The Powers of Distraction – Virtual Reality and Chronic Pain

Dear Pain Matters blog readers,

Being a mom of a teenage boy, I know all about the ‘Powers of Distraction’ of a video game!

Awareness of time and space can completely vanish and your mind can literally be taken away ‘to another world far, far away’ during an immersive 3-dimensional (3-D) virtual reality (VR) experience.

Studies:

Dr Jones and his colleagues collaborated with DeepStreamVR to test a new VR program called “Cool!” (used with VR display goggles) that was specifically designed for chronic pain patients.  The “Cool!” program incorporates biofeedback components that promote mindfulness and resilience training.  Built-in biosensors facilitate a ‘flow state’ to control the intensity of the 3-D VR experience that in turn may maximise pain relief.

Two (2) studies were performed:

  1. The first study included 10 men and 20 women with chronic nonmalignant pain (median age = 50).  All were offered only one 5-minute VR treatment session.  Of these 30 patients, 9 had 100% pain relief (30%).  Average pain scores decreased by 33% ‘after the VR session‘, compared to ‘before‘, while average pain scores decreased by 60% ‘during the VR session‘, compared to ‘before‘.
  2. The second study is still ongoing, and includes 7 patients with chronic nonmalignant neuropathic pain (median age = 50).  All 7 patients are offered three (3) 20-minute VR treatments.  Average pain scores decreased by 57% ‘after the first VR session‘, compared to ‘before‘, while average pain scores decreased by 75% ‘during the first VR session‘, compared to ‘before‘.

There were no side effects, and none of the patients experienced headache, nausea or dizziness during either of these 2 studies.  NB An older VR-based pain study noted a significant risk of ‘cyber-sickness’ during VR-based treatment.

Significantly, most of the patients experienced reduced pain that lasted anywhere from 2 to 48 hours, post-VR treatment.

Quoting Dr Jones:

“One of our most exciting early results is that the analgesia from virtual reality lasts after the session is over, sometimes days afterwards.  About 10% of subjects said it did not help, while 30% said it gave them complete pain relief while doing virtual reality.

“My initial impression is that the analgesia seems to be more pronounced, not surprisingly, in subjects who ‘get into the game’ more.  So regardless of gender, age or amount of depression, if someone allows themselves to be involved in the VR experience, it has pronounced analgesia.

Unknown.jpeg

Dr Jones showing the “Cool!” VR program to a patient.

Source:   DeepStreamVR

An earlier study showed that patients with:

  • Fibromyalgia;
  • Dental pain; and
  • Combat-related burn injuries

may obtain pain relief from VR pain treatment (Wiederhold et al, 2014).

Summary:

More patients may benefit from VR-pain-based programs once they gain affordable and ongoing access via their smartphones to programs similar to the “Cool!” program.  Ongoing research is warranted.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

Media:

(1) Virtual Reality Ventures Into Real World of Chronic Pain

Nancy A Melville

Medscape Medical News (27 May 2016)

http://www.medscape.com/viewarticle/863926#vp_2

(2) DeepStreamVR (Provider of the “Cool!” pain program)

http://www.deepstreamvr.com

Peer-Reviewed Papers:

(3) Wiederhold BK, Gao K, Sulea C, Wiederhold MD.

Virtual Reality as a Distraction Technique in Chronic Pain Patients.

Cyberpsychology, Behavior and Social Networking (2014); 17(6):346-352.

doi:10.1089/cyber.2014.0207.

(4) Garrett B, Taverner T, Masinde W, Gromala D, Shaw C, Negraeff M.

A Rapid Evidence Assessment of Immersive Virtual Reality as an Adjunct Therapy in Acute Pain Management in Clinical Practice.

Clinical Journal of Pain (Dec 2014); 30(12):1089–1098.

doi: 10.1097/AJP.0000000000000064

 

 

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Low Level Laser Therapy (LLLT) for Migraines Caused By Traumatic Brain Injury?

Dear Pain Matters blog readers,

Low level laser therapy (LLLT) may alleviate migraines in some cases.

Case Study:

A 25-year old man suffered a traumatic brain injury (TBI) when he was savagely attacked and repeatedly hit over the head with a lead pipe in May 2010.  He required many surgical stitches and sutures to close the head injury, and was left with a permanent scar on his brain.

Since that fateful day, the TBI victim experienced ongoing excruciating and incapacitating migraines for 2 long years.  His daily migraine pain ranged from 7 to 10 (on a scale from 0 to 10, using the visual analog scale ‘VAS’).  He stated that his migraines were ‘throbbing’ and ‘squeezing’, and were mainly in his occipital part of his brain.  He was unable to sleep properly nor play with his 4 children (aged up to 9) due to his constant migraines.

After ‘literally trying everything’ for 2 long years, and almost giving up hope, he agreed to try LLLT.  He was given 5 LLLT treatments over 2 weeks.

Specifically, LLLT treatment was delivered at 905 nm (near infrared) superpulsed wavelength set to 50 mW average power.  His LLLT targeted 4 areas on his scalp, 2.5 minutes each area (i.e. the occipital region, the area above the Circle of Willis as well as above the mastoid processes, both right and left side), totalling 10 minutes per treatment.

Results:

Following the first 10-minute-treatment, the patient immediately reported a 43% reduction in migraine pain (i.e. from VAS = 7 to VAS = 4).  He added that the ‘throbbing’ and ‘squeezing’ part of his migraine had disappeared immediately following his first LLLT treatment, and he was left with a residual ‘dull achy pain’.

He continued with 4 additional LLLT treatments, and his migraine pain further diminished after each treatment.

After completing 5 LLLT treatments (10 minutes per LLLT treatment), the patient’s overall migraine pain had decreased by more than 90%, while a ‘minor ache’ remained (that was hardly noticeable to him).

The patient had no side effects other than a slight ‘warm’ feeling above the region where the laser was placed.

The patient no longer has constant excruciating migraine pain, and his family says he looks much happier.  After 2 years of severely excruciating ‘throbbing’ and ‘squeezing’ migraines, he was finally able to sleep properly.

Possible Mechanisms:

Low level laser therapy (LLLT) may reduce inflammation and promote temporary vasodilation in capillaries by activating the nitric oxide pathway, leading to increased blood flow.  This may enhance oxygen delivery to TBI-affected brain regions that may ultimately lead to decreased migraine pain.

The 905 nm ‘pulsed’ (as opposed to ‘continuous’) wavelength may increase the expression of the inducible nitric oxide synthase (iNOS) gene by 700% (Stephan et al, 2012; Moriyama et al, 2009).

Summary:

Mr Banas has achieved significant success with most of his LLLT-treated migraine patients (more than 65 migraine patients including TBI and non TBI) (Stephan et al, 2012).

Targeted low level laser therapy (LLLT)  may offer significant, life-changing relief from pain due to migraines.

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

(1) Stephan W, Banas L , Bennett M and Tunceroglu H.

Efficacy of super-pulsed 905 nm Low Level Laser Therapy (LLLT) in the management of Traumatic Brain Injury (TBI): A case study.

World Journal of Neuroscience (2012), 2, 231-233.

doi: 10.4236/wjns.2012.24035

http://www.scirp.org/journal/PaperInformation.aspx?paperID=24793

(2) Moriyama Y, Nguyen J, Akens M, Moriyama E H, Lilge L,

In vivo effects of low level laser therapy on inducible nitric oxide synthase.

Lasers Surg. Med. (2009), 41: 227–231.

doi:10.1002/lsm.20745

http://www.ncbi.nlm.nih.gov/pubmed/19291752

Interstitial and Intra-Articular Laser Therapy for Chronic Pain Including Back Pain and Painful Osteoarthritis

Featured Image – Intra-articular laser treatment

Source:   http://www.webermedical.com/en/weber-medical-for-patients/the-principle/

Dear Pain Matters blog readers,

Recent developments have enabled the delivery of low level laser therapy (LLLT) beneath the skin including via:

  • Interstitial laser therapy;
  • Intra-articular laser therapy; and
  • Intravenous laser therapy.

492001f88f.jpg

Dr. Med. Dipl. Chem. Michael Weber

Source:   http://www.webermedical.com/en/the-business/dr-weber/

Overview:

This Blog Post will focus on:

  • Interstitial laser therapy; and
  • Intra-articular laser therapy

for pain management.

Different laser lights are used in interstitial and intra-articular laser therapy including:

  • Red laser light – Red laser may increase cell activity and blood circulation as well as enhance regeneration of damaged body tissues in chronic pain conditions;
  • Green laser light – Green laser may have anti-inflammatory effects in acute painful conditions including acute swellings; and
  • Blue laser light – Blue laser may have strong anti-inflammatory effects, hence reduce acute pain as well as promote wound healing.

Interstitial Laser Therapy:

(Percutaneous) interstitial laser therapy may offer some pain relief for chronic back pain (spinal pain) including:

  • Chronic spinal illnesses;
  • Slipped discs;
  • Scar pain after slipped disc surgery;
  • Spinal stenoses;
  • Neural lesions; and
  • Deep tendinitis and strains.

Interstitial laser therapy uses a sterile catheter to enable laser light (e.g. green and blue laser light) to access deep within the tissue (up to 12 cm penetration depth).  Thus, for example, blue laser light can exert its anti-inflammatory effects deep within the body tissue.

Without a sterile catheter, green and blue laser light cannot access deep body tissue regions.  Instead, most of the higher energy waves (i.e. green and blue) are absorbed in the skin during external laser therapy only.

a88d9186f2.jpg

Interstitial laser therapy

Source:   http://www.webermedical.com/en/weber-medical-for-patients/the-principle/

A Study Involving Interstitial Laser Therapy for Back Pain: 

Eleven (11) patients with chronic spinal disorders (disc herniation and spinal stenosis) received interstitial laser spine laser treatments (average = 7.64 treatments per patient).

26e7178d17.jpg

Where:

Red = Pain (before interstitial laser spine treatments)

Green = Pain (after interstitial laser spine treatments)

(‘Kreuzschmerzen’, in German = Back pain; VAS = visual analogue scale; Pain from 0 to 10)

Chronic back pain before interstitial laser spine treatment averaged 5.45 (VAS) (Refer to red).

Chronic back pain after 7 interstitial laser spine treatments decreased to an average of 2.55 (VAS) (Refer to green) (Weber).

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/clinical-results/

Intra-Articular Laser Therapy: 

Intra-articular laser therapy may offer some pain relief for painful arthroses including:

  • Knee osteoarthritis;
  • Hip osteoarthritis;
  • Painful shoulder syndromes; and
  • Ankle joint osteoarthritis.

Specifically, intra-articular laser therapy allows direct access into painful and injured/diseased intra-articular joints including knee and shoulder joints.

0693eda699.jpg

Intra-articular laser therapy

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

A Study Involving Intra-Articular Laser Therapy for Shoulder Pain:

Ten (10) patients with chronic shoulder pain received intra-articular laser treatments (average = 9.2 treatments per patient).

52560c56a3.jpg

Where:

Red = Pain (before intra-articular laser treatments)

Green = Pain (after intra-articular laser treatments)

(‘Schulterschmerzen’, in German = Shoulder pain; VAS = visual analogue scale; Pain from 0 to 10)

Chronic shoulder pain before intra-articular laser treatments averaged 6.2 (VAS) (Refer to red).

Chronic shoulder pain after 7 intra-articular laser treatments decreased to an average of 2.8 (VAS) (Refer to green) (Weber).

Source:   http://www.webermedical.com/en/weber-medical-for-professionals/clinical-results/

Other Information About Low Level Laser Therapy (LLLT):

Classical low level laser therapy (LLLT) can be topically and non-invasively applied to the skin surface and may include:

  • External laser therapy;
  • Laser needle acupuncture; and
  • Laser needle treatment of the skull (transcranial) and the ear.

Low level laser therapy (LLLT) can also form part of photodynamic therapy including external/topical, systemic and interstitial.  Photodynamic therapy includes:

  • Photodynamic tumor therapy (for cancer); and
  • Anti-microbial photodynamic therapy.

Treatment and research involving stem cells and laser therapy is ongoing.

Summary:

Whilst relatively new (and undergoing further research), interstitial laser therapy may be useful for reducing chronic back pain (spinal pain), while intra-articular laser therapy may provide certain relief from painful arthroses including knee osteoarthritis, hip osteoarthritis, painful shoulder syndromes and ankle joint osteoarthritis.

Dear Pain Matters blog readers, if you would like to get in touch with Dr Michael Weber and his team, please email Martin Junggebauer on:

junggebauer@webermedical.com

Martin is an integral member of Dr Michael Weber’s team, and he will be sure to assist you with your enquiries.

http://www.dr-weber-laser-clinic.com/en/home/

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

“Medical knowledge is not enough; we must apply it with a passion”

Dr Henri Basam, Spine Care Center, Cairo, Egypt

REFERENCES

(1A) Michael Weber, MD, President of International Society for Medical Laser Applications (ISLA)

http://www.webermedical.com/en/the-business/dr-weber/

http://www.webermedical.com/en/weber-medical-for-professionals/the-principle/

(1B) Medical Low-Level-Lasertherapy – Foundations and Clinical Applications (2nd Edition, June 2015)

Michael Weber, MD, Robert Weber, Martin Junggebauer

http://www.isla-laser.org/en/

(1C) Michael Weber, MD

Interstitial and intraarticular laser therapy – attractive new therapeutic option for the treatment of spinal diseases and advanced joint osteoarthritis

http://www.lyranara.com/content/Weberlaser_Interstitial%20Weber.pdf

(1D) Dr Henri Basam, Sherry N Fanous

Knee Pain Management Using Ultrasound-Guided Weberneedle Endo-Laser in Comparison to Fluoroscopy-Guided Thermal Radio-Frequency (2015) (9AP5-10)

Spine Care Center, Cairo, Egypt

http://www.basemhenri.com/en/scc/article/48

(1E) Michael Weber, MD, Thomas Fussgänger-May, MD, Tillman Wolf, MD

“Needles of Light”: A New Therapeutic Approach

Medical Acupuncture (2007); 19(3)

DOI: 10.1089/acu.2007.0539

http://www.my-dr.de/FG/texte/infounten/Publikationen/Medical_Acupuncture.pdf

(1F) Litscher G, Rachbauer D, Ropele S, Wang L, Schikora D, Fazekas F, Ebner F.

Acupuncture using laser needles modulates brain function: first evidence from functional transcranial Doppler sonography and functional magnetic resonance imaging.

Lasers Med Sci. 2004;19(1):6-11.

DOI: 10.1007/s10103-004-0291-0

http://www.ncbi.nlm.nih.gov/pubmed/15316852

(1G) International Society for Medical Laser Applications (ISLA)

http://www.isla-laser.org/en/

YouTubes (in English and German):

(http://www.webermedical.com/en/weber-medical-for-patients/news/)

http://www.webermedical.com/en/weber-medical-for-professionals/med-lasertherapy/interstitial-and-intra-articular-laser-therapy/

(2A) New fiber optic cannula. Interstitial therapy at the root of the Ischia hernia

(2B)

(2C) Where ‘Coxarthrosis’ = Osteoarthritis of the hip joint

(2D)

Low Level Laser Therapy (LLLT) for Chronic Pain Including Fibromyalgia

Dear Pain Matters blog readers,

I will introduce the topic of low level laser therapy (LLLT) for chronic pain (e.g. fibromyalgia) here, and in future blog posts.

Low level laser therapy (LLLT) is relatively safe, and has no known adverse effects.

People with fibromyalgia often have extreme fatigue, pain and insomnia.  For some sufferers, even getting dressed in the morning can be a daunting task.

Ms Kay Greenlee (aged 70, of Indiana, USA) had suffered from fibromyalgia for years.  This painful condition made it difficult for her to perform domestic chores including washing windows without incurring pain in her legs, shoulders and elsewhere.  Due to allergic reactions, she was unable to take pain medication for pain.

A study by the Indiana State University allocated fibromyalgia patients into 4 groups that performed:

  1. Resistance training only;
  2. Low level laser therapy (LLLT) only;
  3. Placebo (instead of LLLT) only; and
  4. Both LLLT and resistance training.

The patients who were in the 4th group enjoyed the most improvements, compared to the other 3 groups.

Ms Greenlee was randomly allocated to the 4th group.  Following months of LLLT and resistance exercise training including chest presses, leg extensions, seated rowing and leg curls, Ms Greenlee had reduced fibromyalgia pain.  

In other words, months later, Ms Greenlee is almost pain free.  As a result, she was able to exercise (see photo).  Quoting Ms Greenlee:

“I have gone from having a lot of pain to very minimal amount of pain in the shoulder. I have little or no pain at all in the legs.”

“It is exciting to be able to go for several hours and be energetic and do the work that needs to be done at home and to enjoy things.”

Targeted LLLT and resistance training may facilitate increased blood flow into the painful areas as well as the release of endorphins, hence contributing to reduced pain.

Quoting Ifeanyi Osude (LLLT researcher, see photo):

“I’ve seen great results. Women came in with immense pain they have had for weeks or even months and after they have done the laser treatment, along with the resistance training, they came to me and said, ‘Ifeanyi, I feel a lot better.'”

Thus, LLLT can help reduce fibromyalgia pain, while physical activity can help keep the painful symptoms at bay.

04_24_13_Fibromyalgia_research-0049-L.jpg

Source:   http://www2.indstate.edu/news/news.php?newsid=3598

Summary:

Low level laser therapy (LLLT) plus exercise may be useful for reducing pain in fibromyalgia by increasing blood flow into the painful areas (Taylor, 2013). 

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

Media:

(1) Research uses lasers, resistance training to zap fibromyalgia pain

Taylor, Dave

Indiana State University Newsroom (10 June 2013)

http://www2.indstate.edu/news/news.php?newsid=3598

(2) LLLT a treatment option for fibromyalgia patients

Stewart, Dava

Chiropractic Economics (21 August 2014)

https://www.chiroeco.com/lllt-a-treatment-option-for-fibromyalgia-patients/

Peer-Reviewed Papers:

(3) Kingsley JD, Demchak T, Mathis R

Low-level laser therapy as a treatment for chronic pain. Front. Physiol. (2014), 5:306.

doi: 10.3389/fphys.2014.00306

http://journal.frontiersin.org/article/10.3389/fphys.2014.00306/full

Refer also to References section of paper by Kingsley et al (2014) for additional information.

(4) Ruaro, JA, Fréz, AR, Ruaro, MB, et al.

Low-level laser therapy to treat fibromyalgia. Lasers Med Sci (Nov. 2014), 29(6):1815-1819.

doi:10.1007/s10103-014-1566-8

http://www.ncbi.nlm.nih.gov/pubmed/24801056

 

 

 

 

 

Restoration of Tactile Performance in the Affected Hand via High-Frequency Repetitive Sensory Stimulation May Lead to Reduced Pain in some CRPS Patients

Dear Pain Matters blog readers,

Prof. Dr. Christoph Maier and team recently found that restoration of sensation (i.e. tactile performance) in the affected hand via high-frequency repetitive sensory stimulation (HF-rSS) may result in significantly decreased pain in patients with complex regional pain syndrome (CRPS).

Specifically, the Current Pain Intensity decreased by more than 30% in 4 of 16 CRPS patients who underwent HF-rSS of the CRPS-affected hand for 45 minutes a day for 5 consecutive days only.

Significantly improved tactile discrimination in the CRPS-affected hand also occurred in all 16 CRPS patients following HF-rSS intervention.

There were no medication changes in the 16 CRPS patients who had HF-rSS  intervention.

Univ.-Prof.-Dr.-med.-Christoph-Maier.jpg

Prof. Dr. Christoph Maier

Featured Image and Above Image:

Sources:  

http://bergmannsheil.bg-kliniken.de/behandlungsspektrum/anaesthesie-intensivmedizin-palliativmedizin-schmerzmedizin/schmerzmedizin.html

http://www.schmerzfreies-krankenhaus.de/kooperationspartner.html

The Study Including Results:

The study involved 20 CRPS patients, 16 who underwent HF-rSS treatment for 45 minutes a day for 5 consecutive days, while another 4 had low-frequency repetitive sensory stimulation.

Targeted electrical stimulation was applied to all the fingertips in the CRPS-affected hand by a custom-made hand pad.

Four (4) of 16 enjoyed significant pain reduction (more than 30% pain reduction) following HF-rSS treatment for 5 consecutive days.  

According to Table 1 in the study by Maier and his team, the following 4 patients had significantly reduced pain intensities immediately following HF-rSS treatment for 5 days (compared to their average pain levels, 4 weeks preceding this treatment):

  • Patient #2 (46 years, male; CRPS, right hand, duration = 5 months; fracture/surgery)
    • Average Pain (prior) = 7
    • Current Pain (after) = 0
  • Patient #8 (58 years, male; CRPS, left hand, duration = 4 months; surgery)
    • Average Pain (prior) = 6
    • Current Pain (after) = 1
  • Patient #9 (60 years, female; CRPS, left hand, duration = 2 months; fracture/surgery)
    • Average Pain (prior) = 10
    • Current Pain (after) = 1
  • Patient #15 (60 years, male; CRPS, right hand, duration = 8 months; fracture/surgery)
    • Average Pain (prior) = 9
    • Current Pain (after) = 2

The same Table 1 also listed 2 additional patients with significantly reduced pain following low-frequency repetitive sensory stimulation:

  • Patient #19 (58 years, female; CRPS, right hand, duration = 9 months; surgery)
    • Average Pain (prior) = 7
    • Current Pain (after) = 3
  • Patient #20 (58 years, male; CRPS, left hand, duration = 4 months; fracture/surgery)
    • Average Pain (prior) = 5
    • Current Pain (after) = 0

It is not known how long these pain reductions lasted.

Summary:

High-frequency repetitive sensory stimulation (HF-rSS) to all fingertips in the CRPS-affected hand:

  • to improve sensory loss (i.e. restore sensation including tactile performance); and/or
  • to reduce pain in the CRPS-affected hand

may be a useful non-pharmacological (add-on) treatment for some CRPS sufferers.

Maier and his colleagues conceded that while CRPS patients were only tested for 5 consecutive days, greater pain reductions for more CRPS patients may have resulted had the testing period been significantly longer.

This is a fair comment given that a study involving 2 amputees with phantom limb pain resulted in restoration of sensation as well as nil phantom limb pain following ‘prosthetic system treatment’ for (up to) 2 years.

https://painmatters.wordpress.com/2016/08/11/restoration-of-sensation-may-lead-to-reduced-phantom-limb-pain-in-amputees/

Sabina Walker

“Sedare dolorem divinum opus est”
“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCE

(1) David M, Dinse HR, Mainka T, Tegenthoff M, Maier C.

High-Frequency Repetitive Sensory Stimulation as Intervention to Improve Sensory Loss in Patients with Complex Regional Pain Syndrome I.

Frontiers in Neurology. 2015;6:242.

doi:10.3389/fneur.2015.00242.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4648023/pdf/fneur-06-00242.pdf

(2) High Frequency Stimulation in Pain Medicine

Kalus, Annegret

Ruhr-University Bochum (No. 163 – 20.11.2015)

http://aktuell.ruhr-uni-bochum.de/pm2015/pm00163.html.en

(3) Hochfrequente Stimulation Hilft Menschen Mit Schmerzsyndrom

Schubert, Christine

CRPS Bayern Morbus Sudeck Selbsthilfegruppe (19.2.2016)

https://by.crps-netzwerk.org/cms/blog/2016/02/19/hochfrequente-stimulation-hilft-menschen-mit-schmerzsyndrom/

Music Therapy and Chronic Pain

Dear Pain Matters blog readers,

Music therapy took Melody Gardot from the aftermath of her bicycle/Jeep accident (that lead to severe injuries and chronic pain) and helped her become an international jazz musician.

https://painmatters.wordpress.com/2016/08/13/melody-gardot-jazz-singer-songwriter-musician-and-music-therapy-for-her-chronic-pain-following-a-bicyclejeep-accident/

This blog post will offer some of the science behind music therapy and its potential benefits on chronic pain.

For music to offer therapeutic benefits, a patient has to enjoy music in the first place.  Furthermore, patients need to listen to, or play/sing, their favourite music before music can improve pain tolerance and reduce perceived pain intensity.

The ability of some music to express positive emotions as well as deeply evoke these same emotions in the listener (via ‘entrainment’, or resonance) may also contribute to reduced pain perception and increased pain tolerance.

When patients are exposed to their favourite ‘up-lifting’, emotionally-engaging music, this music can help displace negative emotions and feelings including fear, anxiety, depression, loneliness and distress due to pain, and replace them with positive emotions including happiness and joy, while also empowering patients to feel more in control over their pain levels.

Certain music played pre- and post-operatively, as well as during surgery, may result in less sedation/anesthesia being required during an operation, as well as reduced opioid medication, post-surgery.  These patients often report lower pain intensity levels, post-operation.  Pre-surgery, patients who listened to their favourite music tend to feel less anxiety and stress, and instead, feel more physically relaxed.

In cancer patients, music therapy can decrease chemotherapy-induced nausea and vomiting.

If welcomed by the patients, music therapy can be a cost-effective adjunct for patients including children in dental, paediatrics, surgery, anaesthesia, palliative care and other clinical settings.  After all, music is safe, natural and non-invasive, with nil adverse effects.

Music Therapy for Chronic Pain:

Music therapy for chronic pain including cancer pain can include:

  • Listening; and
  • Participating via
    • Group singing/choir – that releases oxytocin; and
    • Playing/learning a musical instrument (including a wind instrument; e.g. saxophone); and
  • Other music therapy techniques (Magill, 2001).

The best results are obtained when the selected slow music is personalised to the patients’ unique and personal preferences.

Research into music therapy for many painful medical conditions is underway worldwide including at The Louis Armstrong Department of Music Therapy, Mount Sinai Beth Israel, New York.

http://www.wehealny.org/services/bi_musictherapy/readings.html

Neuroscientist and musician, Professor Daniel Levitin, Department of Psychology, McGill University, Montreal, is another leading researcher on the benefits of music therapy.

https://www.mcgill.ca/psychology/daniel-j-levitin

http://daniellevitin.com/publicpage/in-the-news/in-print/

Physiological Effects of Musical Rhythm:

Music therapy that involves music with a slow tempo but strong (positive) emotions can reduce heart rate, blood pressure and body temperature, as well as increase heart rate variability, plus exert other physiological responses controlled by the brainstem.  This can result in reduced pain levels, stress and anxiety.

Slow music with 10-second repetitive cycles/waves may have a particularly calming effect on its listeners.  It is possible that such music may match the control rhythm of the cardiovascular system including the brain’s natural 10-second waves/cycles of blood pressure control (to regulate blood pressure, heart rate, etc).

The brain monitors blood pressure measurements after each heartbeat, and it sends signals to control blood pressure in the blood vessels via 2 separate nerves operating at different speeds, resulting in signals that are ‘out of phase’ every 9 of 10 seconds, and signals that are ‘in phase’ every 1 of 10 seconds (Professor Peter Sleight et al, University of Oxford).

‘Entrainment’ (or resonance) of the body’s natural 10-second waves of blood pressure control may be amplified via exposure to slow music that also has a 10-second repetitive cycle.

Examples of slow music with 10-second repetitive cycles/waves include music by Verdi, the arias of Puccini’s opera Turandot and slow movements of Beethoven’s Ninth Symphony.

Interestingly, certain prayers may also have a calming effect including the prayer Ave Maria that has a 10-second rhythm when read out in Latin 50 times (as is the norm in some Italian Catholic church services) (Professor Peter Sleight et al, University of Oxford).

Listening to music that has a slow beat of only 50-60 beats per minute can cause the listener’s heart rate to gradually synchronise with this slower tempo (via ‘entrainment’).  A song with a slower tempo that is longer than 5 minutes long may lead to a deeper sense of relaxation than songs that are shorter than 5 minutes.  This is because a body may take around 5 minutes before is is fully entrained with an external rhythm.  

This was confirmed by a study that found that out of 15 songs tested, ‘Weightless’ (an 8 minute-track by Marconi Union) had the most profound effects on relaxation.  This song resulted in reductions in overall anxiety by 65% and physiological resting rates by 35% (Gerges, 2011; Gillett, 2016).  Whilst not tested in this study, these positive results could have spill-on effects on pain levels.    

Physiological Effects of Music on Neurotransmitters, Cortisol and the Immune System:

Neurotransmitters including endorphins (the brain’s natural opioid/morphine) and oxytocin may be released during exposure to preferred music.  These neurotransmitters help reduce pain levels and induce analgesia as well as decrease anxiety and stress.

Music can reduce cortisol levels in the bloodstream (a sign of reduced stress).

Researchers discovered that singing certain slow, sad songs can lead to increased s-IgA, an immunoglobulin that enhances overall immunity.

Prolactin may be released via tears of sorrow during ‘sad music’.  Increased prolactin can have an overall calming and consoling effect….which is why a good cry can sometimes be a good thing.

Summary:

Music therapy, in particular, exposure to slow music with certain rhythms (e.g. slow music with 10-second rhythms/cycles/waves) can reduce overall pain levels. In part, this may be due to selected musical rhythms having a beneficial effect on the heart and blood vessels.

Sabina Walker

“Sedare dolorem divinum opus est”

“It is divine to alleviate pain”

Galen, 130-200 C.E.

REFERENCES

Media Releases:

For English readers:

(1A) Music and pain relief

Jeanette Bicknell

Psychology Today (1 Nov 2011)

https://www.psychologytoday.com/blog/why-music-moves-us/201111/music-and-pain-relief

(1B) How music can help relieve chronic pain

Don Knox

The Conversation (10 September, 2015)

http://theconversation.com/how-music-can-help-relieve-chronic-pain-47302

(1C) The doctor will sing to you now: Music therapy and the coming rise of minstrel medicine

Dr. James Aw

National Post (13/07/02)

http://daniellevitin.com/levitinlab/printmedia/2013-07-02-National-Post.pdf

(1D) Why joining a choir is the easiest way to make yourself happier

Stacy Horn

Slate (July 25, 2013)

http://daniellevitin.com/levitinlab/articles/2013-08-12_Slate.pdf

(1E) Want to relax? Listen to Verdi, scientists say

Steve Connor

The Independent (9 June 2015)

http://www.independent.co.uk/news/science/want-to-relax-listen-to-verdi-scientists-say

10306136.html

 

(1F) Music to mitigate pain

18 August 2016

http://www.thehindu.com/features/metroplus/music-to-mitigate-pain/article8999737.ece

(1G) Gillett, Rachel. Science Says This Song Can Reduce Your Anxiety In Less Than 10 Minutes. Business Insider Australia (7 Nov 2016).

https://www.businessinsider.com.au/the-song-that-could-reduce-your-anxiety-in-less-than-10-minutes-2016-11?r=US&IR=T

(1H) David, Gerges. Just Don’t Play It While You’re Driving! Warning Over ‘Most Relaxing Song Ever Created’.  Daily Mail Australia (18/10/2011)

http://www.dailymail.co.uk/news/article-2049948/Most-relaxing-song-UK-band-Boffins.html

For German readers:

(2A) Schmerzen lindern mit Musiktherapie

Alexandra Springler

MedMix (9 October 2015)

http://www.medmix.at/schmerzen-lindern-mit-musiktherapie/

(2B) Musiktherapie in der Behandlung chronischer Schmerzen

Bacher, B.

14. Schmerztherapeuten-Treffen, Universitätsklinikum Freiburg (20 November 2015)

https://www.uniklinik-freiburg.de/fileadmin/mediapool/09_zentren/schmerzz/st2015/MusiktherapieBehandlungChronischerSchmerzenBacher2015-11-20.pdf

Peer-reviewed papers:

(3A) Bernatzky, G, Presch, M, Anderson, M & Panksepp, J. Emotional foundations of music as a non-pharmacological pain management tool in modern medicine. Neuroscience and Biobehavioral Reviews (Oct 2011), 35(9), 1989-99.

DOI: 10.1016/j.neubiorev.2011.06.005

http://www.ncbi.nlm.nih.gov/pubmed/21704068

(3B) Knox, D, Beveridge, S, Mitchell, L & MacDonald, R. Acoustic analysis and mood classification of pain-relieving music. Journal of the Acoustical Society of America (Sept 2011), 130(3), 1673-82.

DOI: 10.1121/1.3621029

http://www.ncbi.nlm.nih.gov/pubmed/21895104

(3C) Magill, L. The use of music therapy to address the suffering in advanced cancer pain. Journal of Palliative Care (2001), 17(3), 167-172.

http://www.ncbi.nlm.nih.gov/pubmed/11816757

(3D) Young, Emma. Healing rhythms. New Scientist (12 September 2015), 227(3038), 36–9.

http://www.sciencedirect.com/science/article/pii/S0262407915311775

(3E) Chanda, ML & Levitin, DJ. The neurochemistry of music. Trends in Cognitive Sciences (April 2013), 17(4), 179-93.

http://www.cell.com/trends/cognitive-sciences/abstract/S1364-6613(13)00049-1

Melody Gardot (Jazz Singer, Songwriter, Musician) and Music Therapy for Her Chronic Pain Following a Bicycle/Jeep Accident

Dear Pain Matters blog readers,

In live jazz concerts, Melody Gardot’s fans can expect to see her walk on stage with a walking cane, tinted glasses …. and her elegant 4-inch stiletto heels.

b942fad7f345aaeb1daa66a594826440.jpg

Sources:  

Featured Image:   http://www.laut.de/Melody-Gardot

Smaller Image:   gestalt-terapia.es

Born on 2 February, 1985, tragedy struck the (then 18-year old) fashion and art student in Philadelphia, USA, on 11 November 2003.  While riding her bicycle through an intersection, she was smashed to the ground by a Jeep Cherokee who ran a red light while making an illegal left turn.  Quoting Melody:

“And the next thing is, I remember I heard this sound, and I thought, ‘Who is that? What is that?’ And I realized that it was me screaming.”

She remembers that she was unable to move.  On a scale from 0 to 10, her pain was ’40’.

Melody’s near-fatal injuries were severe and extensive and included serious skeletal and neurological damage including a fractured pelvis (broken in 2 places), injured spine and traumatic brain injury.  While bedridden in a body cast on her back in hospital for a year, she had therapy to learn to walk and talk again.  Her memory (both long- and short-term) was poor and she couldn’t remember what happened an hour ago, let alone earlier in the day, nor what she had eaten.  She couldn’t do simple tasks like brush her teeth or take a shower.  She felt as if she was 85 and helpless.  Post-accident, she became hypersensitive to loud noises and bright light (protected by her tinted glasses) and she now carries a cane for possible vertigo attacks.

Melody suffers from near-constant physical pain including chronic lower back pain since her bicycle/Jeep accident.  

YouTubes: Melody Gardot (See YouTubes 1 and 2 of 4 – The Accidental Musician)

WARNING: Graphic visual and audio footage from 10:05 to 10:57 minutes in the first (1.st) YouTube and from 5:32 to 5:47 minutes in the second (2.nd) YouTube that simulates Melody’s near-fatal bicycle accident.  Do not watch these parts if sensitive to accident scenery. 

Music Therapy for Chronic Pain:

Melody decided she would rather live with the chronic pain than take her pain medication, along with all the nasty side effects that made her very sick.

When the doctor found out that she used to play piano in local piano bars, he suggested that she try music therapy instead for her chronic pain.

For Melody, this was the best medical advice for her pain.  Music therapy succeeded where medication (and all its adverse effects) and therapy failed.

Interestingly, onstage, sometimes she does not feel the chronic pain.  Quoting her:

“The first maybe half a dozen times experiencing this, that was the only 30 minutes in my life that I did not feel pain for that moment. And it was addictive.”

Melody, a talented songwriter, expressed the trauma from her accident by composing ‘Some Lessons’ (See YouTube: Melody Gardot (Part 2 – The Accidental Musician), above; Lyrics, below).  Understandably, she won’t sing this song anymore.

Other Therapy:

Melody also does yoga, Pilates, osteopathic treatment and craniosacral therapy.

Summary:

Not only did music therapy offer Melody Gardot a second lease on life, but it also brought Melody back to a life worth living despite chronic pain.  Music helped Melody make sense of her chronic pain caused by her accident.

Music therapy opened doors to a successful jazz career that Melody may not otherwise have had, and enabled her to make the most of a terrible tragedy.

An international jazz sensation was born from the wreckage of a bicycle/Jeep accident that lead to her injuries and chronic pain.

Sabina Walker

PS  Here are the lyrics to a song written by Melody, in response to her fateful, near-fatal accident on 11.11.2003:

“Some Lessons” 

Written by Melody Gardot – See YouTube: Melody Gardot (Part 2 – The Accidental Musician)

Well I’m buckled up inside
It’s a miracle that I’m alive
I do not think I can survive
On bread and wine alone
To think that I could have fallen
A centimeter to the left
Would not be here to see the sunset
Or have myself a time

Well why do the hands of time
So easily unwind
Some lessons we learn the hard way
Some lessons don’t come easy
That’s the price we have to pay
Some lessons we learn the hard way
They don’t come right off and right easy
That’s why they say some lessons learned we learn the hard way

Remember the sound of the pavement
World turned upside down
City streets unlined and empty
Not a soul around
Life goes away in a flash
Right before your eyes
If I think real hard well I reckon
I’ve had some real good times

PPS  Melody Gardot’s 3.rd and 4.th YouTubes of – ‘The Accidental Musician‘ are also great!

REFERENCES

(1) Melody Gardot’s music career was born in pain

Robert Everett-Green

The Globe and Mail, 3 July, 2012

http://www.theglobeandmail.com/arts/music/melody-gardots-music-career-was-born-in-pain/article4386508/

(2) How Melody Gardot found her voice

Anthony Mason

CBS News, 24 January, 2010

http://www.cbsnews.com/news/how-melody-gardot-found-her-voice/

(3) From death’s door to earning the keys to the world

Stephen Holden

The New York Times, 14 October, 2009

http://www.nytimes.com/2009/10/15/arts/music/15gardot.html?pagewanted=all&_r=1