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

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