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12 Articles in Volume 12, Issue #5
A-Delta Pain Fiber Nerve Conduction Study Benefits Patients With Spinal Pain
Chronic Pain Management of the Noncompliant Patient
Clinical Applications of Radiofrequency Lesioning for Back and Neck Pain
Current Understanding and Management Of Medication-overuse Headache
Fibromyalgia: An Overview of Etiology and Non-pharmaceutical Treatment Options
June 2012 Pain Research Updates
Junk The Term Narcotics—Call Them Opioids
Managing Adverse Drug Effects in Pain: Focus on Muscle Relaxants
Music Therapy for Pain Management
Perioperative Pain Management in the Opioid-tolerant Elderly Patient: Case Challenge
Practical Tips in the Treatment Of Osteoarthritis of the Knee
Sudden, Unexpected Death in Chronic Pain Patients

Music Therapy for Pain Management

The experiences of five patients who used music therapy to manage various types of pain including pain associated with cancer, childbirth, and surgery.

Music for pain? Surely such a benign modality could not be much of a panacea. But perhaps we take music for granted. After all, it is everywhere—from grocery stores to elevators—and these days we can hear almost anything we like on radio, iPods, mp3s, YouTube, and the latest digital media. Most of us are fully aware of the impact of music on mood and emotion, but can music help us feel better?

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 [Lyrics are from the musical, ‘On a Clear Day You Can See Forever.’] 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. [Music therapy] relaxes [the] physical body [and] 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.

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.

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.


Update: A paper published in the Journal of Pain and Symptom Management in June 2020 included a review of 18 randomized controlled trials, including over 1,100 patients (60% male; mean age 60 years) on the relation between music interventions and pain scores. Researchers found that music reduced pain in general and that music interventions lasting 20 to 30 minutes decreased pain scores (music interventions under 20 minutes had less of an effect). On a 0 to 10 scale, the 20 to 30 minute music sessions decreased patients' self-reported pain scores by an average of 1.06 points.11

Last updated on: June 3, 2020
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