Music for Pain Management

Music listening had significant effect on both pain severity as well as anxiety levels. On average, the pain levels decreased 27%, anxiety levels dropped 36%.

Management of pain is a major goal in the treatment of many conditions. Alongside traditional options for pain alleviation, music therapy shows promise as a powerful, non-pharmacological intervention. In addition to active therapy conducted by trained professionals, the possibilities of mere music listening in pain alleviation are intriguing. Could such a seemingly simple, everyday activity actually produce observable improvements in pain?

This question has also aroused the curiosity of scientists and the effects of music listening on pain have been investigated in a number of settings. Recent studies suggest music listening can decrease the need for sedative medication before surgery and pain-alleviating drugs after surgery, as well as decrease the experience of post-operative pain and, in combination with relaxation suggestions, support faster recovery.

These are very encouraging findings, and an important consideration in the efforts to decrease the use of opioid medication, for which the US Government Center for Health and Human Services (HHS) has devoted over $110 million to counteract opioid and heroin related abuse. However, pain is not restricted to just surgical settings. Pain is a prevalent symptom in just about any medical condition. Could music listening be a way to support pain management also on a broader scale?

As stakeholders in US government and medical care decry an opioid abuse epidemic, music is emerging as a safe, non-habit forming option for pain management

A recently published study sought to find out. It employed an innovative way of delivering music as a means for treatment of chronic pain in hospital settings. In the study, 53 patients with a wide variety of conditions such as neuropathic pain, migraine or rheumatic pain were given access to a smartphone app that delivered a standardized 20-minute music session. The patients could select what type of music they wished to listen to (jazz, classical, rock etc), but the structure of the music session was specifically designed to promote relaxation through gradual reduction of for instance tempo and volume. Towards the end of the 20-minute session, the music picked up again into a more invigorating form.

The patients were asked to fill in evaluations of their pain intensity, anxiety levels before using application as well as after the listening session. Pain intensity was rated on a scale of 0 (no pain) to 10 (most intense pain). Anxiety was rated on scale of 0 (no anxiety) to 10 (most intense anxiety). Additionally, a background questionnaire was administered to control for factors such as musical background.

According to the results of the study, the music listening app had a significant effect on both pain severity as well as anxiety levels. On average, the pain levels decreased 27%, going from a rating of 5.1 to a rating of 3.4. Furthermore, 16 participants reported a clinically significant drop in pain levels of 33% or greater. Anxiety levels showed a similar trend, decreasing from an average rating of 4.2 to 2.5, indicating a drop of 36%.

Interestingly, there was a connection between experience of pain relief and musical background. Namely, the patients who reported actively playing an instrument were more unlikely to report a decrease in pain intensity of more than 33%.

Why would music listening decrease pain? And why would this not happen as much in musically trained individuals?

There is ample evidence that relaxing music (with slow tempo and volume) can induce a relaxation response characterized by a decrease in heart rate, blood pressure, and other physiological indicators. This relaxation may alleviate anxiety and thereby the feeling of pain, coaxing the body to a state that is is finding hard to attain on its own.

Another reason for the analgesic effects of music may stem from it serving as a distraction from the pain sensation. Here, the narrow scope of our attention produces an advantage. We all know that one of the best ways to soothe a child with a boo-boo is try to attract their attention to something else. The same may in effect be happening with music that captures our attention.

In the special case of musicians, it may be that musical stimuli are processed differently, and in a way that inhibits the relaxation or distraction effects they have on musically non-trained individuals. The writers of the article speculate that musicians may be more prone to listen to music analytically, thinking about its structure and the performance of the other musicians - thereby inhibiting the full extent of the positive effects that music could have.

In summary, music listening seems like a valuable, worthwhile, and sorely needed addition to non-pharmacological pain management options. As something that may be administered through a regular smartphone, as evidenced here, it trumps many other options in approachability, non-stigmatizing nature and ease of use. And when considering the possibilities for pain management outside hospital settings, it may be that we have just scraped the surface of what music can offer.  Future studies utilizing and exploring the possibilities of smart devices, streaming services and sensor technology could show exactly how individually tailored music listening could be used as prescription medication for pain in real-life settings.

Written by Ketki Karanam & Marko Ahtisaari

References

1. Koch, M. E., Kain, Z. N., Ayoub, C., & Rosenbaum, S. H. (1998). The sedative and analgesic sparing effect of music. The Journal of the American Society of Anesthesiologists, 89(2), 300-306. http://dx.doi.org/10.1097/00000542-199808000-00005

2. Allred, K. D., Byers, J. F., & Sole, M. L. (2010). The effect of music on postoperative pain and anxiety. Pain Management Nursing, 11(1), 15-25. http://dx.doi.org/10.1016/j.pmn.2008.12.002

3. Finlay, K. A., Wilson, J. A., Gaston, P., Al-Dujaili, E. A., & Power, I. (2016). Post-operative pain management through audio-analgesia: Investigating musical constructs. Psychology of Music, 44(3), 493-513. http://dx.doi.org/10.1177/0305735615577247

4. Nilsson, U., Rawal, N., Uneståhl, L. E., Zetterberg, C., & Unosson, M. (2001). Improved recovery after music and therapeutic suggestions during general anaesthesia: a double‐blind randomised controlled trial. Acta Anaesthesiologica Scandinavica, 45(7), 812-817. http://dx.doi.org/10.1034/j.1399-6576.2001.045007812.x

5. Guétin, S., de Diego, E., Mohy, F., Adolphe, C., Hoareau, G., Touchon, J., Thayer, J.F., Julian Koenig (2016). A patient-controlled, smartphone-based music intervention to reduce pain—A multi-center observational study of patients with chronic pain.European Journal of Integrative Medicine. http://dx.doi.org/10.1016/j.eujim.2016.01.002