The Effects of Music on Pain Perception

The link between music and medicine has existed for many years. Ancient civilization artifacts as well as Biblical references suggestmusic was considered a powerful influence on physical health andwell-being (Gfeller, 2003). Also, the historical writings of theEgyptians, Chinese, Indians, Greeks, and Romans describe music as ahealing medium (Music, n.d.). In the United States, music therapy asa profession did not begin to develop until World War I and World WarII; professional and amateur musicians went to veteran's hospitals toplay for veterans suffering both physical and emotional trauma fromwar (American, n.d.). Hospital doctors and nurses observed thepositive psychological, physiological, cognitive, and emotionalresponses when veterans actively and passively engaged in musicactivities to relieve pain (Music, n.d.). Veteran's hospitals beganhiring musicians, thus the need for musicians who had receivedtraining prior to entering the hospital environment grew (American,n.d.). Colleges and universities responded by offering programs totrain musicians how to apply music in therapeutic ways (Music, n.d.). In 1950, music therapists who had worked with veterans, mentallyretarded, hearing/visually impaired, and psychiatric patients formedthe National Association for Music Therapy (NAMT) (Music, n.d.). In1998, NAMT joined another music therapy organization to become whatis now known as the American Music Therapy Association (AMTA).

An estimated 35 to 75 million people in the United States sufferfrom some type of pain problem (Walsh, Dumitu, Ramanurthy, &Schoenfeld, 1988 as cited in Wade & Hart, 2002). Chronic pain isconsidered one of the most costly health problems in America,totaling more than $50 billion each year (Brittman, n.d.) With somany people living with pain, it is not surprising music therapistswork in a variety of environments including medical hospitals,outpatient clinics, psychiatric hospitals, rehabilitation facilities,day care treatment centers, residences for developmentally disabledpersons, community mental health centers, drug and alcohol programs,senior centers, nursing homes, hospice programs, correctionalfacilities, halfway houses, and schools (Music, n.d.). Such a rangeof work environments indicates the use of music therapy is notlimited to a particular age group or to people experiencing pain as aresult of a physical injury. Children, adults, and the elderly withmental health needs, learning and developmental disabilities, andsubstance abuse problems, and even mothers in labor can benefit frommusic therapy (American, n.d.). However, most research focusing onmusic and pain examines individuals who are experiencing primarilyphysical pain as a result of surgery (Roberts, 2002). This does notmean the psychological/emotional component involved in perceivingpain is ignored; in fact, the recognition of this component as animportant element in pain perception allows for the modification ofpain through psychological techniques such as music therapy (Yang,n.d.). Therefore, music therapists not only assess the physicalhealth but also the emotional well-being, social functioning, and thecommunication and cognitive abilities and skills of their clients(American, n.d.). This holistic approach to healing and painmanagement and the lack of adverse side effects often accompanyingdrugs or surgery are the primary reasons why music therapy is soappealing.

Music therapy as an intervention to address perceived pain due tosurgery can be beneficial to patients physically and psychologically. Hospitalization can result in physical stress from invasive surgeryand therapies, as well as emotional stress due to unexpected news,unfamiliar environments, and a sense of losing control (Music, n.d.).There are several theories about how music therapy positively affectsperceived pain: (1) music serves as a distracter, (2) music may givethe patient a sense of control, (3) music causes the body to releaseendorphins to counteract pain, and (4) slow music relaxes a person byslowing their breathing and heartbeat (Roberts, 2002). It isimportant to recognize interactions between physical andpsychological responses to pain. For instance, fear of surgeryincreases blood pressure, prolonging the healing process, enhancingthe perception of pain, and in turn increasing blood pressure; thecyclical nature of psychology, physiology, and biology in theperception of pain results in difficulty when measuring pain, becauseit is a subjective experience. Just as music therapy is a holisticapproach to medicine, the way music functions in reducing perceivedpain encompasses whole human experience - psychological andphysiological events.

Weisenberg (1994) as cited in Megel, Houser, & Gleaves (1998)suggested distraction can be effective in moderating pain primarilythrough the cognitive component of the Gate-Control Theory of Pain. Attending to a pleasant stimulus occupies the capacity of theinformation processing system, disabling the individual from fullyattending to the pain-causing stimulus (Kwekkeboom, 2003). Livingston(1985) as cited in Stevens (1990) points out the importance of adistracter for patients undergoing surgery; this distracter providesan escape through imaginative thought which is important in relievingstress, anxiety, and fear associated with pain. Melzack & Walls(1965, 1982) as cited in Stevens (1990), suggest pleasant imageryincreases a sense of control, thereby decreasing anxiety and feelingsof helplessness. Music can be a strategy for refocusing attentionduring a painful experience (Music, n.d.). By acting as a competingstimulus to pain or distracter, it can reduce the perceived intensityof pain (Gfeller, 2003). Simultaneously, it can decrease the senseof loneliness and feelings that the hospital environment isimpersonal (Stevens, 1990).

Music may also be effective on a physiological level as well. Music with a slow, steady tempo can be used to cue slower breathingand trigger a relaxation response (Gfeller, 2003). This training iscalled the entrainment principal. According to Bradt (2002) thisprincipal involves bodies that are vibrating in slightly differentways that eventually catch up with each other to vibratesimultaneously. Bradt (2002) states music therapists entrain aclient's heart rate (or respiration) by first matching the music tothe heartbeat, then slightly altering the music tempo so that theheart rate follows the beat of the music. The type of music used canentrain the body to respond in different ways. Sedative music canalleviate anxiety and stress levels resulting in less use of painmedication, shorter recovery periods, and higher patientsatisfaction, while stimulative music can be physically andpsychologically motivating, which is beneficial during rehabilitation(Music, n.d.).

Research supporting these four perspectives concerning theusefulness of music therapy in pain management has varied. Musictherapy has been shown to successfully reduce the reported pain andnausea experienced by cancer patients who had undergone bone marrowtransplants (Music therapy, 2003). Furthermore, the new bone marrowof patients who participated in music-assisted relaxation andimagery, took hold faster (13.5 days) than in patients who receivedno music therapy (15.5) days (Music therapy, 2003). Good,Stanton-Hicks, Grass, Anderson, Lai, Roykulcharoen, & Adler(2001) explored the effects of music and relaxation on postoperativepain across and between two days and two activities: ambulation(walking, moving around) and rest. The results of this studyindicated reported pain significantly decreased from day one to daytwo. Participants used music to both relax and distract and reportedless pain during ambulation and after recovery than the groups whohad not received music or relaxation therapy. In a pilot study ofpatients' perceptions of music during surgery, 45% of participantsranked the helpfulness of music as excellent (Stevens, 1990). Thisresearch referred to patients describing the music as a relaxationtool, method of distraction, and as direct intervention (the painended abruptly when the music began). Miluk-Kolasa & Matajek(1996) as cited in Cohen (2001) indicated dental patients providedwith information about surgery before the surgical procedureexhibited physiological signs of stress such as changes in heartrate, blood pressure, and skin temperature. The physiologicalresponses of patients who listened to music returned to their initialstate within an hour, while those of patients who did not listen tomusic remained at the heightened level throughout the procedure. Bally, Campbell, Chesnick, & Tranmer (2003), in examining theeffects of music on patient psychophysiological stress responses tocoronary angiography, found music therapy did not significantlyaffect anxiety, perceived pain intensity, heart rate, blood pressure,or use of additional pain medications, yet patients favored havingmusic. Nurses reported the music's calming affect and even sought itout for patients not participating in the study.

Alternatively, other studies have indicated music has had littleeffect on pain perception and patient anxiety. In a study by Megel,et al. (1998) children, from three to six years old, assigned to theexperimental group were given musical intervention (a series oflullabies played through headphones) during immunizations. Before achild received an immunization, his or her blood pressure and heartrate were measured and data about his or her distress level werecollected. While this study found no significant differences inblood pressure, heart rate, or perceived pain between theexperimental and control groups, total distress scores weresignificantly less for the group that received music intervention,suggesting the stress/perceived pain associated with immunizationscan be somewhat alleviated through the use of a distracter such asmusic. Kwekkeboom (2003) compared the effects of music and adifferent distracter (book on tape) on the perceived pain of cancerpatients, and found no significant differences in pain between thegroup that received music and the group that received thebook-on-tape distracter. Additionally, no significant differences inpain perception between the two distracter groups and the controlgroup were found. Evans (2002) conducted a survey of researchinvolving the application of music therapy in reducing pain andanxiety in hospital patients. This review indicated music waseffective in reducing anxiety during normal care delivery, but had noeffect on select medical procedures and little effect on breathingrate, heart rate, blood pressure, etc. Although these studiesindicate music has little impact on pain perception, researchersrecommended music be offered in medical facilities due to thevariance in patient abilities to cope with pain and the inexpensivenature of music intervention.

Overall, music does have positive effects on pain management. Prior research does not consistently identify the role music plays asdescribed by the previously listed theories, but does indicate theconsistent use of vital signs as a measure of stress in response topain. Generally patients report music intervention positivelyimpacted their experience of pain associated with surgicalprocedures, and despite the weak findings of some studies,researchers recommend music therapy should be offered to patients asan additional method of pain management. Music entrainment iscomplementary to pain medication (Bradt, 2002). Even if playing asecondary role in managing pain, music therapy is non-invasive, hasno negative side effects, is inexpensive to hospitals and patients,and can be completely personal, reaching a patient beyond thephysical realm of drug therapies. If a patient chooses his or hermusic, as is the case with practicing music therapists, they can onlybenefit from the recollection of pleasant memories, divertedattention, and resulting relaxing physiological responses.

Generally, future research in pain management should focus onholistic medicine. Because pain is a unique subjective experience,the treatment should also be unique. Additionally, research shouldattempt to clarify how music and the Gate Control Theory of Pain areintegrated. Perhaps by identifying the physiological basis for paincontrol, we can better understand the corresponding neural/emotionalresponse

References

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Cohen, B. (2001). Use of aromatherapy and music therapy toreduce anxiety and pain perception in dental hygiene. Access, 15(6),34-41.

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