Music for pain reduction

Hello dear reader. I apologise for my silence over the past couple of weeks. It has been a busy time, what with the end of the exam period and the end of the summer term in the UK. But I have not forgotten about you! I have updated the jobs page and added some videos to the resources page (including a nice summary of music and mood studies from Frank Russo’s lab in Canada). I hope you enjoy.

In addition I have just read a really nice study that I thought I would share with you. It appears in PloS ONE so you can all access the paper, which is called “Superior Analgesic Effect of an Active Distraction versus Pleasant Unfamiliar Sounds and Music: The Influence of Emotion and Cognitive Style”

The paper explores the underlying mechanisms by which music might help reduce pain. It does a great job of doing what many music and medicine based studies fail to do – use a good set of controls.

What this means is that they do not just compare music and silence. This kind of design tells you nothing about the effect of music; it just tells you about the result of doing something other than nothing. If you want to look at the effects of music then you have to compare music to a third, ideally one that is similar to the music but is not in itself music.

The researchers in this paper looked at ratings of pain following safe induction with a heat mechanism applied to the forearm. They compared a number of conditions to a baseline control of pink noise:

1) Mozart music (“String Quartet No. 1 in G major, K. 80 – Adagio” and “Divertimento in E flat, K. 563 – Adagio”)

2) Environmental sounds (matched to the music for arousal & valence; ‘Rain’ and ‘Water’)

3) Mental arithmetic (Paced Auditory Serial Addition Test or PASAT)

The authors also added a final interesting factor. They looked at the effects of different cognitive styles on response to the conditions. Cognitive style was divided into three groups: empathizers, systemizers, balanced.

Forty-eight people took part in the study aged between 19 and 39 years (mean = 24, SD = 4). The authors presented two trials with four different temperatures: 42, 43, 45, and 47°C in a random order. Each heat stimulus lasted ~10 s and was separated by approximately 15–20 s. The participants rated pain intensity and unpleasantness on the Visual Analog Scale (VAS; putting a mark on a straight line between 0–100 mm) at each temperature.

As you can see in the results, the mental arithmetic worked best at reducing pain and unpleasantness compared to the control (PASAT in the figure).

The authors begin their discussion by stating that ‘In this study we found that the active distraction, represented by mental arithmetic, reduced pain more than the passive distractions, which included music and sounds‘.  I found this very refreshing – a study that compared a series of well balanced controls and produced an interesting result that for once was not all about music.

Should we give up on music? There are a number of reasons to say no. Firstly, there was a signficant effect of both music and the environmental noise on pain compared to the control. This suggests that music (& similar sounds) may have an important role in pain management that we need to investigate further.

Secondly, consider the study by Mitchell, et al. 2006 who showed that music has a superior analgesic effect compared to mental arithmetic. How might we explain the difference?

1) It may be the difference between acute pain (as used in the present study) and chronic pain (more similar to the effect induced in the Mitchell et al. 2006 study). This could be an interesting avenue for future research.

2) The music used in the Mitchell et al (2006) study was self-chosen and familiar, and therefore, individual preferences and familiarity could have enhanced the drive to listen attentively to the music and thus act as a distractor from the pain.

Interestingly and finally, the authors also found that ‘Sytemizers’ perceived less pain during the mental arithmetic than empathizers and balanced participants. Sytemizers are more driven to analytical modes of thinking and the authors suggest that they might have found the mental arithmetic more enjoyable, and therefore distracting. If so, this would support the idea that the stimulus that is more enjoyable (including maybe your favourite music) would be the best thing for pain relief.