Jurnal Kesehatan

Vol. 15, No. 1, April 2024

ISSN 2086-7751 (Print), ISSN 2548-5695 (Online)
http://ejurnal.poltekkes-tjk.ac.id/index.php/JK

Combination of Autogenic Relaxation Therapy with Instrumental

Audiomusic to Reduce The Pain Scale of Patients After Caesarean Section

Dian Ayu Ningsih Ismi, Aprina*, Purwati

Nursing Department, Poltekkes Kemenkes Tanjung Karang, Bandar Lampung, Indonesia

ARTICLE INFO ABSTRACT

Article history Pain on the first day of cesarean section creates psychological anxiety and fear of pain
after the drug reaction ends. One method of pain management is autogenic relaxation
Received date therapy using instrumental audiomusic media. This study aims to determine the effect
07 Feb 2024 of autogenic relaxation using instrumental audio music on the pain scale in post-
cesarean section patients at RSUD Dr. H. Abdul Moeloek Lampung Province. This
Revised date research uses a quantitative approach with a pre-experimental one-group pretest-
10 Mar 2024 posttest design. The research was conducted from February to March 2023. The
population in this study consisted of patients after the cesarean section. The sampling
Accepted date method in this research used the Accidental Sampling technique and obtained a sample
20 Mar 2024 of 32 respondents. The instrument used to measure the pain scale is the Numerical
Rating Scale (NRS), an observation sheet that records the pain scale before and after
the procedure. Statistical tests use the Wilcoxon signed rank test. The research results
Keywords: showed that the average pain scale decreased from 7.28 to 6.21 before and after the
intervention. Thus, a p-value of 0.000 was obtained (p-value<0.05), which means that
Numerical Rating Scale; there was an effect of autogenic relaxation using instrumental audio music on the pain
Non-pharmacological scale in post-cesarean section patients at RSUD Dr. H. Abdul Moeloek, Lampung
therapy; Province in 2023. Researchers suggest that nurses or midwives treat pain not only with
SC pain. pharmacological therapy but also with non-pharmacological therapy, namely autogenic
relaxation with instrumental audio-music media.

Corresponding author:

Aprina
Nursing Department, Poltekkes Kemenkes Tanjung Karang, Bandar Lampung, Indonesia
Email: aprinamurhan@yahoo.co.id

INTRODUCTION was 19.8% from a sample of 31,764 mothers

who gave birth in the last five years and were
Cesarean section is a birth that is made surveyed from 33 provinces (Ministry of Health
where the fetus is removed through an incision RI, 2018).
in the uterus and abdomen in one piece, and the Based on previous research by Sukma &
fetal mass is above 500 grams (Ulandari et al., Sari (2020) about the Influence of Pregnancy
2022). Age Factors on the Type of Delivery at Dr. H.
According to the World Health Abdul Moeloek Lampung Provincial Hospital,
Organization (WHO) in Mulyainuningsih et al., the number of deliveries was 1461. Of these
(2021), about 5-15% of births worldwide are data, 606 spontaneous births, 92 forceps
performed via cesarean section. Data from the extractions, 454 vacuum extractions, and 309
WHO's Global Survey on Maternal and cesarean sections were performed.
Perinatal Health 2021 shows that 46.1% of all Wounds in the abdominal wall and uterus
deliveries are by cesarean section. Based on the cause pain (superficial pain) by severing nerve
2012 Indonesian Demographic and Health fibers and also by pressure of the sutures.
Survey (IDHS) results, 12% of deliveries were (Morita et al., 2020). The pain associated with a
performed by cesarean section. The incidence cesarean section is 27.3% higher compared to
rate was 7% higher in the 2012 IDHS compared standard delivery, which is only 9%. Pain on the
to the 2007 IDHS results (Mulyainuningsih et first day of a cesarean section causes
al., 2021). Based on the 2018 Basic Health psychological anxiety and fear of pain after the
Survey results, the cesarean section rate in drug reaction ends (Utami et al., 2016).
Indonesia exceeds the maximum WHO standard For some women, effective and
of 5-15%. The cesarean section rate in Indonesia appropriate treatment is required to minimize

66
 Ismi et al., Combination of Autogenic Relaxation Therapy with Instrumental Audiomusic
to Reduce The Pain Scale of Patients After Caesarean Section 67

pain and not harm their health. During recovery, consisting of form and style, timbre, rhythm,
when the pain medication wears off, the client harmony, and melody, which are adjusted to
can still feel pain. There is evidence that many produce music that has benefits for mental and
patients experience pain even after taking physical health (Bingan, 2020). Music can
painkillers (Haryani et al., 2020). Medications improve, heal, and maintain mental, social,
and treatments commonly used in physical, emotional, and spiritual health as a
pharmacological and non-pharmacological pain therapy. Music has many benefits; it is fun,
management include stimulation and massage soothing, relaxing, structured, and universal.
techniques, transcutaneous electrical nerve Since human breathing, heart rhythm, and pulse
stimulation, distraction, and autogenic are all rhythmic and repetitive, music can be a
relaxation techniques (Syamsuddin & Modjo, companion in restoring and preventing pain
2014). Relaxation techniques are non- (Bingan, 2020). Based on research conducted by
pharmacological pain management techniques Mappagerang et al. (2017), music therapy
that can be used to manage acute pain, especially relaxes patients and reduces pain levels.
pain due to diagnostic and surgical procedures. Based on some of the descriptions above,
Post-cesarean section patients are often the researcher combined relaxation with
afraid to move their limbs for fear of pain. audiomusic instrumental media to reduce the
Because of the pain, patients usually do not do pain scale in post-cesarean section patients.
independent activities and do not protect their When these two procedures are combined, the
environment. Pain management at Abdul results are very effective and efficient on the
Moeloek Hospital: administration of analgesics pain scale, namely through the production of
such as ketorolac, mefenamic acid, and endorphins by the brain, which function as a
paracetamol, as well as warm compresses and natural tranquilizer. In addition, both focus on
deep breath relaxation techniques. However, breathing and heart rate to create a sense of well-
autogenic relaxation with instrumental audio- being and reduce pain. So researchers are
music media has never been applied. interested in researching autogenic relaxation
Autogenic relaxation comes from within with audiomusic instrumental media on pain
through words, short phrases, or thoughts that scale in post sectio caesarea patients at Dr. H.
can create peace. In autogenic relaxation, the Abdul Moeloek Lampung Hospital.
self imagines a calm state and focuses on
regulating breathing and heart rate. This
relaxation helps increase parasympathetic nerve METHOD
activity and further inhibits sympathetic nerve
activity. The autogenic relaxation technique This type of research is quantitative with a
aims to bring the mind to an optimal mental state pre-experimental design. The research design used
(Saunders, 2012). pre- and post-tests of one group. The research was
Based on previous research conducted by conducted in February-March 2023. The
Sonhaji et al. (2021), autogenic relaxation is a population of this study consisted only of post-
relaxation technique that can produce cesarean section patients at Dr. H. Abdul Moeloek
endorphins, which act as natural relaxants and Hospital Lampung Province, with a sample size of
are produced by the brain. This hormone creates 32 respondents according to the calculation using
a pleasant feeling and thus can relieve pain. the Lameshow formula.
According to Burhan et al. (2022) study, there is The sampling technique used accidental
an increase in comfort status after autogenic side and met the inclusion criteria consisting of
relaxation therapy. patients with composmentis status, patients with
In addition to autogenic relaxation therapy conventional cesarean section after completion of
that can be used in patients with pain after a surgery for more than 6 hours, patients aged 20-45
cesarean section, there is another relaxation years, willing to undergo the procedure, patients
therapy that can relieve pain. This therapy is done with signed informed-consent; Exclusion criteria
by listening to instrumental music. Music therapy include patients with hearing loss, heart disease,
is a health therapy that uses music to treat diabetes mellitus, Covid-19 positive patients and
problems related to various factors of individual hypertension patients. and patients who are not
psychological, cognitive, social, and physical willing to be respondents.
needs (Mappagerang et al., 2017). An observational pain scale was used to
According to Smeltzer & Bare (2002), the collect data. Post-cesarean section patients
purpose of music therapy is to improve mental received non-pharmacological treatment
and physical quality through sound stimulation (autogenic relaxation with instrumental audio-
68 Jurnal Kesehatan, 15(1), 66-71, http://dx.doi.org/10.26630/jk.v15i1.4262

music media), and the pain scale was measured Table 1. Respondent characteristics
with a Numerical Rating Scale (NRS) pain meter. Respondent characteristics n %
Data collection is carried out in 3 stages, the Age
first stage is that the researcher identifies patients Late adolescence (17-25) 7 21.9
who meet the inclusion criteria, then explains the Early adulthood (26-35) 17 53.1
research procedure and the purpose and purpose of Late adults (36-45) 8 25.0
Jobs
the research to be carried out, if the respondent is
Housewife 23 71.9
willing to participate in this study the research Civil servants 9 28.1
subject signs informed consent, the researcher Tribal Nation
makes an agreement with the respondent to get a Lampung 9 28.1
relaxation technique that will be received for Jawa 20 62.5
approximately 20 minutes, then explains the Palembang 2 6.3
standard operating procedures of autogenic Sunda 1 3.1
relaxation and instrumental music, then the Operation Experience
researcher conducts a pre-test for pain assessment Ever 8 25.0
with a numeric rating scale, for the observation Never 24 75.0
sheet will be filled in by the researcher; in the
second stage, the researcher intervenes by giving Table 2 shows the average measurement of
mp3 and attaching earphones to the patient to the pain scale before intervention was 7.28. The
listen to a combination of autogenic relaxation and standard deviation results were also obtained at
instrumental music classic and the duration of the .729; the lowest pain scale was 6, the highest pain
intervention is 20 minutes; and in the third stage scale was 8, and the average pain scale
the researcher conducts a post-test for pain measurement after the intervention was 6.12. The
assessment with a numeric rating scale after 20 standard deviation results were also obtained at
minutes of intervention, after the data is collected, .793; the lowest pain scale was 4, and the highest
the researcher checks the completeness of filling pain scale was 7.
in the observation sheet data, then processes the
data obtained with a computer program, then after Table 2. Distribution of pain scale before and
the statistical analysis is done, it is interpreted in after autogenic relaxation with
the discussion and conclusions are compiled into audiomusic media instrumental
the research report. Pain Std. Min -
Mean Median
Scale Deviasi Max
Data analysis used is univariate and
Pre 7.28 7.00 .729 6-8
bivariate analysis. Univariate analysis in this Post 6.12 6.00 .793 4-7
study is the independent variable (autogenic
relaxation with instrumental audio music media) Table 3 concluded that the average
and the dependent variable (pain scale in post- difference in pain scale is 1.16 before and after
sectio caesarea patients). The statistical test used intervention. The results of statistical tests with the
was the Wilcoxon signed rank. This research has Wilcoxon Signed Ranks test obtained a p-value of
undergone an ethical review process and 0.000 (p-value<0.001<α0.05); it was concluded
obtained an Ethical Exemption with number that there was an effect of giving autogenic
015/KEPK-TJK/I/2023 by the Health Research relaxation with instrumental audiomusic media on
Ethics Committee of the Poltekkes Kemenkes the pain scale in post sectio caesarea patients at Dr.
Tanjung Karang. H. Abdul Moeloek Hospital, Lampung Province in
2023.
RESULTS Table 3. Difference analysis test results pain
measurement pre-test post-test
Table 1 shows that most respondents are autogenic relaxation with audiomusic
in early adulthood (26-35 years), as many as 17 media instrumental
people (53.1%). Most occupations as housewives Pain Std. Sum of p-
were 23 people (71.9%). Most respondents came n Mean
Scale Deviasi Ranks value
from the Javanese ethnic group, 20 people Pre 32 7.28 .729
(62.5%). Most respondents, 24 (75%), had no 465.00 <0.001
Post 32 6.12 .793
previous surgical experience.
 Ismi et al., Combination of Autogenic Relaxation Therapy with Instrumental Audiomusic
to Reduce The Pain Scale of Patients After Caesarean Section 69

DISCUSSION (65.5%) had no previous surgical experience.

Respondents have no experience with surgery but
Pain scale before autogenic relaxation with are not familiar with pain and, therefore, do not
instrumental audiomusic media on pain scale know how to feel pain.
In the researcher's opinion, they are seen
The results of the average pain scale from the characteristics of respondents' age,
analysis test on 32 respondents found that the ethnicity, and history of surgical experience,
average pain before the autogenic relaxation where in the age characteristics of most
intervention with instrumental audio-music media respondents, namely 17 people (53.1%) in the
was 7.28. early adult category (26-35 years). Researchers
The average results of the pain scale before assume that in early adulthood, a person will be
intervention in post-sectio caesarea patients align more able to withstand and control pain. In early
with the research of Mappagerang et al. (2017), adulthood, cell function is still undergoing cell
showing that the average value of pain levels regeneration (formation), so a person's adaptive
before intervention was 8.33. Also supported by response to pain will be lower.
research by Amalia and Agustina (2020), they However, when viewed from ethnicity,
obtained the average pain scale results before most respondents were Javanese, as many as 20
intervention in post-sectio caesarea patients, people (62.5%). Researchers assume that
namely 7.75. respondents with Javanese ethnicity are more
According to the theory of Potter and Perry closed in responding to pain, while those with
(2016), the elderly are at high risk of being in Lampung and Palembang ethnicity will express
situations that cause them pain. The reason is that their pain response more.
the elderly suffer from pathological diseases that Meanwhile, when viewed from the history
lead to pain. Elderly people who suffer from pain of the respondents' surgical experience, most of
can experience significant functional impairments the respondents had no previous history of
such as mobilization, socialization in the home surgery, as many as 24 people (75%). Researchers
environment, self-care activities, and decreased assume that respondents who have never had a
activity tolerance. history of surgery have a higher pain scale than
In addition, Potter and Perry's theory (2016) respondents who have had surgery. Respondents
also says that cultural beliefs and values can affect who have never had surgery may be more anxious
how a person deals with pain. Individuals learn about the pain they feel, so their perception of the
what is expected and accepted in their culture, pain they feel increases. Meanwhile, someone
including how to respond to pain. who has experienced a history of surgery and feels
This is also supported by the theory of prolonged pain will be more tolerant of pain.
Potter & Perry (2016) that when a person has
experienced a series of pains that do not go away Pain scale after autogenic relaxation with
over some time, or when they experience severe instrumental audiomusic media on pain scale
pain, anxiety or even fear can arise. On the other
hand, when a person experiences the same type of The results of the analysis test of the
pain repeatedly but can be alleviated, they find it average pain scale in 32 respondents found that the
easier to interpret the pain sensation. They are average pain after autogenic relaxation
more willing to accept the actions needed to intervention with instrumental audio-music media
relieve the pain. was 6.12.
This study aligns with the research of The decrease in pain scale is not the same
Febriaty and Anita (2021), who obtained data that between one individual and another. This study
ages 20 to 35 years (65.7%) feel pain more often aligns with the theory of Potter and Perry (2006)
than those over 35 and under 20 years. At the age that relatively small changes in value occur due to
of 20-35 years, a person is still learning to control several factors. One of them is that due to
his pain, so many patients at the age of 20-35 years subjectivity, there are no two occurrences of the
experience pain. same pain that cause the same response or feeling
In addition, in the research by Febriaty and in individuals.
Anita (2021), it was also found that most This research is in line with the research of
respondents were Javanese (54.1%). The customs Saputra et al. (2023), showing that the average
taught by ethnic groups vary, as does the way autogenic respondent's head pain scale on a pain
culture teaches a person to feel pain. scale of 5 (range 0-10) before being given
Also supported in research by Febriaty & relaxation and the average respondent's head pain
Anita (2021), it was found that most respondents
70 Jurnal Kesehatan, 15(1), 66-71, http://dx.doi.org/10.26630/jk.v15i1.4262

on a scale of 3 (range 0-10) after being given from the trigeminal nerve are inhibited and cause
autogenic relaxation. the substantia gelatinosa of the thalamus to close,
Also supported was research by stopping stimulation of the cerebral cortex and
Mappagerang et al. (2017), who obtained the reducing pain intensity.
research results on the average pain scale after the The effects of instrumental music can
intervention, namely 7.36, with an average decrease sympathetic nervous system activity,
difference of 0.98. reduce anxiety, heart rate, blood pressure, and
According to the researcher, the decrease in respiratory rhythm, and have a calming effect on
the average pain scale in respondents is due to sleep and muscle relaxation (Septiani et al., 2020).
autogenic relaxation combined with instrumental This research is in line with the research of
music, which can control blood pressure, Saputra et al. (2023) that the average respondent's
respiratory function, blood flow in the body, and head pain scale was on a pain scale of 5 (range 0-
heart frequency becomes smooth so that it has a 10) before being given autogenic relaxation, and
positive impact in the form of calmness for the average autogenic respondent's head pain was
someone who listens to it, which can reduce a on a scale of 3 (range 0-10) after being given
person's anxiety and pain. relaxation. The results of the paired T-test showed
that Ha was accepted, indicating an effect of
Effect of autogenic relaxation with instrumental autogenic relaxation on reducing hypertension
audiomusic media on pain scale in post-sectio pain (p-value 0.000 <0.05).
caesarea patients It is also supported by the research of
Mappagerang et al. (2017) obtained the results of
Based on the study's results, there was a the study of the average value of the pain scale
decrease in the average pain scale before and after 8.33 before intervention and after the intervention,
autogenic relaxation with instrumental audio- namely the mean 7.36 with an average difference
music media by as much as 1.16. The results of 0.98, standard deviation 0.235 with a min value
obtained indicate that there is an effect of giving of 1 max 1 with a p-value=0.0001 with p<α=(0.05)
autogenic relaxation with instrumental audio- which is 0.0001<0.05, it is concluded that there is
music media on the pain scale in post-sectio an effect of music therapy on pain levels in
caesarea patients at Dr. H. Abdul Moeloek fracture patients at Nene Mallomo Hospital,
Hospital, Lampung Province, in 2023. Sidrap Regency, which means Ho is rejected and
This study aligns with the theory of Ha is accepted.
Smeltzer and Bare (2002) that relaxation According to the researcher, the effect of
techniques can relieve pain by releasing muscle autogenic relaxation with instrumental audio-
stiffness that makes pain. music media on the respondent's pain scale is
Relaxation techniques allow for individual because autogenic relaxation by breathing and
self-control in pain and physical and mental stress closing the eyes can help a person become more
in times of illness. Autogenic relaxation allows relaxed and focused, allows the person to control
individuals to control various bodily functions respiratory function, blood pressure, blood
such as blood pressure, breathing, blood circulation in the body and a stable heart rate.
circulation, and heart rate to achieve a relaxed They were combined with the sound of
state. Autogenic training can train individuals for instrumental music that provides positive effects
self-suggestion. The goal is for the individual to for the listener in the form of calmness and
relax their muscles and control or reduce coolness. This results in a relaxing effect that can
emotional responses (Asmadi, 2012). ease a person's pain.
In autogenic relaxation, impulses are
transmitted through non-nociceptive afferent
nerve fibers, causing the substantia gelatinosa to CONCLUSIONS
close and thus preventing and reducing pain
stimulation (Septiani et al., 2020). The two-gate Autogenic relaxation with instrumental
control theory states that in the thalamus, another audio-music media affects the pain scale in post-
substantia gelatinosa regulates trigeminal nerve section caesar patients at Dr. H. Abdul Moeloek
pain impulses. Upon relaxation, pain impulses Hospital, Lampung Province.
 Ismi et al., Combination of Autogenic Relaxation Therapy with Instrumental Audiomusic
to Reduce The Pain Scale of Patients After Caesarean Section 71

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