconscious tension caused by the diagnosis • Shifting focus from illness • Shifting focus from breast ablation The obtained results show a wide range of subthemes and reflections re- lated to the participants’ evaluation of the experience and meaning of music. These include recognizing and becoming aware of positive emotions triggered by music in everyday life and during hospitalization, facilitating everyday ac- tivities, intensifying positive emotions, evoking memories, and using the pow- er of music to stimulate imaginative and meditative processes that allow dis- traction from thoughts of illness and reality to imagining and finding one’s own pleasant place. The positive emotions triggered by personally chosen mu- sic were confirmed by the following associations: love, beauty, calmness, relax- ation, fulfilment, enjoyment, freedom, comfort, spirituality, joy, mood, emotion, an oasis of peace, a unique world, a world where everything else disappears, a world where a person can find themselves, creating a unique world through mu- sic, a nicer place, etc. Brig ita V ilč , Ren ata M a rtin ec , D a m ir M ih o lić ◆ TH E EFFEC TS O F M U SIC LISTEN IN G O N PA IN PERC EPTIO N A N D C O PIN G W ITH BREA ST C A N C ER 137 The positive influence of music on reducing pain perception and coping with painful stimuli was also emphasized. The ability of music to captivate and draw attention to itself distracts from pain and shifts the focus from dis- comfort to the feeling of joy and satisfaction due to positive emotions, sooth- ing images and meditative states evoked by free associations, negating possible limitations and the hopelessness of reality. This emphasizes the power of mu- sic as it enables a transition from negative physical experiences into the realm of daydreaming and transcendence. Participants reported how music relaxed, calmed, uplifted, comforted, and elevated them. In addition, with music as a guide, they combated depressive states, feelings of sadness and abandonment, and expressed less fear of pain. The contribution of music to improving daily functioning was particular- ly evident in self-perception and reactive daily activities during hospitalization. For example, participants reported sleep problems and how they independent- ly used music as a tool for falling asleep, using it as a lullaby or sedative. Some participants noted that the music improved their physical condition, e.g. that the discomfort of lying in bed disappeared when listening to music. Most par- ticipants recognized music listening as a factor that made hospitalization more comfortable by making hospital conditions more acceptable, facilitating adjust- ment to hospital routines, and making daily functioning more successful with less effort. For most participants, daily functioning also includes worries about the diagnosis, pain, possible consequences of the illness, possible complications, duration and type of treatment and the future. These worries can undoubt- edly exacerbate existing psychological distress. According to the participants, the music gave them the opportunity to think about new ways of coping with the diagnosis. For some, it acted as a stimulus to fight against the disease, shift- ing their focus from illness to comfort and from the impact of breast ablation. One participant also highlighted the positive impact of music in relieving the uncon- scious tension caused by the diagnosis. When asked ‘What would you like to highlight as important that we did not discuss during the interview?’, participants mentioned the following: sup- porting music selection based on individual preference; suggesting that music lis- tening should last longer than recommended; recommending integration of music listening with conventional medical therapies after surgical procedures; express- ing satisfaction with participation in research; and expressing a desire to find mu- sic-induced peace in a home environment. In relation to the last point, it is worth mentioning a recent study that showed that even home-based music interven- tions can have a lasting effect (up to 24 weeks) not only on pain intensity, but also on physical and emotional fatigue, as well as strength and vitality (Hsieh et al., 2019). The effectiveness of receptive music therapy as a complementary method to other medical interventions has been confirmed in various studies, which g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 138 have found that it can reduce pain, stress, and anxiety (Gramaglia et al., 2019) or reduce the emotional distress associated with pain, anaesthesia and opioid use (Deng, 2018). Given the meditative, imaginative, and transcendent nature of music, additional benefits can be achieved when combined with other com- plementary approaches such as guided imagery, meditation, progressive muscle relaxation, massage, aromatherapy and more. This approach can be described as a holistic body-mind practice, like a necessary part of a multidisciplinary approach to improving the quality of life in breast cancer patients. Conclusion Evaluation of the use of music listening in the clinical setting has provided new insights into its applicability in individuals with breast cancer. The results suggest that music listening may be a valuable adjunct to conventional medi- cal and pain-relieving therapies in the treatment of breast cancer. Music has been shown to evoke positive emotions, relieve physical pain, improve daily functioning during hospitalization and make coping with a breast cancer dia- gnosis easier. Immersion in music has resulted in physical pain being forgotten by shifting the focus of thoughts from physical pain to music and from physi- cal discomfort to a sense of pleasure and comfort. The importance of choosing music according to personal preference was recognized, and many participants expressed satisfaction with their participation in the study and recommended that music listening in clinical settings should be incorporated alongside con- ventional medical treatments following surgical procedures. References American Music Therapy Association. (2005). What is music therapy? https://www.musictherapy.org/about/musictherapy/ Apfelbaum, J. L., Chen, C., Mehta, S. S., & Gan, T. J. (2003). Postoperative pain experience: Results from a national survey suggest postoperative pain continues to be undermanaged. Anesthesia & Analgesia, 97(2), 534– 540. Babikian, T., Zeltzer, L., Tachdjian, V., Henry, L., Javanfard, E., Goodarzi, M., & Tachdjian, R. (2013). Music as medicine: A review and historical perspective. Alternative and Complementary Therapies, 19(5), 251–254. Binns-Turner, P. G., Wilson, L. L., Pryor, E. R., Boyd, G. L., & Prickett, C. A. (2011). Perioperative music and its effects on anxiety hemodynamics, and pain in women undergoing mastectomy. AANA Journal, 79(4 Suppl), S21–27. Brig ita V ilč , Ren ata M a rtin ec , D a m ir M ih o lić ◆ TH E EFFEC TS O F M U SIC LISTEN IN G O N PA IN PERC EPTIO N A N D C O PIN G W ITH BREA ST C A N C ER 139 Bjerkeset, E., Röhrl, K., & Schou-Bredal, I. (2020). Symptom cluster of pain, fatigue, and psychological distress in breast cancer survivors: Prevalence and characteristics. Breast Cancer Research and Treatment, 180(1), 63–71. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3(2), 77–101. Bruscia, K. E. (2014). Defining music therapy (3rd ed.). Barcelona Publishers. Čorkalo Biruški, D. (2015). Etički izazovi kvalitativnih istraživanja u zajednici: od planiranja do istraživačkog izvještaja. Annual of Social Work, 21(3), 393–423. Cousins, M., & Power, I. (2003). Acute and postoperative pain. In R. Melzack & P. D. Wall (Eds.), Handbook of pain management (pp. 13– 30). Elsevier. Deng, G. (2019). Integrative medicine therapies for pain management in cancer patients. Cancer Journal, 25(5), 343–348. Dupoiron, D., Jubier-Hamon, S., Seegers, V., Bienfait, F., Pluchon, Y. M., Lrebrec, N., Jaoul, V., & Delorme, T. (2022). Peripheral neuropathic pain following breast cancer: effectiveness and tolerability of high- concentration capsaicin path. Journal of Pain Research, 1(15), 241–255. Fingler, M. (2011). Komplementarne i alternativne metode liječenja boli. In M. Jukić, V. Majerić Kogler, & M. Fingler (Eds.), Bol: uzroci i liječenje (pp. 312–315). Medicinska naklada. Gärtner, R., Jensen, M.-B., Nielsen, J., Ewertz, M., Kroman, N., & Kehlet, H. (2009). Prevalence of and factors associated with persistent pain following breast cancer surgery. JAMA, 302(18), 1985–1992. Gramaglia, C., Gambaro, E., Vecchi, C., Licandro, D., Raina, G., Pisani, C., Burgio, V., Farruggio, S., Rolla, R., Deantonio, L., Grossini, E., Krengli, M., & Zeppegno, P. (2019). Outcomes of music therapy interventions in cancer patients: A review of the literature. Critical reviews in Oncology/ Hematology, 138, 241–254. Hamood, R., Hamood, H., Merhasin, I., & Keinan-Boker, L. (2018). Chronic pain and other symptoms among breast cancer survivors: Prevalence, predictors, and effects on quality of life. Breast Cancer Research and Treatment, 167(1), 157–169. Hikmat, R., Rahayu, U., Pebrianti, S., Cahyani, E. M., Sari, C. P., & Afrilia, G. (2022). Post-operative pain management with non-pharmacological interventions in patients undergoing breast cancer surgery: A systematic scoping review. Journal of Palembang Nursing Studies, 1(3), 125–133. Hsieh, F., Miao, N., Tseng, I., Chiu, H., Kao, C., Liu, D., Chen, R., Tsai, H., & Chou, K. (2019). Effect of home-based music intervention versus ambient music on breast cancer survivors in the community: A feasibility study in Taiwan. European Journal of Cancer Care, 28(4), e13064. g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 140 Ilhan, E., Chee, E., Hush, J., & Moloney, N. (2017). The prevalence of neuropathic pain is high after treatment for breast cancer. PAIN, 158(11), 2082–2091. International Association for the Study of Pain. (2020, July 16). IASP announces revised definition of pain. https://www.iasp-pain.org /publications/iasp-news/iasp-announces-revised-definition-of-pain/ Jukić, M. (2011). Farmakologija analgetika. In M. Jukić, V. Majerić Kogler, & M. Fingler (Eds.), Bol: uzroci i liječenje (pp. 23–63). Medicinska naklada. Kievisiene, J., Jautakyte, R., Rauckiene-Michaelsson, A., Fatkulina, N., & Agostinis-Sobrinho, C. (2020). The effect of art therapy and music therapy on breast cancer patients: What we know and what we need to find out; A systematic review. Evidence-Based Complementary and Alternative Medicine. https://doi.org/10.1155/2020/7390321 Köhler, F., Martin, Z.-S., Hertrampf, R.-S., Gäbel, C., Kessler, J., Ditzen, B., & Warth, M. (2020). Music therapy in the psychosocial treatment of adult cancer patients: A systematic review and meta-analysis. Frontiers in Psychology, 11, 651. Kvolik, S., & Ikić, V. (2011). Liječenje akutne poslijeoperacijske boli. In M. Jukić, V. Majerić Kogler, & M. Fingler (Eds.), Bol – uzroci i liječenje (pp. 78–90). Medicinska naklada. Li, X.-M., Zhou, K.-N., Yan, H., Wang, D.-L., & Zhang, Y.-P. (2011). Effects of music therapy on anxiety of patients with breast cancer after radical mastectomy: A randomized clinical trial. Journal of Advanced Nursing, 68(5), 1145–1155. Lyman, G. H., Greenlee, H., Bohlke, K., Bao, T., DeMichele, A. M., Deng, G. E., Fouladbakhsh, J. M., Gil, B., Hershman, D. L., Mansfield, S., Mussallem, D. M., Mustian, K. M., Price, E., Rafte, S., & Cohen, L. (2018). Integrative therapies during and after breast cancer treatment: ASCO endorsement of the SIO clinical practice guideline. Journal of Clinical Oncology, 36(25), 2647–2655. Majerić Kogler, V. (2014): Akutna bol. Medicus, 23(2), 83–92. Majerić Kogler, V., Fingler, M., & Butković, D. (2011). Klasifikacija i epidemiologija boli. In M. Jukić, V. Majerić Kogler, & M. Fingler (Eds.), Bol – uzroci i liječenje (pp. 64–77). Medicinska naklada. Martinec, R. (2013). Multidimenzionalna procjena doživljaja slike tijela u žena s rakom dojke. Hrvatska revija za rehabilitacijska istraživanja, 49(2), 54–68. Matsota, P., Christodoulopoulou, T., Smyrnioti, M. E., Pandazi, A., Kanellopoulos, I., Koursoumi, E., Karamanis, P., & Kostopanagiotou, G. (2013). Music’s use for anesthesia and analgesia. Journal of Alternative and Complementary Medicine, 19(4), 298–307. Melzack, R. (2003). Introduction: The pain revolution. In R. Melzack & P. D. Wall (Eds.), Handbook of pain management (pp. 1–9). Elsevier. Brig ita V ilč , Ren ata M a rtin ec , D a m ir M ih o lić ◆ TH E EFFEC TS O F M U SIC LISTEN IN G O N PA IN PERC EPTIO N A N D C O PIN G W ITH BREA ST C A N C ER 141 Michael, Y. L., Kawachi, I., Berkman, L. F., Holmes, M. D., & Colditz, G. A. (2000). The persistent impact of breast carcinoma on functional health status. Cancer, 89(11), 2176–2186. Poulsen, M. J., Cotto, J., & Cooney, M. F. (2019). Music as a postoperative pain management intervention. Journal of PeriAnesthesia Nursing, 34(3), 662–666. Prstačić, M., Karadžole, V., & Kraljević, N. (1992). Percepcija boli u višestruko konvergentnoj terapiji nakon mastektomije. Defektologija, 28(1–2), 13–20. Šamija, M., Vrdoljak, E., & Krajina, Z. (2006). Klinička onkologija. Hrvatska liga protiv raka. Sapunar, D., & Puljak, L. (2011). Neurobiologija boli. In M. Jukić, V. Majerić Kogler, & M. Fingler (Eds.), Bol: uzroci i liječenje (pp. 5–22). Medicinska naklada. Stark, J. C. (2012). Perceived benefits of group music therapy for breast cancer survivors: mood, psychosocial well-being, and quality of life [Unpublished doctoral dissertation]. Michigan State University. Sun, C., Sang, S., Tang, Y., Niu, X., Yoo, H. S., Zhou, P., Liu, H., Gong, Y., & Xu, L. (2023). Effects of music therapy on anxiety in patients with cancer: Study protocol of a randomised controlled trial. BMJ Open, 13(5), e067360. Tola, Y. O., Chow, K. M., & Liang, W. (2021). Effects of non- pharmacological interventions on preoperative anxiety and postoperative pain in patients undergoing breast cancer surgery: A systematic review. Journal of Clinical Nursing, 30(23–24), 3369–3384. van der Heijden, M. J. E., Oliai Araghi, S., van Dijk, M., Jeekel, J., & Hunink, M. G. M. (2015). The effects of perioperative music interventions in pediatric surgery: A systematic review and meta- analysis of randomized controlled trials. Plos One, 10(8), e0133608. World Health Organization. (2018). WHO guidelines for the pharmacological and radiotherapeutic management of cancer pain in adults and adolescents. Zemba, M., Majerić Kogler, V., & Žunić, J. (2001). Liječenje poslijeoperacijske boli. Argos.. Povzetek UDK 615.851.8:78 Kakovost življenja bolnic z rakom dojke je odvisna od številnih različnih dejavnikov, vključno s trajanjem in z intenzivnostjo bolečine, ki lahko pomembno vplivata na to, kako se bolnice spopadajo z diagnozo, zdravljenjem in s psihično stisko. Pokazalo se je, da lahko nefarmakološke dopolnilne terapije – kot je receptivna glasbena terapija – po- leg analgetikov pomagajo zmanjšati zaznavanje bolečine. Na teh izhodiščih je bila iz- g la sb en o pe d ag o šk i z bo r n ik ◆ le t n ik /v o lu m e 19 ◆ št ev il k a /n u m be r 39 142 vedena raziskava s ciljem ocenitve vpliva poslušanja glasbe v kliničnem okolju na doži- vljanje glasbe, zaznavanje bolečine in s tem na vsakodnevno delovanje v pooperativnem obdobju pri bolnicah z rakom dojke. V raziskavo je bilo vključenih 32 udeleženk z lokali- ziranimi malignimi procesi v dojki in pazduhi. Poleg običajne analgetične terapije so ves čas hospitalizacije uporabljali poslušanje glasbe. Izbira glasbe je temeljila na željah vsake udeleženke, glasbo pa so poslušale dvakrat dnevno po 30 minut ob uporabi predvajalni- ka glasbe in slušalk. Za vrednotenje je bila izvedena kvalitativna tematska analiza z upo- rabo polstrukturiranega intervjuja, ki je vključeval tri raziskovalna vprašanja: 1. Kako udeleženke doživljajo glasbo in kakšen pomen ima zanje? 2. Kako udeleženke opisuje- jo prispevek glasbe k njihovemu obvladovanju bolečine? 3. Katere spremembe v svojem vsakodnevnem delovanju udeleženke opažajo po poslušanju glasbe? Rezultati so poka- zali koristi poslušanja glasbe pri spodbujanju pozitivnih čustev, lajšanju fizičnih bolečin, izboljševanju vsakodnevnega delovanja med hospitalizacijo in uspešnejšem soočanju z diagnozo rak dojke. Zaključimo lahko, da je glasba zlahka uporabna v kliničnem oko- lju brez škodljivih posledic in da lahko služi kot sredstvo za preusmerjanje pozornosti od občutkov bolečine k občutkom ugodja ter zadovoljstva.