Last week I had the privilege of participating in the 20th Annual Maine Pain Symposium, sponsored by the Maine Hospice Council and Center for End of Life Care. The symposium explored the problems that opioid interventions have created, the need for a more comprehensive understanding of pain, and effective non-opioid treatments for pain.
During my ten years as a hospice music therapist, I encountered many patients who struggled with pain. Former addicts looking to manage cancer pain without opioids, patients with end stage lung disease fighting for each breath, and veterans who would never complain but whose eyes would tell of intense suffering. I worked with a young mother whose guilt made her feel that she deserved her pain, and with a 90-year-old man who used humor to cope with the many tragedies life threw his way.
Pain is a physical sensation, but it is influenced greatly by our history, beliefs, personality, and culture. Pain needs to be addressed from a multidimensional, interdisciplinary perspective. The effective treatment of pain must be patient centered, culturally sensitive, and holistic.
Why Music?
Music is a particularly effective treatment for pain because it addresses the multiple dimensions of pain and addiction through various pathways. This post, and the associated infographic, explores how and why music therapy is such a powerful treatment modality.
Music Changes Our Physiology
Heart rate, blood pressure, and breathing change in response to music. Our heart beats to a rhythm, blood pumps through our veins in a rhythm, and we even breath to a rhythm. It is well documented (here and here) that these functions, which are critical to life itself, can be directly influenced by the tempo of music.
Tempo becomes the music therapist's greatest tool when helping someone who is in pain. We often use a technique called the "Iso-rhythmic Principle," in which the therapist provides live music that matches the tempo of a client's pulse or breath, and then gradually slows the tempo of the music in order to decrease these physiological processes. When these processes slow, our body knows it can relax.
Music is Rewarding
Evidence suggests that music affects the same neurochemical systems of reward as other reinforcing stimuli, such as food, sex, and drugs. The experience of reward consists of a wanting or anticipatory phase, and a liking or consummatory phase that reinforces this drive. Listening to music that we love increases dopamine- a neurotransmitter related to the anticipatory phase of reward. It also increases our brain’s natural opioids, which are linked to the “liking” phase. Studies have shown that listening to preferred music lowers the need for opioid drugs after surgery, and music therapy is currently being used to help people struggling with drug and opioid addictions.
Music is Distracting
People love music. Music captures our attention. You may be absorbed in your grocery shopping, but immediately notice when your favorite song starts playing overhead. Or you might be so engrossed in singing along to your car radio that you miss your exit off the highway.
When we are in pain, it is hard to think about anything else. Just the anticipation of pain can hijack our attention and make our experience of pain worse. Music provides a positive competing stimulus on which to focus our attention. Music therapists know that when the goal is distraction and engagement, slow and relaxing music isn't always best! You may see a music therapist providing a live, raucous version of a client's favorite rock song, handing out drums, or leading a soulful call and response. Music making experiences like this give the client an active role to play in their own pain management.
Music Gives Us Control
People suffering from pain often don’t have a lot of choice or control. When you are in the hospital, you are told what to wear, when and what to eat, and when you can have visitors. Pain can make you feel as if you have lost control over your own body. Yet, even trivial feelings of choice and control are significantly correlated with recovery, health, and wellbeing.
Music gives patients control over their environment, and particularly when one lacks control over other aspects of their surroundings, that can be significant. Music therapists provide patients with control by encouraging choice of the type, style, instrumentation, tempo, and dynamics of music. Patients can decide if they want to actively participate in music making or if they want to sit quietly while the therapist provides live music. Patients can select particular songs, decide how long the music lasts, or even chose not to have music at that moment. It is all up to them.
Music Evokes, Validates, and Regulates Emotions
Have you ever heard a song that made you laugh? Cry? Feel chills up and down your spine? Music evokes intense emotions, and listeners report a sense of pleasure even from music that makes them feel sad.
Pain is both a physical and an emotional experience, and music provides opportunities to explore the emotional elements of pain. Hearing lyrics that reflect something you have felt makes you feel less alone. Instrumental music can express feelings that we don't have words for. Music can affirm self worth, give meaning to pain, and help us to explore difficult feelings.
Music is Social
Music has existed as in all cultures, across time. Choirs sing together. Dancers move in perfect rhythm. These synchronized activities promote feelings of social connection and bonding. Evidence shows that group singing and group drumming even increase immune activity.
With the growing understanding of how social factors influence pain, increasing social connectivity and support through music is yet another benefit. Music therapists often involve family members in sessions, providing opportunities for them to actively participate in a meaningful and effective strategy that helps reduce their loved one’s pain.
Want a copy of our infographic on music and pain? Contact us here!