Do You Really Want to Hurt Me?: Music as Pain Relief
Anyone who’s spent time in a dentist’s office has likely noticed the seemingly universal musical taste of that profession, a predilection towards light, airy ambient sound somewhere along the spectrum of true Muzak and the local soft-rock station. After a while, one begins to wonder whether dentists and their staff are a silent demographic of fanatical Classics IV and Sade listeners, or whether there is some other explanation for the omnipresence of soothing tones in tooth-fixing parlors across the country.
It’s not a wild guess to suppose that these soundtracks are chosen for their relaxing qualities in what is, for many, a highly stressful environment, but this utilization may have a more scientific basis than you’d think. In fact, many labs are currently looking for discrete and tangible ways that music can be used in a medical setting, not only to put people at ease, but also to actually reduce the amount of pain suffered during surgical or invasive procedures. Early results suggest that Aaron Neville records won’t be replacing morphine in hospitals any time soon but that music can actually have a measurable impact upon people’s response to painful stimuli and can alter certain biological mechanisms involved in those responses.
Unsurprisingly, dental journals have been reporting the pain-reducing effects of music since the Fifties, which explains why easy-listening tunes are as commonly associated with dentists as drills and sadism. Such articles haunt the deepest corners of scientific search engines, sporting the endearingly conversational and punny titles of 50s and 60s science like “Music calms the ‘angry beast’ of pain” and “A ‘sound’ approach to analgesia” (not to mention the slightly eerie Babel-fished Italian translation “Psycho-musical perspectives in the widest psychological dimension in the dental office”). One 1966 article, “Patients select music for dental ‘hit parade’,” even surveyed patients to find which hits of the era put them most at ease.
The next professional group to take note of music’s magical healing power was the nursing community, which makes sense in the scheme of medical society: doctors do the cutting and probing, then leave the aftermath to the nurses. Dealing with patients in various states of pre- or postoperative pain and not wanting to hand out painkiller addictions like the corner pusher, nurses have tried a number of nonpharmacological methods of pain control: not just music, but also distraction, conversation, meditation, and cutaneous stimulation (icepacks or heating pads). Many of these studies were observational in nature, with small groups of subjects tested according to subjective or indirect measures like patient-reported pain scales or amount of morphine taken. Yet studies proved consistently that patients allowed to listen to music were significantly more comfortable after surgical procedures, and many nursing journals recommended the use of relaxation tapes or personal headphones for postoperative patient care.
Eventually, doctors began to catch on to music as a relatively simple and cheap (though I’m sure they found some way to charge for it) means of reducing patient pain and discomfort. Clinical researchers have recently tested the efficacy of music as a relaxant during certain types of highly unpleasant procedures that don’t require general anesthesia, fun times like endoscopies, varicose vein removal, and certain types of gynecological surgeries. Most studies found positive results, like Danny Lee et al.’s trial with colonoscopy subjects, which found that music “alleviates anxiety and improves patient tolerance,” probably a useful effect when you’re sticking a tube up somebody’s ass.
But a large grey area remains in all of these studies regarding how music is inducing its effects, and whether the pain relief can even be considered a direct effect of listening to music. After all, if someone is about to thread a camera up your nether regions, you’re far more likely to be relaxed (relatively speaking) if you have something, anything to distract you from the task at hand, be it listening to music, reading a book, or talking about Grey’s Anatomy with a nurse. How can we be sure that music doesn’t have any special analgesic properties, but rather is merely just another piece of stimuli to draw attention away from the pain?
The answer is that we can’t, but that question may not be relevant anyhow: even if the effect of music is chalked up to “taking your mind off things,” there still remains a biological component to that process, however abstract it may seem. Recent studies on the effects of music upon pain and discomfort have gone beyond subjective measures like self-reported pain intensity to measuring objective physiological changes in test subjects, parameters like blood pressure, heart rate, and levels of molecules involved in stress and immune responses.
A lab of anesthesiologists out of Sweden has done some of the more thorough clinical studies looking at music’s effects upon postoperative patients, combining physiological measures with patient interviews for their experiments. A study using 75 people undergoing hernia surgery found decreases in cortisol, the hormone released in response to stress, reduced anxiety, and reduced morphine administration in patients that listened to a CD of “new-age synthesizer” after the procedure. However, these researchers failed to observe any cardiovascular effects of the music “therapy,” which may have been related to the anesthetic applied during surgery; the authors explain, somewhat mopily, that their ethics board would not allow them to reduce or entirely remove the anesthetic for the purposes of their study. There was no comment from the patients that potentially faced anesthesia-free surgery in the name of scientific inquiry.
George B. Stefano and colleagues faced no such complications, as they tested the effects of music-listening in subjects who were not undergoing painful surgery, and thus were not exposed to any potentially confounding anesthetics. Here the authors gathered subjects from a music conservatory, all of whom “clearly expressed their preference for classical music”; they're a real wild bunch, apparently. These subjects were allowed to rock out to some Bach for 20 minutes while having blood samples taken, and the samples were analyzed for cellular markers of stress and immune function. Surprisingly, the researchers found changes in endogenous opioids, biology’s natural heroin, as well as in the expression of the receptors for those opioids, suggesting that the simple act of listening to music could regulate the body’s natural response to pain. Music also caused changes in the immune response molecule IL-6, a change that could explain previously observed music-induced changes in blood pressure and heart rate.
Still, these studies have only formed the outline, and there’s a lot of coloring in yet to do. The first few components of this mechanism remain mysterious; namely, how does music (vs. random and incidental noise) enter via the auditory system of the brain, and what changes does it cause there to increase and decrease various cellular signals? More globally, why would such a functional sensitivity to music ever evolve in humans? And clinically, is there a way to maximize these pain-relieving and anxiety-reducing powers of music, so that it may someday become as standard a hospital procedure as hand-washing? Not to get too sci-fi, but one could easily imagine a hospital’s sound system broadcasting the scientifically determined ideal music for pain relief, 24 hours a day, through the hallways and into each patient’s room.
However, one factor ignored by most of these studies is the issue of personal music preference. For the music being tested, studies tend to automatically choose selections that are traditionally thought to be soothing, the “new-age synthesizer” of the Swedish study described above, for instance, rather than Slayer’s Reign in Blood. But say the patient being tested is a Slayer fan, and while he’s struggling through the pain of his operation for various mosh-pit injuries, you might imagine being forced to listen to James Taylor all day and night would actually augment his pain and discomfort rather than alleviate it. Yet studies that have allowed test subjects to choose their own music have actually shown a reduced analgesic effect relative to studies that use a common, experimenter-chosen piece of music, oddly enough.
So while the actual immediate utility of music as a painkiller remains to be determined, enough evidence is out there to give truth to the clichés: “the healing power of music,” “that kind of music just soothes the soul,” “rock and ro-oh-oll, hoochie coo.” Given the powerful emotional effects music can have, it’s not a reach to consider that it may have profound biological effects as well, unromantic as that may strike some people. But even if you cling to the notion that music’s impact is purely intangible and spiritual in nature, next time you’re in a dentist’s chair, consider whether you’d rather be listening to Spandau Ballet or the D.D.S. symphony of drills, scraping, and suction.
References
Stereolab
Waterfalls of text are produced every day about music’s aesthetic properties, but rarely is this ancient form of human communication addressed on a scientific level. Stereolab’s purpose is to investigate the places where music and science intersect, profiling research into clinical applications of the art form, explaining what we’ve found about its effects upon mind and body, and talking to musicians with science backgrounds and vice versa. Please: no Thomas Dolby references.