1. INTRODUCTION
If burn injuries in themselves in themselves are not the most painful trauma person can sustain
then they likely reach this status once the nature of the treatment is considered.
Pain is a feeling triggered in the nervous system. Pain may be sharp or dull. It may come and
go, or it may be constant. Pain can be helpful in diagnosing a problem. Without pain, you
might seriously hurt yourself without knowing it, or you might not realize you have a medical
problem that needs treatment. Fortunately, there are many ways to treat pain. Treatment
varies depending on the cause of pain. Pain relievers, acupuncture and sometimes surgery are
helpful
Like emotions, perceptions of pain differ from other senses such as sight or vision because
they do not require a particular environmental energy, and the identity of the individual and
their personal belief and value systems appear to affect how pain is evaluated and
interpreted.
Tissue damage at the burn site is the predominant mechanism of pain and suffering in these
patients. Excessive pain can increase the amount of time it takes caregivers to complete the
wound care, and can increase how long the patient remains in the hospital before discharge.
Pharmacologic treatment with potent opioids, anxiolytics, and other agents (e.g., ketamine) is
the first line of therapy. However nonpharmacologic methods of treating burn pain are also
extremely useful.
Indian classical 'Ragas' have been acclaimed by Vedic science to have healing effects. Music
has frequently been used as a therapeutic agent from the ancient times. In India, music is a
kind of yoga system through the medium of sonorous sound, which acts upon the human
organism and awakens and develops their proper functions to the extent of self-realization,
which is the ultimate goal of Hindu Philosophy and religion ] Melody is the keynote of Indian
Music. The 'Raga' is the basis of melody. Various 'Ragas' have been found to be very
effective in curing many diseases related to the Central Nervous System. Before using music
as Therapy, it must be ascertained which type of music is to be used. The concept of Music
Therapy is dependent on correct intonation and right use of the basic elements of music. Such
as notes [swara] rhythm, volume, beats, and piece of melody.
There are countless 'Ragas' of course with countless characteristic peculiarities of their own.
That is why we cannot establish a particular Raga for a particular disease. Different types of
Ragas are applied in each different case. Classical music with its unique swara/note structure
ensures calm and cozy mind by exposure and subdues the emotion provoking situations.
Music plays an effective role in subduing the so-called emotional imbalance.
Research has shown that music has a profound effect on your body and psyche.

2. NEED FOR THE STUDY
Burn injuries are a major medical condition, often resulting in hospital admissions, surgeries,
and extensive therapies. Burns is one of the most painful types of trauma, and pain
management in all aspects of recovery. Patients with burns experience “resting pain”sec
ondary to tissue damage and “procedural pain” caused by interventions such as wound care
and range-of-motion exercises. In addition, repetition of these painful procedures often creates
anticipatory anxiety for patients with burns Research has demonstrated that anxiety and pain
are interrelated and that an individual’s level of anxiety directly influences his or her
perception of pain. This concept is supported by the gate control theory of pain, which states
that there is a gating mechanism in the nervous system that can block the transmission of pain
sensation at the level of the spinal cord. The gate control theory supports the use of music as a
distraction from noxious input. For example, the gate control theory suggests that cognitive
processes, such as relaxation, can exert control over painful stimuli. Additionally, anxiety
creates a state of physiological stress arousal that is manifested by increased activation of the
sympathetic nervous system. Literature shows that sympathetic nervous system activity can be
effectively decreased through the use of relaxation music.
Specifically, pain control is a common obstacle limiting various therapy and treatments.
Patients with burns experience “resting pain” secondary to tissue damage and “procedural
pain” caused by interventions such as wound care and range-of-motion exercises.
Although the type of pain is generally shorter in duration, it is greater in intensity.
Management of this procedural pain is critical for optimal outcomes in therapy. Opioid drugs
are the primary pharmacological treatment for pain management of burn injuries, but they
often do not provide complete alleviation of pain during therapeutic interventions High doses
of opioid drugs may also limit a patient’s ability to function. In addition, repetition of these
painful procedures often creates anticipatory anxiety for patients with burns. Research has
demonstrated that anxiety and pain are interrelated and that an individual’s level of anxiety
directly influences his or her perception of pain. This concept is supported by the gate control
theory of pain, which states that there is a gating mechanism in the nervous system that can
block the transmission of pain sensation at the level of the spinal cord.
Additionally, anxiety creates a state of physiological stress arousal that is manifested by
increased activation of the sympathetic nervous system. Literature shows that sympathetic
nervous system activity can be effectively decreased through the use of relaxation music.
Historically, music has been used in medical settings, such as hospital waiting rooms and
dental offices, to promote relaxation. The use of therapeutic music in controlled environments
for specific patient populations and procedures. Research has shown that music has a
profound effect on your body and psyche. In fact, there’s a growing field of health care
known as Music Therapy, which uses music to heal. Those who practice music therapy are
finding a benefit in using music to help cancer patients, children with ADD, and others, and
even hospitals are beginning to use music and music therapy to help with pain management,
to help ward off depression, to promote movement, to calm patients, to ease muscle tension,
and for many other benefits that music and music therapy can bring. This is not surprising, as
music affects the body and mind in many powerful ways.

3. PROBLEM STATEMENT
A study to assess the effect of music therapy on selected parameters during wound care
in patients with burns injury in selected hospitals.
OBJECTIVES:
• To assess the intensity of pain before and after music therapy in patients with burn
injury.
• To assess the physical parameters before and after music therapy in patients with burn
injury.
• To assess the physiological parameters before and after music therapy in patients with
burn injury.
• To find assess the behavioral responses before and after music therapy in patients
with burn injury.
• To assess the correlation between music therapy and selected variables such as age,
depth of wounds.
OPERATIONAL DEFINITIONS
Assess
According to Oxford dictionary, “assess” means to evaluate the value, importance or quality
of something.
In this study assess means to find out the effectiveness of the music therapy being
provided during wound care to patients with burn injury..
Effect
According to Chamber’s 20th century dictionary, “effect” means result of an action or an
impression produced.
In this study effect means a change produced in selected parameters i.e physical parameters,
physiological parameters and behavioral response.
Parameters
According to Oxford dictionary, “parameters” means a characteristic or feature which is
measurable or quantifiable.
In this study parameters means factors which determine a system and its behavior and are
varied, this includes physical, physiological and behavioral parameters.

4. Physical parameters:
According to Banthams Medical dictionary’ “Physical” means concerning or pertaining to the
body.
In this study physical parameters include: facial expressions, clenching of jaws, moving of
extremities, wrinkling of forehead, closing eyes, perspiration, fisting of hands etc.
Physiological parameters
According to Banthams medical dictionary, physiological means physical functions of the
body.
In this study physiological parameters include pain intensity measured using numerical pain
scale, heart rate, blood pressure and respiration.
Behavioural responses
According to Tabers medical dictionary,”behavior” is a manner in which one acts or they are
the actions or reactions of individual under specific circumstances.
Responses are feelings, movement caused by stimulus or influence.
In this study behavioural response include responses like groaning, crying , screaming etc.
Music therapy
According to Oxford medical dictionary, “music” means the art of combining vocal or
instrumental sounds or both to produce beauty of form, harmony and expression of emotion.
According to Concise medical dictionary, “therapy” means treatment of physical, or mental
disorders, other than by surgery.
In this study music therapy refers to the use of structured music in the form of combination
of western beats and Indian ragas of varying sound frequencies between 30- 60 Hz with a
stereophonic effect. It is a total 22min composure which would be repeated variably
depending on the duration of wound care. The music will be played starting from 15mins
before wound dressing , throughout wound dressing and would be continued for 15 mins after
wound dressing using walkman and overhead phones or handsets.
Wound care
A wound is a break in the skin (the outer layer of skin is called the epidermis). Wounds are
usually caused by cuts or scrape. Wound care are steps taken to ensure that a wound heals
correctly and does not get infected.
In this study wound care involves all the processes involving removal of previous
dressing, soaking of wound, cleansing of wound, application of medicines and covering of
wound. These wound dressing procedures are done regularly without anesthesia.
Burns
According to Blakistons New Gould medical dictionary , a burn is a tissue reaction or injury
resulting from contact with heat, chemicals , radiation, electricity or friction.

5. In this study burns means injury to the skin produced by thermal, chemical, electricity
radiation or friction causes ,with first and second degree burns only.
First-degree burns affect only the outer layer of the skin (epidermis). They cause pain,
redness, and swelling. Second-degree (partial thickness) burns affect both the outer and
underlying layer of skin(epidermis and dermis). They cause pain, redness, swelling, and
blistering.
ASSUMPTIONS
• First and second degree burns are painful.
• Procedure of changing the wound dressing causes pain.
• Music is an accepted form of alternative therapy.
• Music may have influence on pain during wound care in patients with burn injury.
• Physiological parameters under study may vary from individual to individual.
• Duration of dressings vary from patient to patients.
Variables:
Independent variable: Music therapy
Dependent variable: Selected parameters like physical parameters, physiological
parameters and behavioural resposes.
RESEARCH METHODOLOGY
Research approach
In this study descriptive evaluative approach will be used.
Research design
In this study one group pre test – post test research design would be used.
Setting
The selected setting would be various hospitals across Mumbai which specially cater to
patients with burn injuries.
Population
The population consists of all the patients with burns injury admitted in various hospitals.

6. Sample
In this study the sample consists of all patients with first and second degree burns who
undergo regular wound dressing and are admitted in various hospitals across Mumbai and
who fulfil the inclusion criteria.
Sample size
The total sample size consists of total 30 patients.
CRITERIA FOR SAMPLE SELECTION
INCLUSION CRITERIA
• Patients with first and second degree burns injury .
• Patients with burns injury who require daily dressing and wound care.
• Patients who are willing to participate in the study.
• Patients who can understand Hindi, Marathi or English.
EXCLUSION CRITERIA
• Patients with burn injury who have any hearing problem or ear infections or any
external burn injury to ear.
• Third and fourth degree patients with burn injury.
• Patients with burns injury who are unconscious or intubated.
TOOL AND TECHNIQUE
Tool: 1) Observation checklist
2)Interview.
Technique: 1) observation
2) semi structured interview
Analysis and interpretation of data:
• Frequency percentage.

7. • Hypothesis testing: Paired t- test
HYPOTHESIS:
• Ho: There is no significant effect of music therapy on pain during burns wound care.
• H1: There will be minimum variation in physical and physiological parameters in
patients receiving music therapy.
• H2: Patients in the study report pleasant emotions experienced with music therapy
during burns wound care.
• H3: There will be a reduction in frequency of analgesics received by patients before
and during and after burns wound care.
DELIMITATIONS
• As pain assessment is based on observations and verbal response some amount of
subjectivity is inevitable.
• Since the study is being done on a small group the findings of the study cannot be
generalized.
SCOPE OF STUDY
• Music therapy can be used as one of the non pharmacological measures to control
pain during burns wound care.
• Music therapy can be used as an intervention to reduce pain and anxiety in patients
during other painful invasive procedures and conditions.
• This study will bring forth the views of the patients regarding acceptance of
diversional therapy in reducing physical and emotional tension.

8. ReseaRch
pRoposal

9. By: ms Juliet meRline