Music & pain relief

So far, we have examined the positive effects of music on our wellbeing, both physically and mentally. However, if music can indeed make us ‘feel better’, is there any scope for its application towards pain relief? As well as being beneficial, can music be medicinal? There is historical evidence of music playing a role in treating disorders as early as ancient Egyptian times, circa 4,000 B.C. (Thompson, 2015). An additional benefit to the use of music is its lack of invasiveness, compared to other forms of treatment:

Music is perhaps unrivalled by any other form of human expression in the range of its defining characteristics, from its melody and rhythm to its emotional and social nature. The treatments that take advantage of these attributes are rewarding, motivating, accessible and inexpensive, and basically free of side effects, too. The attractive quality of music also encourages patients to continue therapy over many weeks and months, improving the chance of lasting gains (Thompson, 2015)

Rather than being a physical experience alone, pain is a ‘biopsychosocial experience’ (Gregory, 2014, p. 27) which exists in the mind as much as the body: ‘It is affected by psychological and social factors, such as the site and nature of the injury, personality, age, gender, anxiety, understanding and cultural factors’ (Godfrey, 2005, quoted in Gregory, 2014, p. 24). In previous studies on chronic pain, it has been noted that patients who concentrated on other tasks or activities experienced less pain (Löfgren & Norrbrink, 2012, p. 2146). Since many sections of the brain are activated when listening to music (Levitin, 2006, pp. 270-271), it stands to reason that the use of music could be highly effective as a distraction from pain, reducing or cancelling-out pain signals.

A clinical study by Mitchell et al (2007) supported the idea of music as a means of distraction from chronic pain, if not a complete remedy to pain altogether:

Music listening, and in particular listening to our own preferred music, may provide an emotionally engaging distraction capable of reducing both the sensation of pain itself and the accompanying negative affective experience (Mitchell et al, 2007, p. 37)

Mitchell et al’s (2007) study paints a highly optimistic picture for the application of music as an effective means of distraction. In particular, they noted that the patients in their study who place a higher value on music, and listen to it more frequently, responded that they were ‘enjoying life more, having more energy and ability to perform activities, and feeling depressed and in need of medical treatment less often’ (Mitchell et al, 2007, p. 37).

Another study by Silvestrini et al (2011) produced similarly interesting findings:

The present study was designed to test the pain-reducing effects of pleasant music compared to silence, unpleasant music, and to an auditory attention task. Results partially confirmed our hypotheses. Compared to the silence and the unpleasant music, pleasant music had a significant effect on the pain ratings and pain tolerance to the cold pressor test but not on the NFR. This finding suggests that the auditory stimuli used in this study, and more particularly pleasant music, did not produce any central descendent analgesic effect on spinal nociception, which would have resulted in lower NFR. In contrast, music had a significant effect on the NRS, the sensory and the affective thresholds, and on the pain tolerance to the cold pressor test compared to silence and to the unpleasant musical stimulations, and these results are consistent with previous studies showing pain-reducing effect of music on reported pain experience (Silvestrini et al, 2011, p. 268)

Silvestrini et al’s (2011) report suggests that the areas of the brain responsible for processing pain signals are the same as the areas for analysing music we hear. This is mainly because our brains utilize several different areas and functions when listening to music. These include the areas which process movement: the Cerebellum; a combination of Cortexes (Prefrontal, Motor, Sensory, Auditory and Visual); and the areas which process emotions: the Amygdala and Nucleus Accumbens. (Levitin, 2006, pp. 270-271).

Does this mean music is a distraction? Pain acts as a signal in the brain, alerting the conscious mind of something which may be an ‘issue’ or problem. This is a survival-trait ingrained in us through our evolution. Like music, ‘the areas of the brain involved in pain experience and behaviour are very extensive’ (Melzack, 1996, p.134). However, some studies, such as those by Fabbro & Crescentini (2014), indicate that once we are aware of these ‘issues’ with the body, manifested as pain we experience in the affected area, it is possible to cancel out the signal. We can, in effect, ‘switch off’ pain, depending on the individuals attitudes to pain.

This might go some way to explain the variance in results found by Silvestrini et al (2011) and Mitchell et al (2007). Both seemed to find generally positive results when studying the effect of listening to music in relation to experience of pain. However, both reports clearly show mixed results amongst their test groups. Other research, while demonstrating an overall positive effect of music in medicinal use (Hargreaves & North, 2008, p. 301), met with similarly varied outcomes depending on the subject’s gender and age:

With regard to sex, music was less effective for males than it was for females. With regard to age, children responded more positively to music than did adults and infants (Standley, 1995, quoted in Hargreaves & North, 2008, p. 302)

This runs in accordance with the findings of Fabbro & Crescentini (2014), which stated that different people apply varying levels of importance and focus to the pain they experience. What one individual might experience as mild pain, another could feel something altogether more debilitating; the change in pain experience is determined mainly by the “expectations” of the patient’ (Fabbro & Crescentini, 2014, p. 545). Gregory (2014) agrees with this view. As we have already seen, pain is ‘an individual experience and the effectiveness of interventions can vary between individuals’ (Gregory, 2014, p. 24). Therefore, their ability to focus on music instead of the brain’s pain signals will be compromised. Giving focus to anything our minds have deemed important for our attention means the brain is devoting less processing energy to listening to the music. This renders as null the positive effect music can have on our experience of pain, because ‘even if you’re only paying attention to one other factor, our capacity to focus on the music may have already been cut in half’. (Green, 1986, p. 68)

It is especially interesting that both studies yielded more positive results when the participants were listening not only to pleasant music, but to music they preferred (Mitchell et al, 2007, p.37). Levitin (2006, pp. 231) states that we often make our preferred musical choices during our early teenage years, and we attach a level of emotional importance to this music. Therefore, music’s ability to have a reductive effect on pain must be, in part, the mental act of processing these positive emotional feelings when listening to music we enjoy.

(This article was first published in June 2015)

REFERENCES

Fabbro, F., & Crescentini, C. (2014) ‘Review: Facing the experience of pain: A neuropsychological perspective’, Physics of Life Reviews, Vol. 11, pp. 540-552. Available from: 10.1016/j.plrev.2013.12.010.

Green, B. (1986) The inner game of music. United States: Pan Books.

Gregory, J. (2014) ‘Dealing with acute and chronic pain: part two – management’, Journal of Community Nursing, Vol. 28, No. 5, pp. 24-29.

Levitin, D. (2006). This is your brain on music: understanding a human obsession. Great Britain: Atlantic Books.

Löfgren, M., & Norrbrink, C. (2012) ”But I know what works’ – patients’ experience of spinal cord injury neuropathic pain management’, Disability & Rehabilitation, Vol. 34, No. 25, pp. 2139-2147.

Melzack, R. (1996) ‘Gate control theory: on the evolution of pain concepts’, Pain Forum, Vol. 5, No. 2, pp. 128-138.

Mitchell, L., MacDonald, R., Knussen, C. & Serpell, M. (2007) ‘A survey investigation of the effects of music listening on chronic pain’, Psychology of Music. Vol. 35 (1), pp. 37-57.

North, A. & Hargreaves, D. (2008) The social and applied psychology of music. United States: Oxford University Press.

Silvestrini, N., Piguet, V., Cedraschi, C. & Zentner, M. (2011) ‘Music and auditory distraction reduce pain: emotional or attentional effects?’ Music and Medicine. Vol 3 (4), pp. 264-270.

Thompson, W. (2015) ‘The Healine [sic] Power of Music’, Scientific American Mind, vol. 26, no. 2, pp. 32-41.