Listening to music as a complementary treatment for relieving pain is gaining ground in recent years, although the efficacy of music for the treatment of pain is still under active research in India and abroad.
Music therapists around the world study their clients and prescribe an “appropriate” and “acceptable” music for this purpose. There is a near unanimity among them in selecting tones and melodies rich in harmonics and low in rhythm and tempo (percussion) so that maximum results could be obtained in this direction. In a study conducted recently, it was concluded that listening to music reduced pain intensity levels and opioid requirements, but the magnitude of these benefits was rather small and, therefore, its clinical importance is somewhat unclear.
Many an Indian ragas promise such an effect- especially when rendered in a dead-slow pace. Ragas such as Neelambari and Mayamalavagowla have been tested for their soporific effects which also helps in overcoming painful experience- both physical and mental.
A systematic review conducted recently and which included 51 studies involving 3663 subjects has indicated that music could reduce pain in at least 50% of patients even reducing the requirement of analgesics such as morphine.
In the 31 studies evaluating mean pain intensity there was a considerable variation in the effect of music, indicating statistical heterogeneity (12 = 85.3%). After grouping the studies according to the pain model, this heterogeneity remained, with the exception of the studies that evaluated acute postoperative pain. In this last group, patients exposed to music had pain intensity that was 0.5 units lower on a 0 to 10 scale than unexposed subjects (95% CI: -0.9 to -0.2). Studies that permitted patients to select the music did not reveal a benefit from music; the decline in pain intensity was 0.2 units, 95% CI (-0.7 to 0.2).
Four studies reported the proportion of subjects with at least 50% pain relief; subjects exposed to music had a 70% higher likelihood of having pain relief than unexposed subjects (95% CI: 1.21 to 2.37). NNT = 5 (95% CI: 4 to 13).
Three studies evaluated opioid requirements two hours after surgery: subjects exposed to music required 1.0 mg (18.4%) less morphine (95% CI: -2.0 to -0.2) than unexposed subjects. Five studies assessed requirements 24 hours after surgery: the music group required 5.7 mg (15.4%) less morphine than the unexposed group (95% CI: -8.8 to -2.6). Five studies evaluated requirements during painful procedures: the difference in requirements showed a trend towards favouring the music group (-0.7 mg, 95% CI: -1.8 to 0.4).
However, as the magnitude of these positive effects is quite small, it is necessary that more clinical experiments – especially with selected Indian ragas are conducted in the near future to bring in more credibility to this approach. The objective is to evaluate the effects of selected music on acute, chronic or cancer pain intensity, pain relief and other analgesic requirements.
Patients awaiting surgical interventions are found to have less pre-operative anxiety if they mix relaxation and music with analgesics administered to them. A new study by a nurse researcher has found that relaxation and music separately or together, significantly reduce a patient’s pain following major abdominal surgery. Tested in addition to the usual pain medication, these self-care methods reduced pain medication alone. Marion Good, a professor of nursing at Frances Payne Bolton School of Nursing at Case Western Reserve University and who plays music at her spare hours also happened to work with patients suffering from back pain for over 15 years. “I would bring music into the room – soft, quiet music. Their faces just relaxed pretty soon they fell asleep,” she says. “I had to tiptoe out of the room and come back an hour or two later to pick up my tape recorder.” Previous research found listening to 45 minutes of soft music before going to bed can improve sleep by more than a third. The conclusion of a systematic analysis combining 51 clinical studies is music to her ears. The Cochrane Review of Evidence-Based Healthcare found that patients exposed to music rate their pain as less intense and even use lower doses of painkillers. On a 0 to 10 scale, patients reported an average drop of 0.5 in their pain rating when listening to music. “It’s not a huge amount,” Good says, “but that’s an average and for some people, it will be more, and for some it will be less.” Since music has no side effects, she points out, there’s no risk in trying it. Good’s latest study, conducted with Sandra Siedlecki of the Cleveland Clinic Foundation and published in the Journal of Advanced Nursing, found that patients with chronic pain who added music for pain relief got other benefits too.
“We found that music reduced pain, reduced anxiety, reduced depressive symptoms, and reduced pain disability,” she says. Pain also interferes with appetite and sleep and can lead to complications that prolong hospitalization. Reduction of pain may improve postoperative recovery. Music and relaxation are useful for patients who have had incomplete relief from pain medication, or who may wish to avoid side effects. They may also be helpful to those who are anxious or who find these methods appealing, relaxation and music are known to decrease anxiety, reduce muscle tension, and distract patients’. attention from pain. They are thought to affect the processes that modulate the transmission of pain signals.
The Pain of Death in the Hospices
As one comes to know that death is approaching, his or her mental state has to be complex and confusing: approaching death can thus be a long descent into pain and fear. Though drugs and social workers can do some justice in reducing these, recent studies show that music could be one of the effective methods to handle such an unfortunate situation. Live harp music played at the bedside has been found to alleviate the misery. There are instances where the agitated patients in hospice who were afraid of dying were quietened by the soft and beautiful strains. Carol Joy Loeb, a former opera singer from Maryland, who is now a certified music practitioner and registered nurse shares her experience: “I use the music to bring a calmness to them,” Loeb says. “It helps with pain and agitation. And in the case of those who are actively dying, it helps them to go peacefully.” When she worked with a dying woman who had been on morphine, but was not relaxed she found that as soon as she started playing, the woman began to relax. Within 10 minutes she stopped breathing. Taking her hands, her daughter said: ‘Mama, it’s okay to go, go to God. Take the hand of God and go to God.’ And within one minute, she was gone.”
One of the more recent research studies conducted by the nurse researcher Dr. Sandra L. Siedlecki of Cleveland Clinical Foundation too indicates that listening to music as such can reduce chronic pain and depression by up to a quarter (i.e 25%). It has been found to be beneficial to them as the patients can feel more in control of their pain and less disabled by their unfortunate condition. In this study sixty people were studied by dividing them into two music groups and one control group. It was found that patients who were suffering from a range of painful conditions (including osteoarthritis, disc problems and rheumatoid arthritis) and who listened to music on a headset for an hour every day for a week reported im-proved physical and psychological symptoms. The music groups reported that their pain had fallen by between 12 and 21%, when measured by two different pain measurement scales. The control group reported that pain increased by between 1 and 2%. People in the music groups also reported 19 to 25% less depression than the control group. Further, the group reported feeling 9 to 18% less disabled than those who hadn’t listened to music and said they had between 5 and 8% more power over their pain than the control group.
While the Cochrane Review cautions that music should not replace traditional primary treatments for pain, Good hopes this evidence will persuade other healthcare providers to consider music therapy as a complement to traditional treatment.
Formally, music therapists work with individuals, couples, families and groups. They assess the response to a selected music (“appropriate” and “acceptable” music) from their patients/clients to determine the most suitable one for them. Then the music is played at appropriate timings for a fixed duration as per their health conditions. In recent years, the therapists also analyze song lyrics or help the lyricist to write positive and self-assertive sentences. The types of music used however, depend on the therapy needs and treatment goals. The number and length of therapy sessions also vary depending on the person’s specific requirements.
The article was published in My Doctor, October 2008 – Pages 42-45
Edited by Geeta Shreedar, July 20, 2021