Music therapy and pain

Music Therapy for Pain Management

Music has the power to soothe, inspire, energize, and uplift. Research shows it can also help manage pain in people who are living with chronic pain. Music therapy for pain management is offered by many pain centers and cancer centers, and helps many people find solace and relief.

Music has been used in medicine for thousands of years. But music therapy emerged as a formal means of care in the United States in the 1940s, after doctors learned that music helped restore World War II soldiers suffering from shell shock. There currently are more than 5,000 trained music therapists working with patients in pain management centers, hospitals, clinics, senior centers, rehabilitation facilities, and drug and alcohol programs across the country.

Music Therapy in Pain Management: How It Works

Music therapy works in chronic pain management by providing sensory stimulation that evokes a response in the patient. Research has found that music used as a clinical intervention can help patients by:

  • Reducing the amount of pain they perceive
  • Promoting relaxation, rhythmic breathing, and rest
  • Alleviating anxiety and stress
  • Giving their mood a positive boost

In chronic pain management, therapists often use music therapy as a means of conditioning the patient to relax and release pain and stress. Soothing music is paired with relaxation techniques, and eventually the patient learns to relax automatically when listening to the music.

Music Therapy for Chronic Pain

Patients undergoing music therapy for chronic pain management have been found to:

  • Require less pain medication
  • Have significant improvements in their respiration, blood pressure, heart rate, and muscle relaxation
  • Enjoy more peace of mind and better quality of life

Music therapists can design musical interventions for people in chronic pain management based on their specific likes and needs. The therapy might include:

  • Making music
  • Listening to music
  • Singing along to songs
  • Writing songs
  • Discussing music and lyrics
  • Using music to form images in the mind
  • Meditating with music in the background

Music therapy is very versatile. It can be done one-on-one or in group therapy sessions, and at home, in a medical facility, or other setting. The chronic pain patient doesn’t need to be skilled or gifted in music to gain benefits from the therapy.

Finding Music Therapy Programs

Music therapists are accredited health care professionals. More than 70 colleges and universities offer music therapy degree programs approved by the American Music Therapy Association.

Music therapists hold a bachelor’s degree or higher and must complete 1,200 hours of clinical training and pass a national board certification exam before they are allowed to practice. They are trained in psychology, counseling, physiology, and anatomy. They also become proficient in four instruments — piano, guitar, voice, and a fourth instrument of their choice.

Music therapy is offered at many cancer and pain management centers. For example, the University of Michigan Comprehensive Cancer Center offers individual, family, or group music therapy sessions that last from 45 minutes to an hour. The center also makes available about 50 CDs of healing music that patients can borrow. Other musical selections are available for download to your MP3 player.

To find an accredited music therapist or music therapy program near you, contact the American Music Therapy Association at (301) 589-3300, or visit their .

The Sweet Sound of Pain Relief: Can Music Therapy Relieve Pain?

Music is a universal language. At its best, it has the power to lift our spirits and transport us to another time or place. But did you know it also has the power to help manage chronic pain? The Ancient Greeks tapped into the healing power of music, issuing musical “prescriptions” for a wide assortment of health challenges. Music therapy was formalized in the U.S. in the 1940s when doctors realized that music was a significant factor in helping soldiers heal from shell shock.

Music can reduce your pain
It’s believed that music triggers the release of natural opioids in the brain that can reduce the feeling of pain and, in turn, reduce the need for pain medication. Research shows that music used as a clinical intervention can not only reduce the amount of pain patients perceive, it can alleviate stress and anxiety, promote relaxation and rest, and give moods a positive boost. For chronic pain management, soothing music is often paired with relaxation techniques so that, over time, the patient learns to relax automatically when listening to music.

Your favorite music is good for you
A recent study of fibromyalgia patients found they experienced less chronic pain after listening to their favorite music. The study also found that the type of music listened to is not as important as how well the music holds the patient’s interest. Since emotion and pain are strongly linked, music that creates positive emotions triggers positive memories that can affect mood and the ability to handle pain.

Another theory behind the power of music therapy relates to how nerve impulses in the central nervous system—otherwise know as the body’s information superhighway—are affected by our emotions and thought processes. Since music can distract us from the pain we’re experiencing, we tend to focus less on the pain, and those nerve impulses are slowed down and reduced until the pain is minimized.

Therapy that’s as individual as you are
Music therapists can design sessions for chronic pain patients based on the patient’s specific likes and needs. In addition to listening to tunes, music therapy might include singing along to songs, writing songs, making music, meditating with music, discussing music and lyrics, and using music to form images in the mind.

In addition to requiring less pain medication, patients undergoing music therapy for chronic pain management have been found to:
• Have significant improvements in their respiration, blood pressure, heart rate, and muscle relaxation
• Experience less pain-related distress and lowered pain-intensity levels
• Enjoy more peace of mind and better quality of life

The Healing Power of Music

Does Pharrell Williams’ Happy buoy your spirit during your morning walk? Does listening to Vivaldi soothe you after a tough day at work? The fact is, you prescribe yourself music all the time.

A tune can make you feel happy, excited, disconcerted or even heartbroken. “Music is an incredibly complex stimulus—the most multifaceted in nature for the brain to process,” says music therapist Tim Ringgold, MT-BC, director of Sonic Divinity Music Therapy Services in Orange, California. Listening to music involves several regions of the brain, including those that affect emotion, cognition, sensation and movement. So it stands to reason that it could also help treat issues in all those areas.

The idea that songs can have therapeutic powers dates back to early civilization, where it can be found in the writings of ancient philosophers Aristotle and Plato. Music therapy developed as a formal practice in the wake of World War I and World War II. Doctors treating hospitalized veterans noticed their patients improved both physically and emotionally following concerts by community musicians.

Music, whether it’s being listened to or performed, can help relieve the pain associated with a wide range of ailments, and it benefits people of all ages. Music therapy is an effective method of what experts call “procedural support,” or helping a patient get through a procedure that is anxiety- or pain-producing.

Many of the pathways the brain uses to process music are the same as the ones that process pain. So if the brain is focused, for instance, on the melody of a Mozart concerto, there won’t be much room left to relay the pain messages coming from a needle stick. Tunes can also help you relax and feel less anxious.

In addition to lessening acute pain, music can also help decrease chronic pain from recurrent bleeds in muscles and joints. You’ve probably heard of the runner’s high, where the brain releases endorphins—feel-good chemicals—during a sweaty exercise session. Music prompts the brain to produce these same endorphins. “Patients frequently report decreases in their own perception of pain, anxiety and nausea after a typical 30-minute music therapy session,” says Ringgold.

“We use the phrase ‘music therapy’ when there are three ingredients present: A client, music and a therapist,” says Ringgold, who’s presented sessions on the benefits of music therapy in managing bleeding disorders at the National Hemophilia Foundation’s (NHF) annual conference and at NHF chapter events.

Working with a board-certified music therapist can be useful because he or she can evaluate your needs, taste and interests. A therapist can also answer detailed questions about types of music and levels of listening that are nuanced but critical to music therapy’s success.

DIY Music Rx

1. Pick your tunes
Begin by choosing music that makes you feel good, whether it’s classical, country or show tunes.

2. Feel the beat
Listen to, play or sing whenever you think you need it, such as while getting a needle stick during an infusion.

3. Watch the volume
Playing music too loudly, especially if you’re wearing earbuds, can damage your ears.

Learn More: There are currently more than 7,000 board-certified music therapists nationwide.

The American Music Therapy Association can provide you with a free list of qualified music therapists in your area. Contact them at musictherapy.org/about/find/.

Actually, research has demonstrated that music can reduce opioid requirements, and that postoperative pain may be lessened.1 In a Cochrane Review conducted by Cepeda et al, investigators examined the effect of music on acute, chronic, or cancer pain intensity; pain relief; and analgesic requirements.1 Of the 51 studies evaluated, four studies reported that subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). In three studies evaluating opioid requirements 2 hours after surgery, subjects exposed to music required 1.0 mg (18.4%) less morphine (95% CI: -2.0 to -0.2) than unexposed subjects. Additionally, in five studies assessing analgesic requirements 24 hours postsurgery, the music group required 5.7 mg (15.4%) less morphine than the unexposed group (95% CI: -8.8 to -2.6).1

In addition, music therapists have designed clinical protocols that are effective in helping people manage different forms of pain. Part of the music therapist’s job is to help people find the music that is significant to them so the patient can use this music in a specific, functional way to help cope with stress and pain. Music therapists teach people to fully listen to that music and also to listen to the effect that the music has on many aspects of their whole selves. These non-traditional therapists show people how to create music and engage the brain actively so the perception of pain is overcome by multiple sources on multiple levels. Some interventional techniques that may be used by music therapists in pain management include singing, playing instruments, rhythmic-based activities, improvisation, composing/songwriting, and listening to music.2

A person is more than a sum of individual parts. Thoughts, emotions, and sensations are interconnected parts of the human condition, and one’s entire self is affected when in pain. Whether chronic or acute, pain is exacerbated by stress and anxiety. Thus, the most effective pain management strategies are holistic, taking into account the body, mind, and spirit. Music is a unique component of holistic pain management because the influence of music is felt on physical, mental, emotional, and spiritual levels (Table 1). Music therapists are privileged to work with the power of music to transform the perception of pain and the experience of suffering. In this review, we highlight five different patient cases where music therapy was effectively used to help manage signs and symptoms associated with various pain-related illnesses and procedures.

Cancer Treatment
Anxiety has been shown to frequently exacerbate the perception of pain. Reducing this emotion prior to any pain-inducing procedures improves patients’ quality of life.3 In a study conducted by Bradt et al comparing the effects of music therapy plus standard care versus the effects of standard care alone, results suggested that music interventions may have a beneficial effect on anxiety in patients with cancer.4 Investigators reported an average anxiety reduction of 11.20 units (P=0.009) on the State-Trait Anxiety Inventory Scale and -0.61 standardized units (P=0.0007) on other anxiety scales.4

When 55-year-old Barbara was diagnosed with metastatic breast cancer, she sought treatment to deal with a constellation of fear, anxiety, depression, and physical pain. In music therapy, she found a coping tool to help. Barbara wrote in her pain journal: “I had to go up for a blood test, which was particularly distressing to me. I had been having repeated problems with the test and had been overly emotional about having it again. I was in tears as the nurse tried over and over to get my vein. She asked me to take a deep breath, but I knew that wouldn’t help. Without even thinking, my brain must have automatically felt that music would help me. I found myself singing to myself in my head … The music sounded so loud and powerful that I could not focus on the blood test and the singing at the same time. The music won, the test was over, and I was thrilled to realize that I had found a tool to help me with these procedures. I have tried it on a few other occasions, and it has been successful for me, even with other songs.”5

Barbara’s strong sensory engagement while singing, and the concomitant positive affect and emotion, contributed to her ability to block the sensation of pain.

Spine Surgery
Barbara is not alone. Here are words from Susan’s journal that describe her experience of listening to music through spine surgery:

“Through 30 years of undergoing spine surgeries and medical procedures, I have experienced the power of music to comfort, to distract, to accompany, and to allow my feelings. Prior to my most recent operation, I prepared playlists on my mp3 player. The topics ranged from Broadway to spiritual music, from light opera to music-assisted relaxation and imagery. In the days preceding the surgery, I listened to relaxing music to ease my anxiety. On the morning before surgery, my mother died. I needed my music more than ever before.

“Immediately after donning the hospital gown on the morning of surgery, I put on my headset and let the music play. Listening to ‘Defying Gravity’ from Wicked allowed me to escape the surgical waiting area and travel to the fantastical world of Wicked where a person can fly above the pain. ‘The Prayer,’ sung by Josh Groban and Charlotte Church, led me to a place—oceanside—where I felt safe. As the anesthesiologist inserted the intravenous needle, I was guided by music-assisted imagery and did not feel the prick. My deep state of relaxation removed any resistance that might have impeded the procedure.

“As I was wheeled into the operating room, I felt my mother’s spirit present with me and eased into a gentle sleep, listening to familiar sounds of Daniel Kobialka’s soothing music based on classical themes. The music remained with me throughout the 4-hour procedure, and my first awareness upon waking in the recovery room was the sweet sound of music. I felt calm, comforted, and present. I knew the surgery was complete before I could speak. I recognized the sounds of John Barry’s music from movie soundtracks, which I had preselected to help me rouse in the recovery room. The music was less sedative than the music to which I listened before and during the surgery.

“Although a pain pump had been inserted, I was reluctant to push the button to release the medication into my bloodstream. For me, opioids are a two-edged sword. Though they may relieve the sharp edge of pain, they adversely impact my gastrointestinal system and I find that discomfort far more difficult to bear. Surgical pain is reflective of healing, so I listened to music and allowed myself to remain in a calm, protected zone. My mind was filled with thoughts of gratitude, relief, and hope. I knew that the worst of my ordeal was behind me. After a 5-day stay in the hospital, I returned home to my own bed and eased into a sound sleep with my headset and music right beside me—waiting to be listened to.

“A few weeks after my mother’s funeral, I hesitantly sang my first notes. My spirit soared as I sang: ‘Wake up, bestir yourself, it’s time that you disinter yourself. You’ve got a spot to fill, a pot to fill. And what a gift package of shower, sun, and love, you’ll be met above everywhere with.’6 That gift package is also filled with music.”

When Susan closed her eyes and concentrated on her music, she immediately discovered pleasant memories and positive associations. The music evoked beautiful imagery that offered the sense of calm and peace that she sought at a time of extreme distress. Anticipatory anxiety prior to surgery was dispelled when relaxing music flooded her brain with positive affect, hopeful thoughts, and sensory stimulation involving all her senses. Susan then had a conditioned relaxation response to the musical selections that accompanied her during surgery. All she had to do was turn on the music to evoke a state of mind exuding beauty and peacefulness.

According to Bernatzky et al, the fear and dread of pain caused by an impending surgical procedure promote suffering. Negative emotions, such as anxiety prior to surgery and pain after surgery, can be successfully alleviated through the use of music therapy.3

Waking from anesthesia can be disorienting and traumatic, but Susan was spared an introduction to consciousness through the mechanical sounds of medical equipment in the recovery room, and she was treated to familiar music that could immediately soothe. Singing during the weeks following surgery brought another dimension to Susan’s recovery. Her positive psychological attitude was supported by listening to and singing her favorite songs. The physical requirements of singing necessitated taking deep, healing breaths, while the process of singing songs with strong, positive messages comforted her through the days of pain and loss.

Cardiac Illness
George underwent coronary artery bypass graft surgery. He learned to manage his pain and stress by listening to a recording that blended the music therapist’s spoken voice with music that George identified as relaxing.

“By the end of the time, you feel very, very calm and just very relaxed. relaxes physical body slows down thinking, too. Getting a chance to just stay in one spot and listen to something that’s slower and wants you to relax, tries to help you relax, makes a big difference.”7

Many people living with cardiac illness cope with ongoing pain, stress, and anxiety about the future. A randomized controlled trial involving 68 individuals enrolled in a cardiac rehabilitation program found that music therapy improved regulation of blood pressure, decreased stress and anxiety, and improved selected quality of life measures. Music therapy interventions included playing and listening to live music as well as learning techniques to evoke the relaxation response.8 These techniques involved strategies that could be practiced at home. Compliance with these methods was high, and participants learned that they could take control of their blood pressure using a benign and enjoyable activity.

Childbirth
Meredith was in labor with her first child. As a participant in a research experiment that investigated the impact of music listening on pain-related outcomes, Meredith prepared her playlist of favorite songs, meaningful melodies, and music that was associated with good times in her life.9 The music therapist then categorized these pieces into slow, medium, and fast tempi, and asked Meredith to simulate the experience of having a 60-second contraction while breathing to her specially selected music. Beginning with the slow music, Meredith rehearsed listening while she closed her eyes and imagined a beautiful, healthy baby. Next, she practiced a gradually faster pace of breathing, while hearing music of a slightly faster tempo. Here she focused her attention on making different sounds, like “hoo” and “hee,” as she emphasized her exhalation along with the rhythmic cue provided by the music. Finally, she listened to the fastest, most energetic music with strong beats and an easy rhythm to follow. She breathed directly with the music, as she prepared for the transition stage of labor, the most arduous time immediately before the birth of the baby.

As part of the experimental protocol, Meredith listened to her music for the duration of 10 contractions, and then discontinued the music for the next 5 contractions, followed by 10 contractions with more music, then 5 without music, and so on, throughout labor. The music therapist observed pain-related behaviors during these contractions, consisting of vocalizations of pain, requests for medication, and obvious signs of tension in body parts (eg, clenched jaw or fist, flexed feet, or raised shoulders). These pain-related behaviors were documented, and an average number was calculated so that they could be compared across conditions of music versus no music. Meredith and the six other research participants in this experiment emitted fewer pain-related responses during the periods of music listening than when no music was playing (range of 3 to 30 fewer pain responses with a mean of 12).9 This study was, thus, instrumental in demonstrating the impact of music as a focus of attention during episodes of acute pain, and identifying the potential of music as an “auditory focal point” akin to the “visual focal point” recommended as an efficacious methodology for managing the contractions of childbirth.

End of Life
At the other end of the life cycle, Jay was dying of brain cancer. In what was to be his final hours of life, the music therapist visited his bedside with the hope of providing some comfort to Jay and members of his family who were standing vigil through his ordeal. The music therapist began playing a Native American flute, while breathing along with Jay’s shallow gasps and irregular breathing rhythm. She alternated between long, flowing phrases and short, punctuated breaths that matched Jay’s. Slowly, she stretched the musical notes and lines into extended melodies. Jay’s oncologist, who was witnessing this scene, noted an elongation in the pattern of Jay’s breathing, and a relaxation of his muscles.

Whether or not the sounds of the flute were responsible for Jay’s response, family members reacted to the mood inspired by the flute, and expressed their gratitude for the peaceful atmosphere that accompanied Jay’s passing. This “entrainment” of breathing, rhythm, and tempo was another tool in the music therapist’s repertoire to gently guide Jay and his surrounding family to a more relaxed way of breathing and of being.

Conclusion
In these examples, music, whether heard passively or along with guided imagery, had an impact not only on the senses, but also on perception, and the perception of pain, in particular. Music, sung or performed, was able to serve as a source of concentration for people experiencing various types of pain. The key for most was identifying music that resonated with their needs, like Barbara’s powerful song, Susan’s meaningful musical selections, George’s relaxing music and imagery, and the pieces that guided Meredith’s and Jay’s breathing. These cases were meant to inspire the use of music listening, singing, and other musical activities to help manage the signs and symptoms associated with pain,10 and it is the hope of the authors that this simple, cost-effective medium will be helpful to individuals who are coping with different sorts of discomfort and pain. In the case of music, there are few side effects and there is much creative potential to heal.

Can Listening to Music Help Control Pain?

One good thing about music, when it hits you, you feel no pain. —Bob Marley

There is no disputing that the need for effective pain relief has never been greater. While we all experience pain once in a while, chronic pain (usually defined as pain lasting longer than three to six months) can be devastating for countless pain sufferers. With an estimated ten to 55 percent of people worldwide reporting chronic pain in some form, it’s hardly surprising that pain relievers, particularly opiate-based pain medications, are in constant demand in countries around the world. Along with obtaining these drugs legally through a doctor’s prescription, there are also street drugs that can also be used for relieving pain, including heroin and codeine, and morphine.

As an alternative to medication, non-chemical pain management techniques such as relaxation training or guided imagery can also help control pain by using distraction to reduce awareness. However, while using relaxation training or interactive media such as video games or virtual reality can help provide the distraction pain patients need, these techniques are often not as cost-effective as medication. Whether due to the expense of providing trained staff to teach relaxation techniques or the cost of specialized equipment, many physicians find it easier and cheaper to medicate. Even when pain management programs are available, the demand for treatment can mean long waiting lists and needless suffering.

But what about simpler alternatives? Research looking at the link between listening to music and pain tolerance suggests that it is not only effective in relieving acute and chronic pain but can also help patients manage anxiety and depression. According to one study from 2012, two daily sessions of music listening helped a sample of chronic pain patients relieve symptoms related to conditions such fibromyalgia, inflammatory disease, or neurological conditions as well as the anxiety and depression linked to chronic pain.

Part of the appeal of using music listening to relieve pain is that it is a simple and cost-effective approach that can be tailored to the needs of individual patients. Since emotion and pain are strongly linked, music that resonates with positive emotions triggers positive memories can also affect mood and the ability to handle pain. Listening to pleasant music can also influence how we perceive the passing of time (pleasant memories make time fly faster than unpleasant memories).

To understand more about the process by which listening to music can help relieve pain, two researchers at the University of Buckingham in the United Kingdom conducted a rather novel study which was recently published in the journal Psychomusicology. Psychologists Katherine A. Finlay and Krithika Anil recruited forty-one healthy volunteers (24 women and 17 men) to take part in the study.

The participants were all in their twenties (average age of 25.98) with no history of chronic pain or other illness. On entering the laboratory where the experiment was conducted, they were all asked to remove watches to prevent them from being able to estimate how much time was passing. They then completed questionnaires measuring the levels of anxiety and pain awareness they were experiencing at that specific moment. A digital thermometer was used to measure hand temperature (you’ll understand why in a moment).

During the actual experiment, each participant completed a series of trials in which their dominant arm (depending on whether they were right or left-handed) was placed in a circulatory water bath. The bath was designed to be cooled to a temperature just above freezing (0 degrees celsius or 32 degrees Fahrenheit) for up to four minutes during each trial. Participants were also given time between trials to allow their hand temperature to return to normal. To measure the level of pain they were experiencing, participants used a rating scale to indicate level of discomfort they were feeling. Also, they were asked to estimate how much time had passed for each trial as another measure of pain intensity,

Before the experiment began, the participants were asked to select music which they felt to be happy, sad, or relaxing. Each participant then went through four cold water trials during which one of the three musical selections was played versus a control condition during which no music was played. The order of trials was varied to prevent any experimenter bias. After each trial, participants rated how distracting they found the music to be and how much control they felt they had over the pain.

As expected, participants reported the greatest amount of pain during the no-music condition while listening to happy, sad, or relaxing music affected pain perception in different ways. Participants listening to happy music reported having greater pain control and being able to handle pain longer. Relaxing music reduced anxiety and overall pain intensity which made the cold water trial easier than other kinds of music. While sad music was still better than no music at all, it was not as effective as happy or relaxing music. All three kinds of music helped time pass faster than during the no-music condition since participants were more distracted while dealing with cold water.

So, why was relaxing music more effective than happy music in helping participant pass the time during cold water trials? The main benefit of relaxing music seems to be that it helps relieve anxiety and speed up subjective time so the cold water trial seems to pass much faster than in other trials. Not surprisingly, participants found sad music to be the least effective in helping to manage pain though previous research has already shown that sad music may be preferred by people who are stressed or upset.

While listening to music won’t make pain go away, it can definitely help pain sufferers manage their daily lives better. Admittedly, this study focused on an artificial laboratory setting rather than the genuine chronic pain found in many medical conditions. For this reason, more research is needed to see how well music listening can work with chronic pain patients and whether it can be used in combination with mindfulness programs such as Acceptance and Commitment Therapy.

Although there are definite limits to the kind of pain relief that music listening can bring, it still can be highly useful in helping people with acute or chronic pain to function relatively normally. It may also help people in pain cut back on potentially addictive medications and allow them to handle the emotional distress daily pain can bring.

Whatever the kind of music people in pain prefer, its value as a way to help manage suffering cannot be underestimated.

Something to think about next time you’re reaching for the aspirin….

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