Music the Painkiller
We talked about music therapy in various contexts. To close our music series and start a new series on “pain,” we thought talking about how music affects pain perception would be a good topic to dwell on.
To start, it is worth clarifying some commonly used (and misused) terminology when it comes to the use of music for medical purposes. Music medicine is a type of intervention where the patient listens to pre-selected music, whether it be chosen by the patients themselves or the medical staff (1). On the other hand, music therapy is led by a therapist and requires more direct involvement of the patient (1). Different things fall under the umbrella of music therapy: live music listening to sing-alongs, playing an instrument to even writing songs (2). One meta-analysis points out that despite the clinical benefits of music therapy being higher than music medicine, the difference is not that large (2). Considering the ease of incorporating music medicine into any treatment, the little disadvantage can be worth ignoring.
Literature is full of studies that focus on the impact of music on specific types of pain. Most of the studies I will mention here focus on music medicine based on the definitions in the last paragraph (even if their title can say music therapy). Some studies design experiments to induce pain in the participants, like keeping their hands in cold water (3) or applying an electric stimulus (4). Many other studies look into actual patients, from dialysis and cancer patients to people going through surgery (1,2). A study shows that music can even help reduce pain in labour for new mothers (5). The common conclusion of almost all of these studies and meta-analyses is that music positively impacts pain perception, increasing the pain threshold and decreasing the negative emotions that come with pain, even if the effects may be small. There is one particular study that shows insignificant results on military hospital patients, but they also point to an important point that the music in that study was not selected by the patients themselves (1).
How objective are these studies? Most studies use both subjective and objective measures of pain (1,2). The objective measures are the patient's self-reports and can show variability across different trials. On the other hand, the subjective measures are the ones that the experimenter can measure or observe, like facial expressions or heart rates. There are even some secondary measures the scientists refer to, like the amount of opioid or non-opioid intake (2). It is promising to see that all of these measures agree. With such a robust testing scheme, using music to minimize pain, which is very cheap and easy to incorporate into treatment, is encouraging.
The choice of music is a very important factor. There can be some music that one person enjoys and the other finds as a noise. One study specifically wanted to understand whether patient-preferred music makes a difference in dialysis patients (1). This study not only looks at the pain measures but anxiety measures as well. And not surprisingly, they found that if the patients do not like the music played, it can increase their stress levels (1).
Another study that I really enjoyed reading looked at this question from a different perspective (3). Are the attributes of the music important for it to effectively decrease pain perception? Or whether the fact that the patient enjoys it or not? They did not, however, ask the patients to bring their favorite music. Instead, they created a very interesting dataset to test the participants on. One commonly used objective classification of music divides it into three attributes: arousal, valence, and depth (6). Arousal is the energy the person feels while listening to music; valence is the emotion that the person can feel, either positive or negative; and depth is the complexity of the piece, including at an emotional level. Basiński and colleagues collected unreleased or released but not widely available music that would fall into different scales for these three attributes. These music pieces were not something that the participants were familiar with, and they were later asked how much they enjoyed the music. And the distribution of the impact of the music on pain perception was all over the board when compared to these attributes (3). So it wasn’t the fact that a musical piece was slow or soothing, that made the difference, but whether the participants liked it or not! This is quite an important finding that requires the patient to be involved in their treatment plan for maximum efficiency.
To briefly talk about the mechanisms of how music can impact the pain perception: There are multiple ways suggested. One of them is music being a distraction (3,4): the patient can focus on the music rather than the pain itself. The more biological explanation is the music may impact the descending path pathways (3,4). Luckily we are capable of releasing endorphins (endogenous opioids) in our system that works as natural painkillers. Music is believed to increase the number of opioid receptors as well as endorphin production (4). Two brain regions, amygdala and anterior cingulate cortex, are also shown to be affected by music (4). And these regions are involved in emotional processing, which can explain how music can lower the negative emotions related to pain.
The literature shows that music does help the pain. But can music also be worth the pain? One interesting observation in the Basiński and colleagues' study was that some of the participants said that they would be happy to continue the experiment further than its allotted time just to listen to the rest of the music (3). I would not go far enough to say that music is worth the pain, but this was interesting to read, so I wanted to share it with you too!
Blog by Emine Topcu
1. Kim SK, Jeong HC. Effects of patient-selected music listening on the pain and anxiety of patients undergoing hemodialysis: A randomized controlled trial. Healthc. 2021;9(11).
2. Lee JH. The effects of music on pain: A meta-analysis. J Music Ther. 2016;53(4):430–77.
3. Basiński K, Zdun-Ryżewska A, Greenberg DM, Majkowicz M. Preferred musical attribute dimensions underlie individual differences in music-induced analgesia. Sci Rep [Internet]. 2021;11(1):1–8. Available from: https://doi.org/10.1038/s41598-021-87943-z
4. Antioch I, Furuta T, Uchikawa R, Okumura M, Otogoto J, Kondo E, et al. Favorite music mediates pain-related responses in the anterior cingulate cortex and skin pain thresholds. J Pain Res. 2020;13:2729–37.
5. Hosseini SE, Bagheri M, Honarparvaran N. Investigating the effect of music on labor pain and progress in the active stage of first labor. Eur Rev Med Pharmacol Sci. 2013 Jun;17(11):1479–87.
6. Greenberg DM, Kosinski M, Stillwell DJ, Monteiro BL, Levitin DJ, Rentfrow PJ. The Song Is You: Preferences for Musical Attribute Dimensions Reflect Personality. Soc Psychol Personal Sci. 2016;7(6):597–605.