Music Therapy and Pain Management

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Music Therapy
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Music Therapy and Pain Management

Sophie Krefft

October 1, 2010

Background

Music Therapy

Music therapy is a health profession in which the therapist combines musical

interventions with a supporting relationship and seeks to improve the well
-
being of his
or
her clients

(
http://www.musictherapy.org/
)
.

There are
numerous

goals musical therapy
can seek to accomplish, namely the management of pain, reduction of stress and
anxiety, alleviation of depression, treatment of respiratory problems, exercising of joints
and limbs,
provision of control and self expression,
and gener
al promotion of good
health

(Bailey, 1986;
http://www.musictherapy.org/
)
.
The most common treatment
methods of music therapy are listening to music, singing, dancing, and creating music
(
http://www.musictherapy.org/
).

The
relief

of pain is a primary focus of music therapy,
and numerous studies have proven it to be effective for

alleviating

acute pain (Bailey,
1986; Locsin, 1981; Maslar, 1986; Melzack, Weisz, &

Sprague, 1963; Michel & Chesky, 1995
;
http://www.musictherapy.org/
).

Pain

There are two different kinds of pain: acute and
chronic. Acute pain is sudden but temporary pain,
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whereas chronic pain endures for a l
ong time, even years.
Pain is a signal of suffering in
one or multiple domains (physical, emotional, etc.) and its experience is highly
subjective (Maslar, 1986).

How intensely pain is experienced and the level it can be
tolerated at dep
ends on several fac
tors.
Expectat
ions of pain levels, suggestion

of how
well the treatment will work, mood of the patient

(especially
the presence of
anxiety

or

stress
), amount of focus on the pain,
and
intensiveness and duration of the pain, as well
as early childhood experiences and culture can all impact how an individual encounters
pain
(
Locsin, 1981;
Maslar, 1986; Melzack, Weisz, & Sprague).
Initially, the pain is
fought naturally
by

the body
’s relea
se of

endorphins, a type of
neurotransmitter.

If the
pain persists, it
is typically treated with pain medication, but it can
also be treated by alternative techniques, which is where music
therapy
comes

in
to play

(Maslar, 1986)
.



Music Therapy and Pain
Management

Goals and Methods

Music therapy is generally used to reduce pain when medication does not
provide adequate relief
, in which case the th
erapy is combined with drug use
.
Another
reason for using music is when
pain
medications cause

serious side effects in a patient
and so cannot be used (
http://www.musictherapy.org/
). When music therapy is
employed

for pain management, its goals are to increase the patient’s comfort, well
-
being, and feeli
ng of control over pain (
Bailey, 1986; Melzack, Weisz, Sprague, 1963;
http://www.musictherapy.org/
)
.

The aforemen
tioned methods of music therapy, with the
exception of dancing,

can all

be applied when the therapy’s focus is
pain, and which
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method is chosen depends on the patient’s needs, experience
with music, and coping abilities.

Regardless of the method
chosen, communication between the therapist and the patient
is vital, both to all
ow the patient to participate in the selection
of music and to discuss the emotions and thoughts the music
elicits

(Bailey, 1986)
.

In Bailey’s review of music therapy in 1986,
she said that a

mus
ic therapist can
usually categorize a

client’s exp
erience wit
h music
into one of three
genres
:

performer,
listener, or “event
-
er” (
p. 26
).

A

performer is

define
d

as

a person who has
practiced
creating their own music, either by singing, playing an instrument, or
composing music.

Anyone who has spent time
keenly

listening to music

is classified as a listener
.

Lastly,
an event
-
er is described as a person whos
e

only interaction with music is when it is
i
ncorporated into another event, such as a wedding
.

All three of these groups can
benefit from listening to music, although they can all be given different tasks


performers are told to sing or play along, listeners are told to listen and critique, and
event
-
ers are told to visualize people, places, and e
vents to go al
ong with
the music
.
Furthermore, performers can

create their own music to go along wit
h what they are
hearing
.

As a general rule, the music chosen for therapy should be harmonious, steady,
gentle, and relaxing
.
Instrumental music is the most
widespread

choice
, although
music

that incorporate
s

singing
is

still substantially used (Bailey, 1986).
The iso
-
principle is a
rather common method of music selection and is based on the idea of slowly converting
the patient’s mood from its present state
to a more desirable one (Maslar, 1986).

First
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music is found that matches the patient’s

emotional state

(be it lonely, fearful, etc.)
,

and
then it is gradually
modified

until the

songs being played are cheerful and comforting
and the patient’s disposition
is the same (Bailey, 1986).

O
ther

factors

can

also
influence
what

music is chosen
, such as the patient’s coping abilities

(because music can evoke
strong emotions and feelings)

and musical preferences (Bailey, 1986;
Maslar, 1986;
Michel & Chesky
, 1995
;
http://www.musictherapy.org/
)
.

Effectiveness


The vast majority of studies that regard music therapy for pain managements
focus on acute pain
,
such as den
tistry,
labor
, and postoperative pains
.
These studies
conclusively find it to be effective for reducing a patient’s pain level

(Bailey, 1986;
Locsin, 1981; Maslar, 1986; Melzack, Weisz, & Sprague, 1963; Michel & Chesky, 1995;
http://www.musictherapy.org/
)
.

I
n
Melzack, Weisz, and Sprague’s study, where they
evaluated how music and
suggestion contributed to pain, they discovered that music
therapy works best for slowly rising pain as opposed to sudden, sharp pain (1963).

Music therapy alleviates pain both psychol
ogically and

physiologically (Maslar, 1986;
Melzack, Weisz, & Sprague, 1963
)
.


Melzack, Weisz, and Sprague evaluated forty
-
two Tufts
University students, each of whom
was

provided with
headphones and a listening device (1963)
. The experimental

group

s lis
tening device
s

enable
d

them to adjust levels of music
and white noise, and the control group’s listening device
s

did
not produce any sound, but they were told it
emitted an

ult
rasonic sound
.

Some members of each group were told that the device would
allow

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them to endure more pain,
but

others were told nothing
. Their fingers were then placed
into an ice water bucket and the amount of time
that
they could tolerate the freezing
water was measured.

From this

study, Melzack, Weisz, and Sprague were able to
concl
ude

that
although
neither the music alone nor

just
the suggestion that the
“ultrasonic”
apparatus would work
significantly
elongated the amount of time

of

the

individual’s tolerance
(their p
-
values were 0.073 and 0.254, respectively)
, when those
two
factors were combined
,

the results improved dramatically, with a p
-
value of 0.006.


In 1981, Locsin performed a post
-
operative

study on twenty
-
four women who
underwent gynecologic or obstetric surgery
, testing how music influenced their pain

over the first

forty
-
eight hours

after their surger
y
.

The experimental group listened to
music for fifteen minutes every two hours, after which their pain levels were
documented
; the control group simply had their degree of pain
recorded

every two
hours
.

Pain was measured in
four

different ways. The first method was to

utilize

the
“Overt Pain Reaction Rating Scale

(OPRRS)
,” a scale devised by the experimenters
that ranked different obse
rvations of pain
severity
(
p. 21). The
y also measured pulse,
blood pre
ssure,

and the use of

pain medications
.

The results of their study were that
OPRRS,
the blood pressure measurements
, and the amount of pain medication used

all

showed marked decreases in pain for the experimental groups

for the full forty
-
eight
hours, but that the pulse data only showed differences in the last
twenty
-
four hours
.

After the experiment, they also questioned the women about their post
-
operative pain,
and those who had taken part in the mu
sic therapy recounte
d less pain
.


Physiological Causes

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Both Maslar and
Melzack, Weisz, and Sprague attributed the decrease in pain to
the fact that it hinders signals in the brainstem that are triggered by pain (1986, 1963)
.
Maslar
goes on to explain

that this occurs because of
Melzack’s

Gate Control Theory
,
which
states

that the spinal cord is able to control the flow of nerve impulses to the
brain, and that music affect
s the workings of these “gates”
.
She

says:

This theory validates the fact that it

is the sensory
-
discriminating capabilities of
an individual that will decide the amount, perception, and responses to the pain.
Melzack’s Gate Control Theory substantiates using music as a distraction away
from the pain stimulus, and gives a foundation on

which

future research can be
based. (
p.216)

When multiple separate stimuli simultaneously occur, only the
strongest enters consciousness (Maslar, 1986).



Psychological Causes

The most documented psychological reason that music therapy reduces pain is
that it simply distracts the patient
and directs focus away from him
-

or her
self

(Bailey,
1986; Locsin, 1981; Maslar, 1986; Melzack, Weisz, & Sprague, 1963; Michel & Chesky,
1995).

Furthermore, musical therapy improves mood and reduces stress, tension, and
anxiety, all of which contribute to pain (Maslar, 1986).
Melzack, Weisz, and Sprague
also found that music therapy produces the best results when it is combined with the
assuranc
e that it will help relieve the patient’s pain (1963).

Obser
vable Effects

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Although pain is primarily a subjective experience,
and thus the measurement of it is also fairly subjective,
there are some concrete indicators of pain that can be
used to assess i
ts intensity. To begin with, pain elevates
pulse and blood pressure, but music therapy can regulate both symptoms (Locsin,
1981).

Music therapy also reduces

the
amount of pain medications that

a patient

intake
s
, an obvious sign of pain reduction (Locsin
, 1981; Maslar, 1986). Lastly, those
patients who undergo music therapy have shortened recovery periods (Maslar, 1986).

Chronic Pain


All the research previously discussed has
pertained to the treatment of acute
pain. Although the existing data leans towar
d music therapy being effectual for chronic
as well as acute pain, there
are
simply not enough studies to verify if it is in fact a
reliable method for treating chronic pain

(
McCraffrey & Freeman, 2003)
.

In their 2003
inquiry, McCraffrey and Freeman

analyzed how music therapy impacted chronic pain,
specifically osteoarthritis.

Their study
lasted for fourteen days and
included sixty
-
six
senior citizens, all with
osteoarthritis
.
The experimental group listened to

music for
twenty minutes a day

and the c
ontrol group just sat
quietly for twenty minut
es a day
.
Their results showed that in various ways of comparing the data, those who engaged in
music therapy always fared better. Firstly, on any given day, the pain levels of the
experimental

group

were lowe
r after the music therapy than they had been bef
ore
.
Secondly, for each individual day, the experimental group had less pain after listening to
the music than the control group did after sitting quie
tly
. Lastly, over the course of the
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fourteen days, the experimental group experienced an overall decrease of their chronic
pain, whereas the control group showed no
substantial change
.

Critique

of

Studies


Although all the aforementioned studies and articles are considered by the author
to b
e legitimate sources of scientific information, there are, as there
is

with any scientific
research, some weaknesses in them.

Since pain is

a

subjective experience, it is hard to
measure, and the fact that people have different pain thresholds further comp
licates the
matter. Most of the studies lack
concrete
physical

evidence; they

rely

solely or primarily
on the scientist’s observations and the patient’s reports of pain.
In Maslar’s

1986 review
of music therapy for pain management, she perceived some additional shortcomings:
many experimenters used auditory stimulation instead of music, and those that did use
music failed to include in their publications what kind of music was used,
preventing
r
eplication
.

She states that u
sing auditory stimulation as opposed to music in a scientific
study is understandable

because of the need for objectivity (auditory stimulation is
easier to keep consistent) and because it prevents responses from be
ing influence

by
musical taste
.
Despite these advantages, auditory stimulation is
still
different from
music,
and so one could argue tha
t it produces different results and therefore studies
using just auditory stimulation are inapplicable to music therapy
research.

Conclusion



Music therapy has been proved to be effective for lessening acute pain (Bailey,
1986; Locsin, 1981; Maslar, 1986; Melzack, Weisz, & Sprague, 1963; Michel & Chesky,
1995;
http://www.musictherapy.org/
). Melzack, Weisz, and Sprague found in their
experiments that when an individual listened to music and was told the music would
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9



reduce their pain, the individual was able to tolerate the ice water surrounding their
fingers long
er (1963).

Locsin found when post
-
operative women listened to music,
the
scientists observed less

severe

manifestations of pain and more regular blood
pressures and pulses (although the pulse only showed a significant difference in the
second day) and the
women reported less pain when questioned directly

(1981)
.

In the
reviews by Bailey, Maslar, and Michel and Chesky, music therapy was further
documented to be effective.


Biologically, music therapy

works by inhibiting

the nerve impulses conveying pain
(Mas
lar, 1986; Melzack, Weisz, & Sprague, 1963).

Psychologically, it succeeds in
lessening pain
by distracting the patient from his or her pain and by positively
affecting

other factors that contribute to pain, namely mood and stress (Bailey, 1986; Locsin
,
1981; Maslar, 1986; Melzack, Weisz, & Sprague, 1963; Michel & Chesky, 1995)
.

Music
therapy clearly demonstrates its functionality

for

alleviating
acute
pain in
that it

quickens
recovery, decreases pain medication consumption, and normalizes pulse and blo
od
pressure (Locsin, 1981; Maslar, 1986).

In conclusion, music therapy is highly recommended for acute pain management,
particularly when pain medication is not sufficient or when conditions prevent pain
medication from being utilized. Because it has next
to no adverse side effects and the
few experiments performed have shown it to be helpful, music therapy is suggested for
chronic pain management as well.
However, more research needs to be done on music
therapy and chronic pain before it becomes a commonpl
ace practice, and it is strongly
advocated that more research on this topic be executed.


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Ref
e
rences

American Music Therapy Association
. (1998). (American Music Therapy Association,
Inc.) Retrieved September 2010, from American
Music Therapy Association:
http://www.musictherapy.org/

Bailey, L. M. (1986). Music Therapy in Pain Management.
Journal of Pain and Symptom
Management

, 1

(1), 25
-
28.

Locsin, R. (1981). The effect of music on the pain of selected post
-
operative patients.
J
ournal of Advanced Nursing

, 6

(1), 19
-
25.

Maslar, P. (1986). The Effect of Music on the Reduction of Pain: A Review of the
Literature.
The Arts in Psychotherapy

, 13
, 215
-
219.

McCaffrey, R. &
. (2003). Effect of music on chronic osteoarthritis pain in older people.
Journal of Advanced Nursing

, 44

(5), 517
-
524.

Melzack, R. W. (1963). Stratagems for Controlling Pain: Contributions of Auditory
Stimulation and Suggestion.
Experimental Neurology

,
8
, 239
-
247.

Michel, D. &. (1995). A Survey of Music Therapists Using Music for Pain Relief.
The
Arts in Psychotherapy

, 22

(1), 49
-
51.