Category Archives: Music Therapy

Is There a Link Between Prolonged Psychological Stress And Physical Pain?

Featured Image of the ocean near the beach in the sun taken by myself. 

Dear Pain Matters blog readers,

Prolonged psychological stress can perpetuate chronic pain in some patients, while other people may be prone to chronic inflammatory diseases including cardiovascular disease, type II diabetes, depression, autoimmune diseases, upper respiratory infections and poor wound healing ability.

Immune cells are normally very sensitive to circulating stress hormones (glucocorticoids including cortisol), and as such, are usually able to shut down the pro-inflammatory response in the presence of glucocorticoids.

Chronic psychological stress can reduce the circulating stress hormone’s ability to interact with its receptor leading to glucocorticoid receptor resistance (GCR).

Repeated and ongoing exposure to a long-term threatening (real or imagined) and stressful experience can lead to insufficient glucocorticoid regulation (i.e. GCR), that in turn can lead to:

  • Insufficient control over the inflammatory response towards an infection;
  • Increased duration and/or intensity of the pro-inflammatory response; and
  • Increased pain levels and other signs and symptoms of chronic diseases.  

Studies have shown that some chronic stress sufferers (e.g. parents of children with cancer, spouses of patients with brain cancer and lonely people) present with GCR (Cohen et al, 2012).

Other Biomechanisms that Influence the Pro-Inflammatory Response and its Key Role in Maintaining Chronic Pain and Inflammation-Based Diseases:

See this Blog Post for more information:

https://painmatters.wordpress.com/2014/11/13/can-vagus-nerve-stimulation-decrease-inflammation-hence-reduce-inflammatory-pain-in-some-chronic-pain-patients/

What Can Done To Reduce Prolonged Psychological Stress?:

Steps must urgently be taken to reduce repeated and ongoing exposure to a prolonged threatening (real or imagined) and stressful experience.

This brings us to all those therapies that may induce the ‘relaxation response’ and/or lead one to a calmer disposition including:

Summary:

Any therapy that can induce the ‘relaxation response’ is key to diverting attention away from repeated and ongoing psychological stress.

This will strengthen the immune cells’ ability to interact with circulating stress hormones (glucocorticoids including cortisol) and shut down an exaggerated pro-inflammatory response.

Conventional pharmacological treatment also plays an important role in reducing excessive inflammation.  The effectiveness of pharmacological drugs may be further enhanced by the body’s ‘relaxation response’, leading to lower drug dosages and fewer adverse effects.

The body’s innate ability to properly control a pro-inflammatory response is key to warding off chronic pain and disease.

Sabina Walker

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

Galen, 130-200 C.E.

REFERENCES:

Media

(1) Study Finds Link Between Stress And Physical Pain

Huffington Post (03 April 2012)

http://www.huffingtonpost.co.uk/2012/04/03/pain-stress-link-found_n_1398767.html

Book

(2) Clynes, Manfred

Sentics: The Touch of Emotions

250 pp, Doubleday/Anchor, New York, 1977

http://senticcycles.org/home/sentics/articles/sentics.pdf – Chapter 9 only

Peer-Reviewed Paper

(3) Cohen S, Janicki-Deverts D, Doyle WJ, et al.

Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk.

Proceedings of the National Academy of Sciences of the United States of America. 2012;109(16):5995-5999.

doi:10.1073/pnas.1118355109.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3341031/

 

Advertisements

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