Music Therapy for Pain Management
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.
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.
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.