Music therapy and music-based interventions in the treatment of pain: state of the art

Brazoloto, Thiago Medina; Fujarra, Fabio José Condino

doi:10.5935/2595-0118.20240040-en

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REVIEW ARTICLE • BrJP 7 • 2024 • https://doi.org/10.5935/2595-0118.20240040-en linkcopy

Music therapy and music-based interventions in the treatment of pain: state of the art

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BACKGROUND AND OBJECTIVES: Music therapy promotes positive effects on cognition, psychosocial aspects, control of somatic symptoms and quality of life. The influence on pain is still a controversial topic. The objective of this study was to investigate the state of the art of musical interventions and music therapy in the treatment of acute or chronic pain, as well as developing criteria to facilitate the creation of strategies for applying music in clinical research.

CONTENTS: This research was based on papers published between August 2010 and March 2023 in the Pubmed database. Of these, open access literature review articles were selected. A total of 44 studies whose results and conclusions showed that there is evidence of pain relief in many clinical and environmental conditions were selected, although there is great heterogeneity in methods and controversy in the literature regarding positive and adverse or side effects. The music chosen by a professional or patient alleviates significantly the painful experience by many mechanisms, although statistical data is limited or controversial.

CONCLUSION: Music appears to have a positive impact on various environmental situations or biological conditions that result in painful experience and, therefore, can significantly alleviate pain, which is supported by evidence of complex neural mechanisms involving the descending pain inhibitory system. The benefits justify the use of music as a low-cost and low-risk therapeutic strategy, and the methodological challenges justify a more careful design in future research, including details of the type of musical intervention performed.

Keywords:
Anxiety; Pain; Orofacial pain; Music; Music therapy; Quality of life.

Music activates various brain structures and interferes with neuronal processing, causing changes in the perception of pain and in cognitive, affective and evaluative processes.
The implementation of non-pharmacological therapies, including music therapy, although not the essential management of pain, can be considered an adjunct to patient care.
Individual musical preference should be considered in the music therapy plan, as music has a greater analgesic effect if it is chosen by the patient themselves.

Authors	Year of publication	Objectives	Results and/or conclusions
Bradt and Dileo¹¹	2010	To investigate the effectiveness of music therapy in end-of-life care.	No evidence of a beneficial effect on pain.
Santos and Carvalho¹²	2012	Analyzing nursing care for people with arthritis.	Only one study showed a reduction in pain in elderly people with arthritis, and recommended a 20-minute daily session of listening to music that has between 60 and 80 beats per minute, especially music that promotes relaxation, such as classical music.
Archie et al.¹³	2013	To evaluate musical interventions in palliative cancer care.	Music reduces acute pain and the use of painkillers.
Thrane¹⁴	2013	To clarify which integrative modalities are most effective in reducing pain and anxiety in children and adolescents with cancer.	Music therapy is a modality with good evidence of a positive effect on pain reduction.
Greenlee et al.¹⁵	2014	A clinical guide to inform doctors, patients and researchers about the state of the science regarding the evidence-based use of complementary and integrative therapies for patients undergoing breast cancer treatment.	Music therapy can be considered to relieve the pain associated with surgery (level of evidence: C).
Pauwels et al.¹⁶	2014	To present relevant neurobiological effects of listening to music in adults, the Mozart effect and the benefits of music for diseases.	There is a moderate effect on pain reduction, which is greater if the music is familiar, chosen by the research subject.
Boerner et al.¹⁷	2015	To examine the effects of psychological interventions on pain.	There is no evidence of pain reduction from listening to music during vaccine injection.
Hole et al.¹⁸	2015	To assess whether music improves recovery after surgical procedures.	Music reduces post-operative pain; the choice of music and the time of application made little difference to the results. Music was effective even when patients were under general anesthesia.
Koelsch and Jäncke¹⁹	2015	To Evaluate the effects of music on the heart and the beneficial effects of music in clinical settings.	There is a small to moderate reduction in pain in patients with coronary disease.
van der Heijden et al.²⁰	2015	To analyze musical interventions on pain, anxiety and distress in children undergoing surgery.	There is a potential reduction in pain in children undergoing surgery.
Vetter et al.²¹	2015	To evaluate the effect of art, including environmental features such as music, interior design including visual art and architectural features on health outcomes in surgical patients.	Music reduces pain, especially if it is self-selected.
Chai et al.²²	2017	To describe the neurological mechanisms in which music acts to control pain.	Digital music can modulate pain and reduce the use of opioid painkillers.
Garza- Villarreal et al.²³	2017	To determine the effect of music as an adjuvant for chronic pain and to identify characteristics of musical interventions associated with positive clinical outcomes.	Music reduces the symptoms of chronic pain. Music chosen by the individual has a greater analgesic effect than music chosen by the researcher.
Li et al.²⁴	2017	To analyze studies on burn patients to determine the effect of music during treatments.	There is evidence of pain reduction during treatment procedures, although there is heterogeneity and controversy between the results of the studies.
Kühlmann et al.²⁵	2018	To evaluate anxiety and pain after perioperative musical interventions compared to control conditions in adult patients.	There is a moderate and statistically significant reduction in pain. Individual musical preference should be considered in the music therapy plan.
Schmid et al.²⁶	2018	To provide data on music therapy in palliative care.	There is controversy over the results in terms of pain reduction.
Deng²⁷	2019	To evaluate integrative medicine therapies for pain control in cancer patients.	Music therapy is effective in reducing pain and should be applied in multidisciplinary treatment. Level of evidence: C.
Honzel et al.²⁸	2019	To analyze studies that have evaluated the relationship between music or virtual reality and pain in healthy and pain-affected populations using objective and subjective measures of pain as the primary outcome.	Music activates the auditory cortex, the descending pain inhibitory system, the brain’s reward system and causes changes in the perception of pain and in cognitive, affective and evaluative processes.
Stegemann et al.²⁹	2019	To examine the evidence on the effectiveness of music therapy and other music-based interventions applied in pediatric health care.	Pain can be reduced in medical procedures, cancer care, palliative care and neonatal care.
Ciobica et al.³⁰	2020	To discuss the relationship between neuropsychiatry and oral diseases, as well as professional practices for treatment.	Music increases the pain threshold of the oral mucosa, decreases the activation of the cingulate cortex to painful stimuli and decreases muscle activity due to teeth clenching related to temporomandibular dysfunction.
Fan and Chen³¹	2020	To evaluate the effectiveness of non-pharmacological interventions for pain relief after orthopedic surgery.	Music may have a potential role in controlling orthopedic postoperative pain.
Fu et al.³²	2020	To evaluate the effects of perioperative music on the need for drugs, length of stay and costs.	Perioperative music can reduce the need for sedative and opioid drugs in the postoperative period, medical costs and minimize the risk of adverse events, although there is no reduction in the length of hospital stay. No adverse effects were observed for the musical intervention.
Köhler et al.³³	2020	To analyze the evidence for music therapy in the different phases of cancer treatment.	There is controversy about pain reduction, although there is evidence to support the promising use of music therapy.
SantiváñezAcosta³⁴	2020	To evaluate the effectiveness of music therapy on pain during labor.	There is a significant reduction in pain during and after labor, although the data from the studies on labor and musical intervention is not detailed.
Yu et al.³⁵	2020	To evaluate the effect of musical interventions on short-term pain after total knee replacement.	There was no improvement in pain. Studies are heterogeneous and make it difficult to explore the data further.
Cheng et al.³⁶	2021	To review the effect of music therapy and interventions on hemodialysis patients suffering from pain.	Music therapy and music-based interventions can increase the satisfaction of patients suffering from pain during hemodialysis by minimizing the painful experience.
Wen et al.³⁷	2021	To evaluate the effectiveness of interventions for patients with non-chronic kidney disease.	Two or three interventions a week for 4 to 6 weeks reduces pain in 41% to 61% of cases.
Gauba et al.³⁸	2021	To assess whether music reduces the use of analgesics and anxiolytics during flexible cystoscopy.	Classical music was used in most of the studies and there was a reduction in pain during flexible cystoscopy, which can increase satisfaction with the procedure. The musical intervention is simple, low-cost and easily accessible.
GonzálezMartín- Moreno et al.³⁹	2021	To analyze the effects of music on pediatric and adolescent cancer patients.	Only two studies analyzed the interventions and observed that music can distract the person and listening to familiar music brings back pleasant memories, which reduces the perceived pain.
Hakimi et al.⁴⁰	2021	To evaluate the effects of postpartum music therapy.	Despite the methodological heterogeneity and low quality of clinical studies, music therapy and music interventions are capable of reducing postpartum pain.
Kakar et al.⁴¹	2021	Evaluating musical interventions in cardiac surgery.	Music selection by the patient or the researcher reduced pain by 1.3 points on the Visual Analogue Scale. The average duration of the interventions was 30 minutes.
Patiyal et al.⁴²	2021	To evaluate the effects of music therapy in orthopedic surgery.	There is a significant reduction in pain.
Santa et al.⁴³	2021	To identify the effects of musical interventions in pediatric oncology.	Music is effective in reducing pain and increasing the quality of life of children and adolescents undergoing cancer treatment. Music can be adopted as a mono or multimodal therapy. The musical interventions were classified as passive or active.
Wu et al.⁴⁴	2021	To analyze the influence of music-based interventions on the physical and psychological outcomes of patients with chronic kidney disease on hemodialysis.	There is a mild to moderate effect on pain reduction.
Abushukur et al.⁴⁵	2022	To review adjuvant therapies in order to improve postoperative recovery in patients undergoing breast surgery.	The genre, dynamics and duration of the music depend on the patient, as does its use in an appropriate clinical setting. Music can reduce the perception of pain.
Chiang et al.⁴⁶	2022	To evaluate the applicability of music-based interventions in orthopedic surgery.	The applications are varied (by the patient himself, ambient sound or by a music therapist); the musical genre is varied; applied in various orthopedic, clinical or surgical procedures, before, during and after procedures. The benefits, such as pain reduction, are applicable to both children and adults.
Ormston et al.⁴⁷	2022	To evaluate the effects of music therapy on newborns with perinatal brain damage compared to standard neonatal intensive care.	There is an improvement in physiological parameters, particularly in pain management and feeding capacity.
Rennie et al.⁴⁸	2022	To understand the use of music therapy as a complementary treatment to conventional cancer therapy for pain control.	There is almost unanimity among the articles selected as to whether it is a reliable recommendation with good applicability for modulating pain in cancer patients. It is a non-pharmacological modality with substantial psychosocial and physiological benefits with minimal or no harm to the patient.
Ting et al.⁴⁹	2022	To analyze the effects of musical interventions on pain in newborns and children.	There is a significant decrease in pain levels, from both a psychological and physiological point of view, in both newborns and babies/children. Pain reduction was observed in situations such as needle sticks, chronic pain and in health procedures, as well as in post-operative pain. Classical music, children’s music and pop music had significant analgesic effects, while world music, “pain-specific” musical composition and multiple combinations of music had no analgesic effects.
Gerogianni⁵⁰	2023	To evaluate the factors that affect pain in hemodialysis and its non-pharmacological management.	Pain reduction possibly occurs by influencing the autonomic nervous system and improving emotional aspects, increasing positive emotions and reducing negative emotions. It is a safe and inexpensive method, without the side effects of pharmacological therapy, and can be easily applied.
He et al.⁵¹	2023	To summarize the music therapy strategies applied and their effect on reducing pain, anxiety and physiological changes in patients undergoing prostate biopsy.	Pain was assessed using the Visual Analogue Scale, considering 7 clinical studies with 662 patients, showing that music therapy during prostate biopsy can reduce pain. However, the analysis resulted in a low quality of scientific evidence, especially when considering factors such as imprecision, inconsistency, indirectness, risk of evaluation bias and publication bias.
Huang and Huang⁵²	2023	To identify the effectiveness of music therapy in adult patients with colorectal cancer.	57% of the articles selected showed that music therapy reduced pain. Most used a numerical scale for evaluation and the protocols were heterogeneous. The results were conflicting, which makes it difficult to draw a generalized conclusion for all cancer patients.
Maleki and Youseflu⁵³	2023	To determine the effect of music-based interventions on short-term postpartum episiotomy pain.	Reduction of 1.6 in the visual analog scale of pain in primiparous or multiparous women. The greatest and least effect of music on pain reduction was at 2 and 48 hours after episiotomy repair, respectively. The effect of music on pain reduction was statistically significant from 1 to 24 hours after episiotomy repair.
Tan et al.⁵⁴	2023	To evaluate the effectiveness of musical intervention in patients with dental anxiety during clinical procedures.	There was no significant difference in pain scores between the experimental and control groups preoperatively; postoperatively, music therapy significantly reduced pain scores in patients with dental anxiety; different study populations (children or adults), different oral procedures, different countries and different years did not significantly affect the results of this study.

Parameters/Topics of Methodological Interest
Music selection	• Selected by the patient Selected by a music therapist Selected by a trained health professional
Type of music intervention	• Music therapy Music medicine
Type of music	• Musical genre Copyright Specific musical works
Health care environment/place	• Waiting room, doctor’s office, operating room, intensive care unit, vaccination room, home, others
Music intervention status	• Isolated • Combined with a procedure (e.g. vaccination, surgery, electrotherapy, laser therapy, parturi-tion, acupuncture, others)
Time of application in the service	• Before • During • After
Application methods	• Background sound, headphones, use of musical instruments Frequency Duration
Selection of the population sample
Qualification of the executing professional/researcher
Diagnosis of the patient/research subject Pain assessment parameters/instruments

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