1 2552 200

.. 1980

2 3 3 4 8 8 9 14 14 15 : : 20 23 25

28 29 30 33 35 38 39 41 42 44 Three step analgesic ladder 47 51 55 55 56 56 56 57 61

4 4 5 6 6 6 6

1

11111111

2

3 1) 2) 3)

1. (Composer) (Performer) (Anthony Storr,2003) (,2552)

3

2. A Z ( ,2550)

3. (Music Therapy) (, 2552)

4

( ,2550)

1. (The Middle Ages .. 600 1450) 600 (Secular Song) (Ritural Music) (Melody) (Polyphony) (Organum) (Motet) (Mass) (Guido d Arezzo) (Lute)

2. (The Renaissance Period .. 1450 1600) 4 2 () () 2 () () (Madrigal) () (W. Byrd) (Giovanni Gabrieli) (Palestrina) : http://userserve-ak.last.fm/serve/126s/350056.jpg : http://overheardinthesacristy.files.wordpress.com/2008/04/palestrina.jpg

3. (The Baroque Period .. 1600 1750) (Choristers)

5

- - (Antonio Vivaldi) ( 1 - 4 ) (Johann Sebastian Bach) (Cantata) 5 (Brandenberg Concertos) (George Fredereick Handel) (Messiah : ) (Oratorio) : http://www.pantown.com/data/712/board12/8-20051012095751.jpg

4. (The Rococo Period .. 1750 1775)

5. (The Classic Period .. 1775 1830) (Counterpoint) 2 9 4 (Opera) (Joseph Haydn) (Wolfgang Amadeus Mozart) 600 (Ludwig Van Beethoven)

6

: http://z.about.com/d/classicalmusic/1/0/8/mozart_portrait.jpg : http://cache.gizmodo.com/assets/resources/2007/09/beethoven_hairclub.jpg

6. (Romantic Period .. 1830 1900) - (Peter Ilyich Tchaikovsky) (Johannes Brahms) (Franz Schubert) (Frederic Francois Chopin) (Robert Schumann) : http://www.pianoparadise.com/chopin.jpg : http://web.uvic.ca/~tonicxt/assign_1/img/robert-schumann.jpg

7. 20 (20th Century Period .. 1900-2000) (Richard Wagner) (Bela Bartok) 2 (Arnold Schoenberg) 12 (Twelve Tone Method) (Igor Stravinsky)

7

7777777777777

8

( , 2552)

(Bernstien, 1988) Stressor Stress mediators Stress reaction - Change - Predictability - Physics - Frustration - Control - Psychology - Conflict - Cognitive interpretation - Behavioral - Pressure - Social support - Coping skills

( , 2552) 2 1. 2.

1. 1.1 1.2

9

2. 2.1 2.2

(2001) (Amygdale) (Prefrontal cortex) (Amygdale) (Prefrontal cortex) (Inhibiter center) (Prefrontal cortex) (Amygdale) (Amygdale) (Prefrontal cortex) (Amygdale) (Amygdale) (Amygdale) (Prefrontal cortex) ( Left prefrontal cortex) ( Left prefrontal cortex) (Amygdale) (Prefrontal cortex) (Prefrontal cortex) (Daniel Goleman & Tara Bennett-Goleman,2001) (2007) (Cortisol) (Adrenalin)

10

(Elizabeth Scott, 2007) (1968 cited in Castillo & Richmond (2000) ) (Physical Stress) (Castillo & Richmond, 2000) (2000) 3 1) Alarm Reaction 2) Resistance 1 (Catecholamine) (Corticosteroid) (Cortisol) (Exhaustion) (Castillo& Richmond (2000) 3) Exhaustion (Adrenal Gland) (Epinephrine) (Norepinephrine) (Hydrocortisone)

(2549) ( , 2549)

11

(2000) (Emotional Stress Response) 1) Neverous Wreck 2) Generalized Anxiety Disorder (Castillo& Richmond (2000) (2007) (Elizabeth Scott, 2007)

12

14

(David) (Harp) ( King Sual) ( King Sual) (Elizabeth, 2007)

Mozart Mozart Sonata for Two Piano in D Major Gordon Shaw Frances Rauscher Mozart Effect (Gordon Shaw & Frances Raucher, 1993)

1) (Rhythm) (Concentration) (Relax) 2) (Pitch) 3) (Volume/ Intensity) 4) (Melody) 5) (Harmony)

1) 2) 3) 4) 5) 6)

15

7)

1) 2) (Anxiety/ Stress Management) 3) (Cognitive Skill) 4) (Perception) 5) (Attention Span) 6) (Social Skill) 7) (Communication and Language Skill) 8) (Motor Skill) 9) (Muscle Tension) 10) (Pain Management) 11) (Behavior Modification) 12) (Therapeutic Alliance)

1. 2. 3.

(2006) (Neverous Wreck) (EEG) Alpha (Elizabeth Scott, 2006)

(2007) (Elizabeth Scott, 2007)

16

1. 20 2. 72 (beat) 1 3. 4. 5. 6. 30 7. 15 20 (2548) 5 6 4 7 3

(2548) 1. 2.

17

3. 4.

( , 2548) 1. 70 -80 80 2. 3. 4. 5. 6. 1 7. 8. 9. 10. 1.5 ()

18

3 5

1

20

: (Enlightening Harmony) 5 5 4 40% . 2 4 . (music therapy)

21

5 (, 2552)

1. (Warm up) 70% ( 220 = ) (Endorphin)

22

2.

3.

4. (mouth organ) : (violin) : (piano) : : (, 2552)

23

52 26 60 26 4 26 - 35 36 - 45 46 - 55 56 2 2 5 6 9 4

24

7 1

25

(Active Piano Music Therapy : APMT ) 9 5 (One-to-Five Technique) 1 3 10 10 10 1 One-to-Five 1 - 5 4

1. (THAI-15) 2. 20 3. (DMHs REHAB-6 form) 4. BPRS (Brief Psychiatric Rating Scale) 3

Active Piano Music Therapy : APMT 3 43.77 40.33 THAI - 15 25.22 29.66 21.34 21.79 6 BPRS (Brief Psychiatric Rating Scale) 8 94.23

39 17 12 (Schizophrenia , paranoid type) 3 4

26

34 14 2 3 4 3 5

39 6

One-to-Five Technique

28

3 3

6 - 8 () ()

29

( )

30

6 / 6 ( 1 )

31

9 ()

^^^

^^^

^^^

32

1.

!

2.

3. 1) 2) 3) 4)

33

4. 4.1 4.2

5.

(Vibration)

70 5 6 20

34

1. 10 15 20 ( : ) 2.

35

.. 1989

(Thomas Elbert) Konstanz Motor Cortex Somatosensory 1998 Institute of Experimental Audiology Munster C.Pantev 25% (Thomas Elbert,1998) Mozart Effect

(Frances Rauscher, Gordon Shaw and Katherine Ky., 1995)

1997 Neurological Research Rauscher Shaw 34% (Leslie Brothers, Frances Rauscher, and Gordon Shaw, 1989)

Columbia County School Joyce M. Cheek Lyle R. Smith 8 Cheek (Joyce M. Cheek & Lyle R. Smith, 1999)

36

(Conscious) (Anthony Storr, 2003)

2008 2009 (Tudor Vieru) 1,461 70 beat (p value < 0.05) (Tudor Vieru, 2009)

26 1 - 2538, 23-30 () 1-1.30 2 2 ( , 2538)

(2008) (Adult) 28 1,104 4 1) intervention 2) 3) 4) classic 60 70 beats Nerol (p-value < 0.05) (p-value < 0.01) (Holm. L & Fitzmaurice L, 2008)

37

26 .. 2547 25 1267 - (Music-Mathematics of Feelings) Philip Bethge * (Der Spiegel) 31/28 ..2546 3 35,000 ( 26 .. 2547 25 1267)

(Stefan Koelsch) (Anne Blood) (, 2552)

(Testosterone) 2 (Cortisol) 5,000 () (, 2552)

38

(Nacrcus ,Jucquie,2000:Corol,Hilary,2002)

(Ferrell,1996) (nonphamarcologic intervention) (Stevan,Waldman,2001) (Complementary therapy) (Rimmer,1998)

(Close gate) ( ,2528)

( ,2542) 2546 30 15 30

39

(noninvasive technique)

(Cleeland et al.,1994) (Bonica, 1990) ( 2543) (Ferrell,1996;Glover et al.,1995;Roth&Breibart,1996)

1. 3 ( ,2542; ,2544; Bonica,1990;Richard,2002) 1.1 (direct tumor involvement) 78 1.2 19 1.3 3-10

2. 2.1 2 ( ,2543 Bonica,1990;Luckmann&Sorensen,1993;Richard,2002) 2.1.1 (acute pain) 6

40

2.1.2 (Chronic pain) 6

2

2.2 (Source) 3 (Caraceni,1996) 2.2.1 (somatic pain) (nociceptors) 2.2.2 (visceral pain) 2.2.3 (neuropathic pain)

3. (Bonica,199.;Pitcher&Duncombe,2000) 3 (noxious stimuli) (pain receptors) (pain impulse pathway) 3.1 2 3.1.1 (Physical stimuli) (mechanical stimuli) 3.1.2 (Chemical stimuli) 1. 2. (Acid) (Histamine) (bradykinin) (Prostoglandin) (Primary afferent nociceptor)

41

3.2 (onciceptive stimulation) (Free nerve ending) (Pain threshold) (pain impulse) 3.3 3.3.1 (Pricking fast firs pain) (A delte-fiber) 3.3.2 (ache slow second pain) (C - fiber)

1. (Gate Control Theory) (Gate Control Theory) (large fiber) (small fiber) ..(substantia gelationsa ;SG cell) (transmission cell trigger cell) .. .. .. (close the gate) .. (Open the gate) 2. (Endogenous pain control theory) 2 (enkaphalines) (substance P) .

42

(Ferrell,2003,) 1. 2. psychosocial 3. (Quality) / 4. 5. /cope 6. / 7. 8. 9. 10. Cultural expression of pain 10.1 Pattern of pain experience 10.2 Socio economic status ethnicity

43

11. 12. / pain activity

pain pain pain 1. lab 2. 3. pain pain 4. 5. 6. 7. ( ) 8. ( pain ) 9. / pain 10. pain 1. pain pain 2. 15 30 1 4 30 3. 3.1 pain 3.2 pain 24 3.3 3.4 3.5 pain 3.6 ( ) 3.7

44

3.8 pain /

(Marcus, 2000)

JCAHO (Joint commission on Accrediation of Health Organization) 5 JCAHO 1. 2. 2.1 2 opioid NSAID 2.2 3. elementary 3.1 somatic pain moderate pain severe opioid nonopioid opioid 3.2 supplement 2 (Pharmacological management) ( Non pharmacological management)

45

(Pharmacological management) (Adjuvant drug) (WHO) 3 1. Non opiod analgesics NSAIDS acetaminophen 2. Opioid analgesics - Weak to moderate opioid - Strong opioid 3. Adjuvant ()

1. non opioid paracetamol non steroid antiinflammatory drug ( NSAIDS) opioid physical dependence tolerance ceiling effect 1.1 NSAIDS Transduction Bradydinin, Prostaglandin, Substance P Histamine, Serotonin cell Nociceptors 1.2 Acetaminophen 500 1000 4 6 6,000 Arylating intermediate metabolite

2. Opioid Opioid receptors periaqueductal gray thalamun dorsal horn (pain threshold) neuronal activity 2.1 weak opioids opioid agonist 2.1.1 Codeine 1/10 morphine non opooid paracetamol 2.1.2 Tramadol (Tramal) reuptake catecholamines 2.2 Strong opioid analgesics 2.2.1 Morphine 3 2.2.2 Pethidine synthetic opioid analgesic 1/8 morphine 3 4 Pethidine normeperidine (CNS) ( , 2538)

46

2.2.3 Methadone synthetic opioid analgesic morphine 6-8 2.2.4 Fentanyl trandermal therapeutic system (Durogesic) strong opioid 72 12 24 ( ,2543) 3. Adjuvant () 3.1 anticonvulsant () carbamaxepine phenytoin clonazepam 3.2 antidepressants () amitriptyline 3.3 dexamethasone, prednisolone 3.4 neuroleptics () chlorpromazine, prochloperazine opioid WHO 1. By the mouth 2. By the clock 24 3. By the ladder (WHO three steps analgesic ladder) The American Pain Xocity The United States Agency for Health Care Research (Lewis,Heitkemper& Dirksen,2000) 3

47

4. For the individual opioid 5. With attention to detail

Three step analgesic ladder 1. 2.

0

1 3 Step 1 4 -6 Step 2

7 - 10 Step 3

48

Pain Severity Analgisic Choice Examples

Mild (1-3) Acetaminophen,Nonsteroidal Anti inflammatory agents (NSAID)

TylenolI buprofen

Moderate (4-6) IV Fetorelac, Oral acetaminophen Opioid combinations

Tylenol with codeine Tramadol

Severe (7-10) Opioid Morphine, Fentanyl hydromorphine

Chronic pain Step 1 Step 2 Step 3 Acute pain severe pain Step 3 Three Steps Ladder University of Michigan Health System (UMHS) (2004) 1. severe acute pain 2. start low and go slow 3. around the clock 4.

( Non-pharmacological management)

2.1 (Massage) (cerebral cortex) ( dorsal horn)

49

2.2 (touch) (MxGuire&Shielder,1993)

2.3 (Joshua, 2002)

2.4 (distraction) (Wilkie,2000)

2.5 (Relaxation technique) (Marcus, 2000) (cerebral cortex) (dorsal horn) ..

50

1. 2. 3.

1. 2. 3. 4.

Evidence based practice 1. 2. 3. 4. 5. 6. 7. 8. 9. 5

51

Control of pain in patients with cancer from A National Clinical Guideline Scottish Intercollegiate Guidelines Network

1. 2. 3. 4. 4.1 Likert or Verbal Rating Scale (VRS) 4.2 4.3 Visual Analogue Scales (VAS) 4.4 Numeric Rating Scales (NAS) 0 10 0 10 4.5 Mc Gilln Pain Questionnaire 5. 1- 4 5- 6 7 10 6. 7. 8. 9. 10.

52

Pain Management Staff Development & Education (2004) University of Michigan Health System (UMHS) From: http://www.med.umich.edu/pain/apainmgt.html

0 10 1. (Verbal Descriptive Scale : VDS) 0. 2. 4. 6. 8. 10.

2. (Visual Analouge Scale : VAS) (Graphic Scale : GRS) (simple descriptive scale) 0 2 4 6 8 10

(0 10 numeric scale) 0 5 10

(Stewarts pain color scale) 1 2 3 4 5 6 7 8 9 10

53

Pain Management Nursing : Clinical Issues By Betty Ferrell (2002)

1. / (cognitive/behavioral dimension) 1.1 (cognitive measure) (time estimation of pain magnitude) (Bilting, et al. In Mcguire 1992) 1.2 (Hanken,et,al. In Mcguire 1992) 6 2. (multiple dimension) (McGill Pain Questionmaire : MPQ) (Melzack and Torgerson in McGuire 1992) 4 (1) (2) 20 2 6 (3) (4) (Present Pain Index : PPI) 2 3. / (affective/evaluative dimension) (Johnsons component scale) 2 1 (pain sensation scale) 2 0 1 2 3 4 5 6 7 8 9 10 0 1 2 3 4 5 6 7 8 9 10

54

4. (sensory discriminative dimension) (Verbal Descriptive Scale : VDS) (Visual Analouge Scale : VAS) (numeric scale)

1.

2. 5 2.1 ( 1 10) 2.2 4 ( 1 10) 2.3 2.4 2.5 2.6

3. 3.1 0 10 3.2 0 -10 3.3 () 3.4 3.5

55

4.

5. case study

1. 0 -10

56

1. 2-3 2. 1 3. 4. 5.

1. 2. 3. Plan Do Check Action

/

58

1. . (2552). . 15 2552. http:///www.stouhealth.org/index.php. 2. . (2548). . . 10 2548. 10.00 12.00 . . 3. (2536) . 4. . (2009). . 15 2552. http:///www.panyathai.or.th/wiki/index.php. 5. . (2538). . , 26 1, - 2538, 23-30 6. . (2541) 7. . (2542) () 8. . (2542). () Palliative care ( 17-42) ; 9. .(2544). 10. (2543) (), , ( 51-96) . 11. . .4-.6. : , 2550 12. (2528) : . 13. . (2547). - (Music-Mathematics of Feelings) Philip Bethge., 26 .. 2547, 25 1267 .

59

1. Anthony Storr, Music for Meditation. How to Meditate Octopus Publishing Group Limited, London E14 4JP. 2003 pp. 100 - 102. 2. Bernstien, L. (1988). Hospice Role in Alleviating the Emotional Stress of Terminal Patients and Their Families Lippincott Williams & Wilkins. London. 3. Bonica, J.J. (1990), cancer pain In the management of pain (2 ed.) (pp. 400 - 460) philadephai Lea & Febiger. 4. Cara ceni, A. (1996). Evaluation of cancer pain : multitidimensional assessment and Pain syndromes in J N. Compbell (Ed), pain 1996 an updated review : Refresher Coure syllabus (pp. 219 245). British Columbia : Canada. 5. Caroll D. & seers k. (1998) Relaxation for the relief of chronic pain : a systematic Review Journal of advanced Nursing 27 476 487. 6. Castillo Richmond, A., et al. (2000). Effects of Stress Reduction on Carotid Atherosclerosis in Hypertensive Affrican Americans. Stroke, Mar, 31 (3), 568 73. 7. Cleeland, c.s. et al (1994) Pain and its treatment in out patients with metastatic review. England Jo. jurnal of Medicine., 9, 592 596. 8. Dalton Ja. Lambe C, (1995) Tailoring treatment approacher to the individualized needs of Cancer patients with pain. Cancer Nursing. 18, 180 - 596. 9. Daniel Goleman & Tara Bennett-Goleman. (2001). Emotional Alchemy : How mind can heal Heart, Harmony Books. ISBN 0-609-60752-9. 10. Elizabeth Scott. (2006). How and Why is Music a Good Tool for Health?. Neuropathy, Positive Thought,Positive Feelings. (On Line) Search in 15 July 2009. Available : http:///www.Stress.about.com/od/tensiontamers/a/music_therapy,htm. 11. Elizabeth Scott. (2007). Music and Your Body : How Music Affect Us and Why Music Therapy Promote Health . About.com Healths Disease and Condition content is review by the Medical Review Board. (0n Line) Search in 1 June 2009. Available: http:// Stress.about.com/od/tensiontamers/a/music_therapy,htm. 12. Ferrel, B.R., et al. (1996) Cancer pain guideline ; Now that we have them, what do we Do ? Oncology Nursing forum, 21 (August), 1229-1238. 13. Ferrel, B.(2003). Components of pain. In B.S. Marie(ed), Corn curriculum for pain Management nursing (pp. 150-167). Philadelphia : W.B. Saunders compang. 14. Frances H. Rauscher, & Gordon L. Shaw. (1997). Music Training Causes Long-Term Enhancement of Preschool Childrens Spatial-Temporal Reasoning. Neurological Research, 1997, Volume 19, February. pp. 1 8. 15. Gordon Shaw Frances Rauscher. (1993). Music and Spatial Task Performance. Science Correspondence Journal. 365, 611 (14 October 1993).

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16. Holm, L & Fitzmaurice, L. (2008). Emergency department waiting room stress: can music or aromatherapy improve anxiety scores?. Pediatric Emergency Care Journal. 2008 Dec; 24 (12) : 836 - 8. 17. http:///www.Stress.about.com/od/tensiontamers/a/music_therapy,htm. 18. Joshua, W. (2002) psychological Evuluation of Chronic pain In C.A. Warfield & H.J. 19. Joyce M. Cheek, & Lyle R. Smith. (1999). Music Training and Mathematics Achievement. Adolescent Journal. Vol. 34, 1999. 20. Luck mann, J, & Sorensen. K.C. (1993). Pain assessment and intervention. In I.M. Black & E.M. Jacobs (Eds.). Medical surgical nursing s psychophysiologic approach. 21. Pitcher & Duncombe. (2000) Malignant pain : cancer pain. M muna of J Thim, Chronic pain : a Hand book for nurses. pp. 65 74. Philadephia : Plant a tree. 22. Richard, L.M.(1998). Cancer Pain Management In C.D. tollison & J.R. Satterthwaite & J.W. Tollison Pain Management. (3 ed). (pp. 597 - 630). Philadelphia : Wolters Kluwer. 23. Rimmer, L.M. (1998) What every hom health care nurse should know about complementary Therpy. Home Health Care Nurse. 16 (11), 260 - 265. 24. Roth, A, J, & Breibart, W, i.(1996). Psychiatric emergencies interminally ill patients. Hematology Oncology clinics of North America, 1, 235 - 239. 25. Scottish Intercollegiate Guidelines Network. (2000). Control of pain inpatients with cancer : SIGN 26. Sloman R. Brown P. Aldana E. the use of relaxation for the promotion of comfort and pain Relief in persons with advanced cancer. contemp nurse 1994 ; 3:6-12. 27. Thomas Elbert (2009). The effect of piano lessons on the vocabulary and verbal sequencing skills of primary grade students. J.M. Piro and C. Ortiz (2009) Psychology of Music 37, 325 - 347. 28. Tudor Vieru. (2009). Heart Disease Patients Alleviate Stress Through Music. Sound have a Calming Effect on Heart. Journal of Science Editor. 15th April, 2009. 29. University of Michigan Health System (UMHS). ( 2004). Pain Management Staff Development & Education (online), Available: http://www.med.umich.edu/pain/apainmgt.html (2004, July 31) 30. Wallace KG. (1997) Analysis of recent literature concerning relaxation and imagery Interventions for cancer pain. Cancer nursing. 20(2) ; 79 - 87. 31. WHO Guideline (1990). Cancer pain relief (2 ed), world Health Organization, Geneva.

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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21.