TRANScriptional Pathways Of Surgical Pain Modulated by Music Therapy Exposure (TRANSPOSE)

Official title

TRANScriptional Pathways Of Surgical Pain Modulated by Music Therapy Exposure (TRANSPOSE): A Single Arm Pilot Study

Overview

Participants may take part in this study if they are scheduled to undergo a surgery that meets the following: (1) traditional open surgery via laparotomy, (2) length of surgery \>3 hours, and (3) curative-intent surgical resection of a cancer in the stomach, pancreas, bile ducts, liver, or peritoneal surfaces. The purpose of this study is (1) to evaluate the feasibility of collecting blood samples prior to surgery, post-surgery and pre- music-assisted relaxation and imagery (MARI) intervention, and immediately post-MARI intervention and (2) to identify gene expression changes associated with MARI and explore their relationship with immediate changes in pain intensity. Participants will be in this study for the duration of their hospital admission for surgery.

Detailed description

People undergoing surgery for abdominal cancer often experience high levels of pain, stress, and anxiety. Managing these symptoms after surgery is difficult. People often require strong medications for pain relief and may have other comorbidities and anxiety that accompany surgery. Non-pharmacologic approaches, like music therapy (MT) are needed.

Music-assisted relaxation and imagery (MARI) combines live music with guided relaxation, breathing, and imagery. MARI can be personalized to people's preferences. MARI can also be recorded live so that a recording can be given to the participant to use afterward. In a prior study conducted by researchers, people who receiving palliative care reported a decrease in pain after experiencing MARI. In an additional study, MARI was found to more likely result in bigger decreases in pain when compared to traditional MT alone.

Even though there are several studies that support the efficacy of music interventions, like MARI and MT, for addressing pain after surgery, the biological mechanisms are not well understood. Recent advances in functional genomic science provide an opportunity to understand transcriptomic mechanisms. These approaches have been applied to mind-body therapies, recreational music making (RMM), and music listening. However, they have not yet been applied to MT.

A previous study showed that RMM led to a decrease in stress-induced immune response-related genetic markers in a group of healthy volunteers when compared to a control group. In a similar study, adults with cardiovascular disease also showed changes in their genetic markers when exposed to RMM.

However, to date no research has investigated the relationship between gene expression and pain in a medical population experiencing acute post-surgical pain. Given that people undergoing abdominal cancer surgery often experience severe pain, this population is well-suited for investigating the mechanisms by which MT influences acute pain.

Interventions

• Behavioral Music-assisted relaxation and imagery (MARI)
  Participants will provide their music and imagery preferences, which will be incorporated into the intervention. The intervention will consist of live guitar accompaniment personalized to participants' music preferences and a standardized script directing participants to release tension, take deep breaths, and explore a relaxing place. The MARI intervention will last about 30 minutes. The MARI intervention will be conducted on Day 1 (post-surgery) and a second timepoint determined by participant

Primary outcome measures

• Proportion of participants whose phlebotomy was collected prior to surgery [Time frame: Within 2 weeks prior to surgery]
• Proportion of participants whose phlebotomy was collected post-surgery (pre-MARI) [Time frame: Post-surgery and prior to MARI intervention (up to 30 days)]
• Proportion of participants whose phlebotomy was collected post-MARI [Time frame: Post-MARI intervention (up to 30 days)]

Eligibility criteria

Inclusion criteria

• Age 50 to 80
• Able to speak and understand English
• Scheduled to undergo a surgery meeting the following criteria: (1) traditional open surgery (not laparoscopic or robotic) via laparotomy (midline or subcostal incisions), (2) length of surgery >3 hours, and (3) curative-intent surgical resection of a cancer in the stomach, pancreas, bile ducts, liver, or peritoneal surfaces
• Participant reports pain intensity of 4/10 or above to study staff on day 1 post-surgery or any other day post-surgery through discharge

Exclusion criteria

• Significant visual impairment that has not been corrected
• Significant hearing impairment that has not been corrected
• Significant cognitive impairment that would prevent participant from participating in the study

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Supportive care

Study locations

United States · 1 center

• University Hospitals Cleveland Medical Center, Case Comprehensive Cancer Center — Cleveland

Publications

• Bhasin MK, Dusek JA, Chang BH, Joseph MG, Denninger JW, Fricchione GL, Benson H, Libermann TA. Relaxation response induces temporal transcriptome changes in energy metabolism, insulin secretion and inflammatory pathways. PLoS One. 2013 May 1;8(5):e62817. doi: 10.1371/journal.pone.0062817. Print 2013. PMID 23650531
• Bhasin MK, Denninger JW, Huffman JC, Joseph MG, Niles H, Chad-Friedman E, Goldman R, Buczynski-Kelley B, Mahoney BA, Fricchione GL, Dusek JA, Benson H, Zusman RM, Libermann TA. Specific Transcriptome Changes Associated with Blood Pressure Reduction in Hypertensive Patients After Relaxation Response Training. J Altern Complement Med. 2018 May;24(5):486-504. doi: 10.1089/acm.2017.0053. Epub 2018 Apr PMID 29616846
• Dusek JA, Otu HH, Wohlhueter AL, Bhasin M, Zerbini LF, Joseph MG, Benson H, Libermann TA. Genomic counter-stress changes induced by the relaxation response. PLoS One. 2008 Jul 2;3(7):e2576. doi: 10.1371/journal.pone.0002576. PMID 18596974
• Bittman B, Berk L, Shannon M, Sharaf M, Westengard J, Guegler KJ, Ruff DW. Recreational music-making modulates the human stress response: a preliminary individualized gene expression strategy. Med Sci Monit. 2005 Feb;11(2):BR31-40. PMID 15668624
• Bittman B, Croft DT Jr, Brinker J, van Laar R, Vernalis MN, Ellsworth DL. Recreational Music-Making alters gene expression pathways in patients with coronary heart disease. Med Sci Monit. 2013 Feb 25;19:139-47. doi: 10.12659/MSM.883807. PMID 23435350
• Kanduri C, Kuusi T, Ahvenainen M, Philips AK, Lahdesmaki H, Jarvela I. The effect of music performance on the transcriptome of professional musicians. Sci Rep. 2015 Mar 25;5:9506. doi: 10.1038/srep09506. PMID 25806429
• Kanduri C, Raijas P, Ahvenainen M, Philips AK, Ukkola-Vuoti L, Lahdesmaki H, Jarvela I. The effect of listening to music on human transcriptome. PeerJ. 2015 Mar 12;3:e830. doi: 10.7717/peerj.830. eCollection 2015. PMID 25789207
• Liu Q, Li L, Wei J, Xie Y. Correlation and influencing factors of preoperative anxiety, postoperative pain, and delirium in elderly patients undergoing gastrointestinal cancer surgery. BMC Anesthesiol. 2023 Mar 13;23(1):78. doi: 10.1186/s12871-023-02036-w. PMID 36915054

Identifiers

NCT: NCT07653594 · CASE9226

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗