PPM ACCESS
Access to the PPM Journal and newsletters is FREE for clinicians.
15 Articles in Volume 21, Issue #4
Advanced Practice Matters: Needs Assessment in Pain Management Training
Analgesics of the Future: Novel Capsaicin Formulation CNTX-4975
Ask the PharmD: How to Improve Medication Adherence in Chronic Pain Management
Behavioral Medicine: Applying Mindfulness-Based Stress Reduction for Comorbid Pain and PTSD
Case Report: Multimodal Management of Osteoarthritis
Commentary: The PCP's Role in Preventing Chronic Back Pain
Guest Editorial: Structural Racism in Pain Practice and How to Combat the “Hidden Curriculum”
Hypermobile Ehlers-Danlos Syndrome: An Update on Therapeutic Approaches for Pain Management
Male Clinicians as Allies in Women’s Leadership: What Your Female Peers Want You to Know
Meet the Women Changing Pain Medicine
Perspective: It’s Time to Advocate for Early Interventional Pain Management
Research Insights: Is Spinal Fusion Surgery Being Overused in Back Pain Care?
Tips from the Field: Treating Pain in an Under-Resourced State
Utilizing Music Therapy to Manage Chronic Pain
Woman to Woman: Leaders Share Advice for the Next Generation of Pain Medicine Clinicians

Utilizing Music Therapy to Manage Chronic Pain

Whether guided or used as part of self-care, music has the power to reduce pain and associated feelings of anxiety, depression, and isolation.

Most people enjoy music because as humans we understand, somehow, that music helps us to feel better. Clinically speaking, however, can music actually help to manage chronic pain? According to the research, that may well be the case.

What the Data Show about the Physical and Mental Benefits of Music Therapy

We know that chronic pain is associated with biopsychosocial symptoms that include not just the experience of pain itself but also anxiety, depressed mood, and social isolation.1 For this reason, a multidisciplinary approach that includes teaching self-management skills is considered the optimal therapeutic model.2,3

Music therapy is often recommended or integrated into biopsychosocial care. As a robust stimulus, music impacts the brain in myriad ways. Therapeutic music experiences have been shown to yield evidence of:

  • more regulated states, including improved capacity to self-regulate and connect with others4
  • improved depressive symptoms that continue to improve weekly5,6
  • decreased anxiety and pain5-8
  • increased activity in the reward and pleasure areas of the brain9,10
  • physiological changes associated with lower blood pressure11
  • increased oxytocin production and decreased stress-induced hormones12

In people living with chronic pain conditions, therapeutic music experiences have specifically been demonstrated to:

  • enhance self-efficacy, motivation, empowerment, and social engagement1
  • reduce pain, depression, and disability13

Music therapists– nationally credentialed as board-certified (MT-BC) – are specifically trained to optimize these potential impacts by providing multifaceted, individualized music experiences.

Case Vignettes: Music Therapy for Pain Relief and Mental Health

The following case vignettes* from the author’s private practice illustrate how individual treatment with a music therapist can help individuals experience relief from pain, depression, isolation, and anxiety. Of note is that music therapy interaction can take place in person, on video, or over the phone; it can also be taught to the patient for self-use when needed to provide emotional ballast.

Chronic Pain

Jean is an elderly woman living with chronic pain. Over the course of several months, she and her music therapist have developed a close relationship. During weekly visits, she talks about how she has been feeling and the personal issues that have been troubling her. After asking Jean to locate her pain, Jean is encouraged to give voice to that pain –  not in words but in musical, vocal sounds.

“Let the pain have a voice,” the therapist suggests. The therapist begins by playing two different but simple and repetitive chord patterns for Jean on the guitar; Jean selects the one she likes best. Sitting across from Jean, maintaining eye contact with her and strumming the guitar, the therapist plays those patterns. Slowly, Jean begins to sing sounds. The therapist sings sounds with Jean, echoing the sounds Jean vocalizes and adding other complementary sounds.

The supportive personal contact and musical contact encourage Jean. Through this work with her therapist, Jean expresses and releases her feelings and her pain, validating herself in beautiful music. As the weeks progress in music therapy using vocal and instrumental improvisation, Jean reports that during the weekly sessions she feels both relief from her pain and improvement in her mood.

Chronic Pain & Stress

Farrah, in her mid-60s, is a retired anesthesiologist in a Muslim family, also living with chronic pain. Complicating her pain experience is stress at home, including a divorce. Farrah calls her weekly music experiences “musiking.” During sessions, she and the therapist talk about her week, visits with family, conversations she has had, as well as her pain. Together, they compose lyrics to and sing simple, hopeful songs:

Inshallah I will feel better          

Inshallah I’ll be okay

Inshallah I will get better            

Inshallah to see another day.

As the tune becomes familiar, Farrah is asked to associate the notes and words with hope and relief from her pain burden. Her pain is expressed in the beauty of her own voice and song.   During their sessions, Farrah tells the therapist her mood is improved and her pain reduced.

Isolation

Debbie, a middle-aged professional, mom, grandma, and wife, reports struggling during the COVID-19 pandemic. She shares that although she often feels isolated, her virtual group music therapy sessions have made her feel cared for and connected. During a video session, the therapist teaches the group a simple, upbeat song and encourages participants to add their own lyrics. At Debbie’s request, the therapist sends a video recording of herself leading the song to each group member for individual use. The following week, Debbie reports that the technique of using singing to focus her thoughts and feelings has become a touchstone.  Humming, adding words, and keeping the beat with a simple song, as part of group sessions and on her own throughout the week, have reduced her feelings of isolation and lightened her mood.

Anxiety

Kathy, a front-line health care worker in her mid-30s, has also struggled during COVID –  including contracting the virus. Upon recovery, she is highly anxious about returning to work at the hospital and afraid of reinfection. Struggling to breathe during her bout with COVID has left her voice feeling weak and scratchy.

During a phone session, she and the music therapist softly and slowly sing sounds back and forth while they breathe deeply. Kathy cries, sharing that she had been afraid to use her voice, afraid that her voice would never be the same. Gently using her voice with therapist support provides reassurance.

Weeks later, Kathy sends a follow-up message about how grateful she is for the music therapy. The sessions have helped her express her feelings, gather her strength, and prepare for her upcoming challenges. She reports anxiety relief, elevated mood, and increased self-efficacy.

More on the overlap between mental health and physical health on our sister clinical site Psycom Pro.

Therapeutic Music for Pain: A Mini Self-Care Guide to Share with Patients

The following techniques, based on the author’s clinical experience, may be shared with patients wishing to integrate music therapy into their self-care routines. Urge your patients to find and work directly with a board-certified music therapist before they utilize these strategies at home. There is no substitute for the unique support and guidance therapists provide in and through music, especially as they gain courage to try new music experiences. A trained therapist can develop interventions and adapt those interventions for independent use.

The more people incorporate music experiences into their lives, the greater its potential to help them manage chronic pain and certain associated mental health issues (treatment of moderate to severe mental health disorders should be managed by a mental health professional).

Below is a sequential guide. Music listening is an easy and safe place to start. Patients can add and build up, incrementally bringing more music experiences into their lives and intensifying its benefits. The further they venture, the more they might also benefit from professional support.

Music Listening

Patients can listen to their favorite music; this is the least challenging experience. They can play it for themselves often, especially when in pain. Ask them to take notice of how it makes them feel. Invite them to bring all of the genres and artists they love into their music listening. Notice types of sounds, lyrics, beats. Which pieces bring out feelings of calm, energy, etc?

They can make their own playlists in different categories depending on their needs.

People can expose themselves to new music as well and explore their impact on mood and energy level.

If a movie was made of your patient’s life, what theme song would they choose? Ask patients to play and test different songs until they find their theme song. They can play it and notice what they feel. What other songs are part of their story, such as those fondly remembered from childhood, adolescence, or special events? These songs can be played or made into a playlist.

Musicmaking

Individuals can sing along with their favorite songs – in the car, in the shower, wherever they feel like it, to distract them from their pain experience as well as to help them relax, cheer, energize, or motivate themselves.

They can make up new lyrics to any songs they choose so that the words reflect the patient and their situation. They also can experiment with making up sound songs –  such as songs they make up about loading the dishwasher, or a song of sounds about their achy joints complaining. These songs may have words, or not. They can be completely new lyrics to songs they love, or just tunes patients make up as they go along. They can also add sounds they make while deep breathing. Think of mantras repeated while meditating.

Here are some positive sentence seeds which the patient can complete and sing as affirmations:

I feel good when…

It helps me to…

I hope that…

Playing with Instruments

If your patient has ever played an instrument, they can take it up again. It is not about performing. but rather creating pleasure to distract the brain from processing pain signals. If they are new to playing an instrument, there are lots of ways to play along with their favorite songs:

  • Use countertops or pencils for drumming and tapping
  • Buy some bells, chimes, small drums or maracas (these need not be expensive or professional)
  • Try self-percussion – clap, snap, or make beats on one’s thighs. Notice the beat of favorite songs, follow those beats, and then see if they can add their own beats along with the song.

Moving or Dancing to Music

Physical activity of any kind is generally considered good for managing chronic pain. Encourage the patient to move or dance to music with whatever part(s) they can comfortably move – hands, head, arms, feet – while standing, sitting, even lying down. Movement is about feeling better. Again, they can experiment with different types of music. Rhythmic music might make them want to revive their dance moves or exercise along. Slower, softer music is good for stretching.

Invite them to try some contemplative music while standing or sitting and just allowing themselves to float their arms out in front of them and move interpretively to the music. Start with one arm, follow it with their eyes, add the other arm. They can watch their arms as they move.

Music as a Routine throughout the Day

People can be encouraged to let music be the “special sauce” they add to different parts of their day. Chores, grooming, yoga – music can be added to almost any other activity and occupy their brain in the processing. They can try combining two or three of the above steps: for example, play a song while singing it and moving to it. The more layers patients add to their music experiences, the more they stimulate feel-good chemical production and the more they distract the brain away from the pain toward their music experience.

Practical Takeaways

Music therapy is benign, widely available, relatively inexpensive, and intrinsically pleasurable. Additionally, it is highly adaptable to patient preferences and can be easily taught to carry over for ongoing and independent patient use (ie, self-care).

With potential to enhance many of the protective factors known to assist in the management of chronic pain, including improving function and mood, music therapy is a recommended adjunct to any biopsychosocial treatment plan.

Additional Resources

  • The American Music Therapy Association (AMTA) provides a directory of certified music therapists
  • The Global Council on Brain Health, a collaborative of AARP (aarp.org), has published a guide, Music on Our Minds: The Rich Potential of Music to Promote Brain Health and Mental Well-Being
  • MSinHarmony.com, a joint venture of AMTA and Bristol Myers Squibb, provides information about music therapy for people diagnosed with multiple sclerosis
  • The Sound Health Network (SHN) at UCSF aims to promote research and public awareness about the impact of music on health and wellness.

*Identifying details have been altered.

Last updated on: July 7, 2021
Continue Reading:
Music as a Pain Intervention for Fibromyalgia
close X
SHOW MAIN MENU
SHOW SUB MENU