Clinical Observation on Acupuncture Combined with Five-Element Music Therapy for Postoperative Pain and Anxiety in Patients with Lumbar Disc Herniation

Abstract

Objective

To observe the clinical efficacy of acupuncture combined with five-element music therapy on postoperative pain and anxiety in patients with lumbar disc herniation (LDH).

Methods

A total of 102 patients who underwent surgery for LDH between January 2023 and December 2025 were enrolled in this prospective randomized controlled trial. They were randomly assigned to either a control group (n = 51) or an observation group (n = 51). Both groups received conventional postoperative rehabilitation and acupuncture (once daily, five times per week for 2 weeks). The observation group additionally received five-element music therapy (30 min daily for 2 weeks). Pain intensity was assessed using the visual analog scale (VAS), anxiety level using the self-rating anxiety scale (SAS), and lumbar function using the Oswestry disability index (ODI) at baseline (T0), end of treatment (T1), and 1-month follow-up (T2).

Results

At baseline, there were no significant differences between groups in demographic or clinical characteristics (P > 0.05). At T1 and T2, the observation group showed significantly lower VAS and SAS scores and better ODI scores compared to those of the control group (all P < 0.05). The efficacy rate (ODI improvement ≥30%) was 90.2% in the observation group versus 68.6% in the control group (P < 0.01).

Conclusion

Acupuncture combined with five-element music therapy can effectively reduce postoperative pain and anxiety, and improve functional recovery in LDH patients. The combination therapy is superior to acupuncture alone.

Keywords

lumbar disc herniation acupuncture five-element music therapy postoperative pain anxiety randomized controlled trial

Get full access to this article

View all access options for this article.

References

Abdul Hamid

M. R.

Mansor

M. B.

Zainal Abidin

M. F.

(2022). Music therapy for reducing anxiety in patients undergoing total knee replacement surgery under subarachnoid anesthesia. Journal of Orthopaedic Surgery (Hong Kong), 30(2), 10225536221122347. https://doi.org/10.1177/10225536221122347

Alexandre

A. B.

Kasherwa

Balegamire

J. B. M.

Tunangoya

J. Y.

Mukanga

L. O.

Buhendwa

F. Z.

Rusagulira

M. O.

Hilaire

M. M.

Busane

P. A.

Mugisho

G. M.

Mukengere

D. M.

(2025). Bouncing back after trauma: Music therapy, gender, and mental health in conflict-ridden settings. Discover Mental Health, 5(1), 15. https://doi.org/10.1007/s44192-025-00137-1

Andersson

G. B.

(1999). Epidemiological features of chronic low-back pain. Lancet (London, England), 354(9178), 581–585. https://doi.org/10.1016/s0140-6736(99)01312-4

Anwar

F. N.

Roca

A. M.

Khosla

Loya

A. C.

Medakkar

S. S.

Kaul

Wolf

J. C.

Federico

V. P.

Sayari

A. J.

Lopez

G. D.

Singh

(2024). Impact of preoperative back pain severity on PROMIS outcomes following minimally invasive lumbar decompression. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 33(11), 4262–4269. https://doi.org/10.1007/s00586-024-08275-w

Ballinger

(2008). Adverse effects of nonsteroidal anti-inflammatory drugs on the colon. Current Gastroenterology Reports, 10(5), 485–489. https://doi.org/10.1007/s11894-008-0089-5

Bauer

B. A.

Tilburt

J. C.

Sood

G. X.

Wang

S. H.

(2016). Complementary and alternative medicine therapies for chronic pain. Chinese Journal of Integrative Medicine, 22(6), 403–411. https://doi.org/10.1007/s11655-016-2258-y

Birch

Bovey

Alraek

Robinson

Kim

T. H.

Lee

M. S.

(2020). Acupuncture as a treatment within integrative health for palliative care: A brief narrative review of evidence and recommendations. Journal of Alternative and Complementary Medicine (New York, NY), 26(9), 784–791. https://doi.org/10.1089/acm.2020.0032

Bjurström

M. F.

Irwin

M. R.

Bodelsson

Smith

M. T.

Mattsson-Carlgren

(2021). Preoperative sleep quality and adverse pain outcomes after total hip arthroplasty. European Journal of Pain (London, England), 25(7), 1482–1492. https://doi.org/10.1002/ejp.1761

Zhong

(2022). Electroacupuncture for postoperative pain in mixed hemorrhoids: A meta-analysis. Medicine, 101(50), e32247. https://doi.org/10.1097/md.0000000000032247

10.

Gallagher

L. M.

Gardner

Bates

Mason

Nemecek

DiFiore

J. B.

Bena

Bethoux

(2018). Impact of music therapy on hospitalized patients post-elective orthopaedic surgery: A randomized controlled trial. Orthopedic Nursing, 37(2), 124–133. https://doi.org/10.1097/nor.0000000000000432

11.

Garza-Villarreal

E. A.

Pando

Vuust

Parsons

(2017). Music-Induced analgesia in chronic pain conditions: A systematic review and meta-analysis. Pain Physician, 20(7), 597–610. https://doi.org/10.36076/ppj/2017.7.597

12.

Hall

P. E. D.

Card

E. B.

(2020). Uses of complementary and alternative medicine for perioperative and other patients. The Nursing Clinics of North America, 55(4), 537–542. https://doi.org/10.1016/j.cnur.2020.06.020

13.

Harris

R. E.

Zubieta

J. K.

Scott

D. J.

Napadow

Gracely

R. H.

Clauw

D. J.

(2009). Traditional Chinese acupuncture and placebo (sham) acupuncture are differentiated by their effects on mu-opioid receptors (MORs). NeuroImage, 47(3), 1077–1085. https://doi.org/10.1016/j.neuroimage.2009.05.083

14.

Hoy

March

Brooks

Blyth

Woolf

Bain

Williams

Smith

Vos

Barendregt

Murray

Burstein

Buchbinder

(2014). The global burden of low back pain: Estimates from the Global Burden of Disease 2010 study. Annals of the Rheumatic Diseases, 73(6), 968–974. https://doi.org/10.1136/annrheumdis-2013-204428

15.

Inoue

Kitakoji

Yano

Ishizaki

Itoi

Katsumi

(2008). Acupuncture treatment for low back pain and lower limb symptoms-the relation between acupuncture or electroacupuncture stimulation and sciatic nerve blood flow. Evidence-Based Complementary and Alternative Medicine: eCAM, 5(2), 133–143. https://doi.org/10.1093/ecam/nem050

16.

Kim

Evangelista

L. S.

Park

Y. G.

(2015). Anxiolytic effects of music interventions in patients receiving incenter hemodialysis: A systematic review and meta-analysis. Nephrology Nursing Journal: Journal of the American Nephrology Nurses’ Association, 42(4), 339–347. quiz 48

17.

Kuchinsky

Ascher

(2015). Postoperative multimodal pain management. Lab Animal, 44(4), 132–134. https://doi.org/10.1038/laban.744

18.

Kukreja

Talbott

MacBeth

Ghanem

Sturdivant

A. B.

Woods

Potter

W. A.

Kalagara

(2020). Effects of music therapy during total knee arthroplasty under spinal anesthesia: A prospective randomized controlled study. Cureus, 12(3), e7396. https://doi.org/10.7759/cureus.7396

19.

Lai

H. C.

Lin

Y. W.

Hsieh

C. L.

(2019). Acupuncture-analgesia-mediated alleviation of central sensitization. Evidence-Based Complementary and Alternative Medicine: eCAM, 2019, 6173412. https://doi.org/10.1155/2019/6173412

20.

Min

(2024). Researching how music affects the autonomic nervous system and influences wound healing processes in trauma patients. International Wound Journal, 21(3), e14790. https://doi.org/10.1111/iwj.14790

21.

Liao

Papathanassoglou

Zhang

Q. N.

Gupta

(2023). A cross-cultural randomized pilot trial of western-based and five elements music therapy for psychological well-being. Explore (New York, NY), 19(4), 571–577. https://doi.org/10.1016/j.explore.2022.11.001

22.

Lim

T. K.

Berger

Litscher

(2018). Acupuncture and neural mechanism in the management of low back pain—An update. Medicines (Basel, Switzerland), 5(3), 63. https://doi.org/10.3390/medicines5030063

23.

Zhang

(2021). The effect of warm needle moxibustion on lumbar disc herniation. American Journal of Translational Research, 13(5), 5059–5065.

24.

W. Z.

Zhang

Y. M.

Yuan

Wang

W. Y.

(2011). Effects of balance-acupuncture stimulation of “back pain” and “hip pain” points on plasma beta-endorphin and ACTH contents in rats with lumbar disc herniation. Zhen ci yan jiu = Acupuncture Research, 36(5), 357–360.

25.

Madsen

B. K.

Zetner

Møller

A. M.

Rosenberg

(2020). Melatonin for preoperative and postoperative anxiety in adults. The Cochrane Database of Systematic Reviews, 12(12), Cd009861. https://doi.org/10.1002/14651858.CD009861.pub3

26.

Maher

Underwood

Buchbinder

(2017). Non-specific low back pain. Lancet (London, England), 389(10070), 736–747. https://doi.org/10.1016/s0140-6736(16)30970-9

27.

Paramasivam

Perumal

S. S.

Ekambaram

S. P.

(2024). S100a8 and S100A9–critical mediators of inflammation in arthritis. Current Proteomics, 21(6), 639–656. https://doi.org/10.2174/0115701646347924241111071800

28.

Patiyal

Kalyani

Mishra

Kataria

Sharma

Parashar

Kumari

(2021). Effect of music therapy on pain, anxiety, and use of opioids among patients underwent orthopedic surgery: A systematic review and meta-analysis. Cureus, 13(9), e18377. https://doi.org/10.7759/cureus.18377

29.

Patrick

Emanski

Knaub

M. A.

(2014). Acute and chronic low back pain. The Medical Clinics of North America, 98(4), 777–789. , xii. https://doi.org/10.1016/j.mcna.2014.03.005

30.

Ren

Xue

(2024). Effects of five-element music stimulation in perioperative period on sleep Status and psychological regulation in patients undergoing orthopedic surgery. Noise & Health, 26(122), 403–409. https://doi.org/10.4103/nah.nah_77_24

31.

Siamidi

Konstantinou

Pavlou

Siamidis

Vlachou

(2024). Modified release of acetaminophen from matrix tablet formulations based on chitosan and Xanthan gum. Letters in Drug Design & Discovery, 21(3), 568–574. https://doi.org/10.2174/1570180820666221017162352

32.

Tang

Zhang

(2018). Acupuncture for lumbar disc herniation: A systematic review and meta-analysis. Acupuncture in Medicine: Journal of the British Medical Acupuncture Society, 36(2), 62–70. https://doi.org/10.1136/acupmed-2016-011332

33.

Wei

Huang

Sun

Gao

Cao

Zhang

Liu

(2024). Analysis of preoperative and postoperative depression and anxiety in patients with lumbar disc herniation with radiculopathy treated with percutaneous transforaminal endoscopic discectomy. Frontiers in Psychiatry, 15, 1460274. https://doi.org/10.3389/fpsyt.2024.1460274

34.

Zhang

Shi

Liang

Ning

Wang

Jia

(2024). Efficacy of acupuncture for anxiety and depression in functional dyspepsia: A systematic review and meta-analysis. PloS One, 19(3), e0298438. https://doi.org/10.1371/journal.pone.0298438

35.

Yakdan

Joseph

Ruiz-Cardozo

M. A.

Plog

B. A.

Yahanda

A. T.

Hafez

Huang

Derman

Gardocki

Hasan

Konakondla

Kashlan

Telfeian

(2025). Clinically significant improvement in health-related quality of life (EQ-5D-5 L) after endoscopic spine surgery. European Spine Journal: Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 34(12), 5789–5798. https://doi.org/10.1007/s00586-025-09306-w

36.

Yang

Wang

Wei

Kang

Liu

Zhang

(2021). Effectiveness of five-element music therapy in cancer patients: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice, 44, 101416. https://doi.org/10.1016/j.ctcp.2021.101416

37.

Zhuo

Feng

Wang

Lin

Xiao

Wang

Huang

Zhang

(2020). The effect of musical interventions in improving short-term pain outcomes following total knee replacement: A meta-analysis and systematic review. Journal of Orthopaedic Surgery And Research, 15(1), 465. https://doi.org/10.1186/s13018-020-01995-x

38.

Zhang

Lao

Ren

Berman

B. M.

(2014). Mechanisms of acupuncture-electroacupuncture on persistent pain. Anesthesiology, 120(2), 482–503. https://doi.org/10.1097/aln.0000000000000101

39.

Zhang

Liu

Song

Yang

Cui

Zhao

(2022). Acupuncture for postoperative pain of lumbar disc herniation: A systematic review and meta-analysis. Medicine, 101(49), e32016. https://doi.org/10.1097/md.0000000000032016

40.

Zhou

Wang

L. K.

H. Y.

Gao

Yang

X. D.

(2024). Early-stage postoperative depression and anxiety following orthognathic surgery: A cross-sectional study. BMC Anesthesiology, 24(1), 338. https://doi.org/10.1186/s12871-024-02726-z

41.

Zou

Zhou

Zhang

Xin

Wang

Claire-Marie

Rong

Gao

(2024). Transcutaneous auricular vagus nerve stimulation as a novel therapy connecting the central and peripheral systems: A review. International Journal of Surgery (London, England), 110(8), 4993–5006. https://doi.org/10.1097/js9.0000000000001592

42.

Zung

W. W.

(1971). A rating instrument for anxiety disorders. Psychosomatics, 12(6), 371–379. https://doi.org/10.1016/s0033-3182(71)71479-0