Can Music Reduce Pain Levels?

Dear Pain Matters blog readers,

An interesting question exists:

Can certain types of music lessen the intensity of pain in some patients?

Intuitively, I’ve always felt that music can have a deep effect on us.  Some types of music are deeply relaxing, while at the other end of the music spectrum, it can literally ‘shake us out of our boots’.

Depending on the type of music being listened to, music can evoke 1 or more of a complex range of emotions in the listener including positive emotions such as awe/reverence/gratitude, love, joy, and/or lust/passion (in our imagination or otherwise), or negative emotions such as grief/sadness, hate, and/or anger.

Hans-Joachim Trappe reports that music can cause changes in  heart rate as well heart rate variability.  Cerebral blood flow can be significantly reduced when listening to ‘Va pensioero’ (from Verdi’s ‘Nabucco‘).  A study found that relaxing, preoperative music decreased anxiety levels more effectively than oral midazolam (both ‘before’ and ‘after’ an operation)….with fewer side effects than midazolam.  Stress-related cortisol levels were significantly reduced in the music group after 30 minutes of bed rest, post-operation, compared to the non-music group.

Depending on the patient’s taste in different types of relaxing music, music involving classical and meditation music had the best results.

It is important to note that if the patient prefers meditative music over classical music, then it is likely that classical music will not reduce their pain levels at all.  In these patients, meditative music may be more effective at reducing pain levels.

This was clearly demonstrated by Montreal researchers who reported that only the ‘pleasant‘ parts of music (that induce positive emotions) resulted in significant reductions in both pain levels and unpleasantness due to experimental thermal pain in healthy people.  Thus, the ‘pleasant‘ music reduced pain significantly, while the ‘unpleasant‘ music did not change pain.

It is important to note that the notion of ‘pleasant‘ versus ‘unpleasant‘ music may vary from one person to the next.

In other words, just as ‘beauty is in the eye of the beholder’, the ‘pleasantness of relaxing music is in the ear of the beholder’.

Some people may prefer to listen to more relaxing music than others.  Still others may prefer the sound of silence over relaxing music.

Reduced heart rate, increased heart rate variability, reduced respiratory rate, etc, are all important parameters that may be regularly monitored to assess (and confirm) their links with reduced pain levels.  More research is warranted.  More on this topic in future posts…..

Have a great day,

Sabina Walker

References

(1) Bernardi et al; Dynamic interactions between musical, cardiovascular, and cerebral rhythms in humans. Circulation 2009; 30(119):3171–80.

http://circ.ahajournals.org/content/119/25/3171.full.pdf+html

(2) Roy, Peretz, Rainville; Emotional valence contributes to music-induced analgesia. Pain 2008 Jan; 134(1-2):140-7.

http://www.ncbi.nlm.nih.gov/pubmed/17532141

(3) Hans-Joachim Trappe; Role of music in intensive care medicine; Int J Crit Illn Inj Sci. 2012 Jan-Apr; 2(1): 27–31.

doi: 10.4103/2229-5151.94893

PMCID: PMC3354373

http://www.ncbi.nlm.nih.gov/pubmed/22624099

(4) Hans-Joachim Trappe; [Music and health–what kind of music is helpful for whom? What music not?].  [Article in German]; Dtsch Med Wochenschr. 2009 Dec; 134(51-52):2601-6.

doi: 10.1055/s-0029-1243066.

http://www.ncbi.nlm.nih.gov/pubmed/20013543

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Stem Cells and Nerve Pain

Dear Pain Matters blog readers,

Stem cells have always intrigued me!  One day, stem cells may even play a role in relieving nerve pain.

Recently, Sydney researchers removed mesenchymal stem cells via liposuction (lipoaspirate collection) from 10 patients with neuropathic trigeminal pain.  Once isolated, these stem cells were locally injected into the patients’ facial nerve pain fields via syringe.

It was found that the mesenchymal stem cells significantly reduced pain levels at 6 months in half of the 10 female patients with neuropathic trigeminal pain (5 patients), also resulting in reduced pain medication intake by these patients.    

This study demonstrates that stem cell therapy may offer additional pain treatment options for nerve pain sufferers (following further research).

Wishing all pain sufferers less pain.

Sabina Walker

References:

(1) Vickers ER, Karsten E, Flood J, Lilischkis R; A Preliminary Report on Stem Cell Therapy for Neuropathic Pain in Humans; Journal of Pain Research (2014); 7: 255–263

doi: 10.2147/JPR.S63361

PMCID: PMC4020887

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4020887/pdf/jpr-7-255.pdf

(2) Franchi et al; Adult Stem Cell as New Advanced Therapy for Experimental Neuropathic Pain Treatment; BioMed Research International (2014); Article ID 470983, Pages 1-10 (10 pages).

doi: 10.1155/2014/470983

PMCID: PMC4147203

http://www.hindawi.com/journals/bmri/2014/470983/

German Composer, Richard Wagner, His Painful Migraines, and the Opera Siegfried

Source of Featured Image of painting of Cosima Wagner (née Liszt), Richard Wagner, Franz Liszt and Hans von Wolzogen (by Wilhelm Beckmann, 1881):

Richard Wagner Museum, Lucerne, Switzerland 

http://www.schmerzklinik.de/2013/12/12/how-richard-wagners-operas-held-secrets-of-his-disabling-migraines-and-headaches/

Dear Pain Matters blog readers,

Richard Wagner, a gifted composer, suffered from intense migraines for more than 4 decades of his life.  He described these painful and severely disabling migraine attacks as the main plague of his life‘.    

Top pain researcher, Professor Hartmut Göbel (Kiel Headache and Pain Centre, Kiel, Germany), recently published a paper called:

Compulsive plague! pain without end!” How Richard Wagner played out his migraine in the opera Siegfried.

Many of Wagner’s compositions reflected his own deep suffering due to his recurring painful migraines.  For example, an episode portraying a painful migraine is vividly acted out in the opera Siegfried (third part of the Ring Cycle).  Wagner’s personal experience with severe migraines is mirrored in this scene, where the music starts off with a pulse-like thumping that becomes increasingly intense.  The audience experiences this as ‘a directly tangible almost painful pulsation….this frightening headache sensation.  Mime (Siegfried’s foster father, in the opera Siegfriedis seen pounding with his hammer, creating the acoustic trigger for the musically induced throbbing, painful perception (quoting from the paper by Göbel et al).

images.jpeg

Source of image:

http://www.schmerzklinik.de/ngg_tag/deutscher-schmerzpreis-2014-prof-hartmut-goebel-schmerzklinik-kiel/

The string instruments were played to correspond to 16 Hz at a tempo of 120 beats per minute (close to a typical migraine aura).  The listener may become aware of an ‘almost painful pulsation‘.  Thus, the opera Siegfried was able to precisely mirror Wagner’s own suffering due to debilitating and painful migraines!

For more information, please view:

Is it possible that the opera Siegfried may ‘acoustically transfer’ Wagner’s painful migraine experience to today’s listeners, albeit transiently (via ‘entrainment‘ and ‘vibrational resonance‘)?

The term, ‘Composer’s Pulse’, was coined by the renowned Manfred Clynes (born 1925), who found that each composer has his/her own unique ‘Composer’s Pulse’.  Thus, Wagner’s ‘Composer’s Pulse’ could incorporate the temporal and spatial neural patterns that underpinned his debilitating and painful migraines.

Thus, while certain types of music may be therapeutic and relaxing, others may (transiently) induce physical pain in some listeners (depending on the type of music).  It is already known that music can induce emotions causing listeners to cry, laugh, etc, depending on the music.

Stay tuned for music and its ability to also lessen pain ….

Have a great day,

Sabina Walker

References:

(1) Göbel CH, Göbel A, Göbel H; “Compulsive plague! pain without end!” How Richard Wagner played out his migraine in the opera Siegfried

Carl Göbel and colleagues explain why listening to Wagner might give you a headache

British Medical Journal (BMJ) 12 Dec 2013; 347  http://dx.doi.org/10.1136/bmj.f6952

(2) Göbel A, Göbel CH, Göbel H; Phenotype of migraine headache and migraine aura of Richard Wagner; Cephalalgia (2014); 0333102414527645, first published on March 28, 2014

http://cep.sagepub.com/content/early/2014/03/24/0333102414527645.abstract

(3) How Richard Wagner’s operas held secrets of his disabling migraines

Research: “Compulsive plague! Pain without end!” How Richard Wagner played out his Migraine in the Opera Siegfried (13.12.2013)

http://www.schmerzklinik.de/2013/12/12/how-richard-wagners-operas-held-secrets-of-his-disabling-migraines-and-headaches/

(4) How Wagner’s operas held secrets of his disabling migraines, headaches (December 13, 2013)

http://www.sciencedaily.com/releases/2013/12/131213094945.htm

(5) Why Wagner’s operas may give you headaches

http://www.minnpost.com/second-opinion/2013/12/why-wagners-operas-may-give-you-headaches

(6) The migraine suffering of Richard Wagner (28 March 2014)

https://www.schmerzklinik.de/2014/03/28/the-migraine-suffering-of-richard-wagner/

References for German readers and listeners:

(1) Richard und Cosima Wagner: Ehekrach wegen Migräne

http://www.schmerzklinik.de/2013/12/15/richard-und-cosima-wagner-ehekrach-wegen-migraene/

(2) Wie Richard Wagner das Geheimnis seiner Migräne in der Oper Siegfried verbarg

http://www.schmerzklinik.de/2013/12/12/wie-richard-wagner-das-geheimnis-seiner-migraene-in-der-oper-siegfried-verbarg/

(3) Das Migräneleiden von Richard Wagner aufgeklärt

http://www.schmerzklinik.de/2014/03/29/das-migraeneleiden-von-richard-wagner-geklaert/

(4) Göbel H; NDR Kulture Klassik à la carte; NDR Kultur (16 January 2017, 13:00 – 14:00)

http://www.ndr.de/ndrkultur/epg/Volkskrankheit-Kopfschmerzen,sendung604696.html

Complex Regional Pain Syndrome, Dysfunctional Capillaries and Reduced Oxygenation

Dear Pain Matters blog readers,

Danish researchers just published a paper called:

‘Capillary dysfunction and impaired tissue oxygenation in complex regional pain syndrome: A hypothesis’

(in press still)

People with complex regional pain syndrome (CRPS) have severe pain in either a hand, arm, foot, or leg.  This may occur after physical trauma, crush injury, etc.  In the acute stage of CRPS, the autonomic nervous system appears completely ‘out-of-balance’, as evidenced by reddening, excess swelling and sweating of the affected limb region.

Danish researchers provide a hypothesis that localised hypoxia may lead to CRPS.  Prolonged hypoxia (significantly reduced oxygen saturation, oxygen deficiency, and blood flow disturbances) in the capillaries of the CRPS-affected limb may maintain CRPS.  Localized hypoxia can lead to small-fibre dysfunction (and even neuronal cell death), localised inflammation and, of course, severe pain.

Getting to the bottom of CRPS is necessary.  This will enable prompt diagnosis and proper treatment.

I recently co-wrote a 24-page Review Paper (published in 2011) that fits in very well with the Danish researchers’ hypothesis (see below).

Of course, the good news is that once the pain researchers can confirm the key mechanisms that underly CRPS, this will hopefully lead to prompt and effective treatments for CRPS patients (and hopefully, lead to recovery from CRPS).

Another point:

Recovery from CRPS is possible in some patients (with proper treatment).  This is evidenced by the very large Table that is included in our 24-page Review Paper that lists many studies that have successfully (or, at least, partly successfully) treated CRPS patients (more on this later).

Have a great day!

Sabina Walker

References:
(1)  Østergaard et al; Capillary Dysfunction and Impaired Tissue Oxygenation in Complex Regional Pain Syndrome: A Hypothesis; Pain, Volume 155, Issue 10 , Pages 1922-1926, October 2014

http://download.journals.elsevierhealth.com/pdfs/journals/0304-3959/PIIS0304395914002802.pdf

(2) Sabina Walker and Professor Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome; Pain Medicine, Volume 12, Issue 12, Pages 1784–1807, December 2011

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01273.x/abstract

Nerve Pain (Neuropathic Pain) and Heart Rate Variability

Dear Pain Matters blog readers,

I recently enjoyed this excellent Review Paper:

Heart Rate Variability and Experimentally Induced Pain in Healthy Adults: A Systematic Review (March 2014)

While chronic pain is currently assessed via the McGill Pain Questionnaire, and other diagnostic tests, there is scope for additional non-invasive tests for assessing pain levels.  Heart rate variability (HRV) testing may be done ‘before’, ‘during’, and ‘after’ pain treatment(s) in a real-time manner.

Heart rate variability measures can provide important insight into autonomic nervous system (ANS) function.  Low HRV has been linked with many chronic conditions including heart disease.

Julian’s team reviewed 20 different studies involving experimentally-induced pain in healthy adults.  It found that induced pain in healthy people usually resulted in increased sympathetic activity and reduced parasympathetic (vagal) activity.

Many different chronic inflammatory conditions have been linked with ANS dysfunction, as indexed by HRV.

In the ‘Conclusion’ of the Review Paper by Thayer’s team, it is stated that reduced HRV is observed in many painful conditions including:

– Complex regional pain syndrome (CRPS);

– Fibromyalgia;

– Neck pain;

– Irritable bowel syndrome; and

– Headache.

Ongoing research is warranted to ascertain the usefulness of HRV in the assessment of pain levels, as well as its ability to assess the effectiveness of pain treatments.

Wishing all pain patients a pain-free day,

Sabina Walker

Reference

Koenig, Jarczok, Ellis, Hillecke, Thayer; Heart Rate Variability and Experimentally Induced Pain in Healthy Adults: A Systematic Review; European Journal of Pain (March 2014); Volume 18, Issue 3, Pages 301–314

http://robjellis.net/papers/Koenig_et_al_2013_EJP.pdf

Sperm Whales….What they can teach us about pain….

Dear Pain Matters blog readers,

As we all know, most humans have 5 senses (i.e. sight, hearing, touch, smell, and taste).  In addition to these 5 senses, some consider pain to be a 6th, albeit very unpleasant, sensation/sense/perception.

Today, I will share something amazing about sperm whales, and their ability to use echolocation, or biosonar, as one of their senses (like other cetaceans, bats, etc).

I recently read James Nestor’s book called ‘Deep – Freediving, Renegade Science and What the Ocean Tells Us About Ourselves’.

In the chapter called ‘-10,000′, James describes his own personal experience while in the ocean with a friend, Prinsloo, and two sperm whales (a mother and her calf).  He states that these whales’ echolocation clicks sound ‘like jackhammers on pavement’, while ‘the whales are scanning us inside and out’ (like an ultrasound machine!).  While in the water with these 2 whales, James and Prinsloo heard (and even felt the vibrations of) the rhythm of the whales’ clicks change from echolocation clicks to another type of click rhythm called coda clicks.  While in awe of these 2 whales, James and Prinsloo were literally showered with coda clicks and echolocation clicks….that eventually faded away as the 2 sperm whales disappeared….’and the ocean, once again, (fell) silent’.

The sperm whales’ echolocation clicks, even when produced miles under the sea, are strong enough to cause a five-foot long piece of timber (i.e. wooden oar) to vibrate, making ‘an audible clicking sound’ (a soft ‘tick-tick-tick’).

I could go on and on about this interesting book called ‘Deep’, but I will let you read this book yourself. However, there is one other part I would like to bring to your attention:

A pod of female sperm whales, when approached by (another) free diver, ‘showered him with clicks and gently interacted with him’ for many hours.  However, a perturbed young bull sperm whale approached him, somewhat annoyed at all this attention that the female whales were giving to this free diver.  This bull whale ‘shot (the free diver) with clicks powerful enough to stun him.  He managed to kick to the surface and crawled back to the ….boat, where he experienced debilitating pain in his stomach and chest.’  (Isn’t the bull whale’s ability to induce acute pain in the free diver amazing??  What a display of energy and power by nature!)  ‘After three hours, he recovered fully….’

On a different day, another diver was approached by a curious calf whale who started to bump the diver with its nose.  When the diver held his hand out to gently push the calf back, he ‘felt a sudden shock of heat rush up his arm.  The energy from the clicks coming out of the calf’s nose was strong enough to paralyse (the diver’s) hand for the next few hours.  He too recovered.’

What does this tell us?  Pain (acute or otherwise) can have many different causes/triggers (including exposure to certain mechanical vibrations). As weird as it may sound, certain vibrations in the sea caused by an acutely stressed whale can even cause instant and excruciating acute pain in humans who happen to be swimming nearby.

This brings us to the centuries-old philosophical question – what exactly is pain?  For example, how can acute pain arise in a diver who is merely in the watery vicinity of a stressed sperm whale that is emitting pain-inducing vibrations through the water??  What vibrational patterns are inherent in these pain-inducing clicks??  Are these certain vibrational patterns used by some animals to generate acute pain or (partial) paralysis in other animals including humans?  If yes, what are these pain-inducing vibrational patterns?  Will we be able to decipher these ‘pain patterns’ one day?  If there are ‘pain-forming vibrational patterns’, can these ‘pain patterns’ be reversed, leading to the reversal of pain itself?  These, and other pain-related philosophical questions, remain our challenges.

In the book ‘Deep’, 3 hours after being painfully stunned by the whale’s pain-inducing clicks, the free diver luckily recovered.  From a biological perspective, did the free diver recover because he was able to get out of the water, and hence, away from the stressed whale’s pain-inducing clicks/vibrations in the water??

I hope one day you will enjoy James Nestor’s book called ‘Deep’.  It will take you to another world, being the wet, wild, and watery world of our oceans that is teeming with life. The wonders of nature never cease to amaze….

In the meantime, please also enjoy the following YouTube that celebrates the awe-inspiring beauty and wonder of sperm whales:

‘The Azores — Photographing Sperm Whales With Dr Chris Brown And Krystle Wright’ (Canon Australia)

https://youtu.be/_USBDcAtjcc

Until my next Pain Matters blog,

Sabina Walker

Reference:

Nestor, James; Deep – Freediving, Renegade Science and What the Ocean Tells Us About Ourselves; 2014 http://www.amazon.com/Deep-Freediving-Renegade-Science-Ourselves/dp/0547985525

Long-Lasting Reduction of Phantom Limb Pain Following Pharmaceutical Blockade of the Brachial Plexus

Dear Pain Matters blog readers,

More hope for Phantom Limb Pain sufferers…

Phantom Limb Pain was reduced for a long time (in fact, 6 months) in one patient following pharmaceutical blockade of the brachial plexus.  

Prior to this single temporary blockade, this patient had suffered years of Phantom Limb Pain and cramping of his immovable phantom hand.

During a diagnostic axillary blockade of the brachial plexus, the patient experienced a reduction of Phantom Limb Pain for the first time in years.  The muscles in his phantom hand became relaxed and the ‘cramping’ in his phantom hand was also 100% eliminated.

The reduction in Phantom Limb Pain was accompanied by blockade-induced cortical reorganisation in the primary somatosensory cortex (i.e. re-reorganisation).

In summary, the good news:

The beneficial effects of a sole blockade of the brachial plexus were long-lasting (extending out to 6 months after a single temporary blockade) in this one patient.

Given the long-lasting therapeutic effects of the Brachial Plexus Blockade in this patient, it is likely that his Phantom Limb Pain was (at least in part) caused by peripheral mechanism(s).

The mechanisms underlying Phantom Limb Pain may vary from one patient to the next, and may either be peripherally– and/or centrally-mediated.  Once (pain-inducing) mechanisms are identified, pain treatment options may be tailored to each patient, hopefully leading to reduced pain levels as well as improved function and well-being.

(Possible mechanisms underlying chronic pain will be discussed in future blog posts.)

‘DEREK’, AND HIS NERVE BLOCK FOR PHANTOM LIMB PAIN

Another patient, ‘Derek’ (see below Youtube that shows 4 pain patients) had severe Phantom Limb Pain before he was offered a Nerve Block.  Derek’s Phantom Limb Pain had resulted due to amputation above his left knee following a blast while deployed in Iraq.  

The pain-reducing effects of a Nerve Block were amazing, and gave Derek a new lease on a life with significantly reduced Phantom Limb Pain and increased mobility (that even included long-distance running via a specially-designed prosthesis).  

Regarding the successful pain-relieving effects of his Nerve Block, Derek states (quoting; go to 27:43 in the Youtube, below):

“….At that moment, it was instant pain relief for me.”

Thus, Derek’s Nerve Block offered instant and complete pain relief.  This suggests that the mechanisms underlying Derek’s nerve pain including Phantom Limb Pain were completely peripherally-mediated (more on pain mechanisms later). 

Wishing you ALL a great, pain-free day,

Sabina Walker

References (NB This is not a complete list of References):

(1) Preißler et al; Brachial Plexus Block in Phantom Limb Pain: A Case Report; Pain Medicine (Nov 2011); Vol 12 (11); 1649–1654;

DOI: 10.1111/j.1526-4637.2011.01247.x

http://onlinelibrary.wiley.com/doi/10.1111/j.1526-4637.2011.01247.x/abstract