The BIG-5 of pain, anxiety, stress, sleep disturbances, and delirium, and the effects of music in hospitalized patients.

Hospitalized, surgical patients frequently experience pain, anxiety, stress, sleep disturbances, and delirium, collectively referred to as the BIG-5. The first four are patient-reported outcomes, which may contribute to the development of a delirium. Although not all classified as complications, all five represent a deviation from the ideal postoperative course and can significantly hinder recovery. Their subjective nature complicates detection and treatment, yet their impact is substantial, contributing to increased morbidity, prolonged hospitalization, higher medication use, and increased healthcare costs. Treatment often relies on pharmacological agents, such as opioids and benzodiazepines, which all carry the risk of serious adverse events, including respiratory depression, cognitive impairment, dependency, and increased delirium incidence. Consequently, the need for non-pharmacological strategies is increasingly recognized. Among these, pre-recorded music intervention has emerged as a promising, low-cost, safe adjunct. Music intervention effectively reduces each component of the BIG-5. Moreover, it decreases analgesic requirements. This narrative review aims to compile the evidence on the occurrence and consequences of the BIG-5, as well as to summarize clinically relevant findings with regards to music intervention as a complementary therapy. In conclusion, we highlight the importance of recognizing pain, anxiety, stress, sleep disturbances, delirium, and recommend implementing music into routine perioperative care to improve patient recovery.