The Role of Music in the Opioid Crisis and Pain Management
By: Marcie Camero
With the opioid epidemic upon us, doctors and other care providers face the constant dilemma between treating patients by their ethical standards and abiding by the ever-tightening guidelines set by regulating bodies such as the Drug Enforcement Agency (DEA). From the moment pain management begins, the patient has the potential to spiral into the realm of the uncontrolled, the dependent, and the addict. Even with the best intentions, dose reduction and changes can lead patients to desperation, even suicide. In 2016, 12,101 people in the United States died from unintentional drug overdoses involving prescription opioids, this does not differentiate those who succumbed to polypharmacy. Concurrent and adjunctive medications for conditions such as neuropathy, anxiety, depression, and insomnia inadvertently add to the risk of addiction and death. Insurance companies have the power to help the patient and the provider by adding safer, abuse deterrent options to their formularies. However, carriers such as Medicare and Medicaid opt for cost effective drugs and require patients to attempt a minimum of three standard narcotics first – Making the situation more difficult.
These limitations have made way for alternative modalities of pain modulation to arise. Some therapies have their roots in Eastern Medicine such as acupuncture and reflexology; others in nature like Cannabinoid (CBD) Oil. Nonpharmacological interventions do not have the side effects and addiction risks commonly associated with medications. Listening to music triggers a well-defined neurochemical response creating both positive and negative emotions through endogenous opioids within the brain. The chemical pathways used in music therapy are the same reward pathways as food, drug and sexual pleasure. Pain relief occurs with the release of endorphins, changes in catecholamine levels or distraction via memories the music elicits. Listening to and performing music modifies levels of serotonin, epinephrine, dopamine, oxytocin, and prolactin; and activates the nucleus accumbens, the anticipatory pleasure network, according to several studies. Music’s simplicity and basic ability to ‘help with pain’ make it the perfect adjunct to any pain medication regimen.
Acute pain, caused by initial injury or surgical intervention, is a common starting point for opioid use and abuse. In order to augment this, hospital-based personnel set out to prove music limits narcotic use with easy implementation. The American Journal of Critical Care recently published a study confirming that lower doses and frequency of pain medications and sedation were required when music was used in the critical care setting. They also found significant decrease and control in respiratory rate, breaths per minute, heart rate, as well as self-reported pain and anxiety levels.
Anesthesiology and surgical studies found similar effects on vital signs as well as lower complaints of, and interventions for, pain post operatively when music is played during surgical procedures. The most clinically significant results were found in those who underwent local anesthesia procedures. Pain control in the post-operative phase can be especially problematic for children and the elderly due to the side effects of the commonly used opioid medications. The non-pharmacological benefits of music were noted in pediatric patients who listened to 30 minutes of Rihanna, Taylor Swift and other singers of their choosing giving them a significant reduction in pain after major surgery. Strategies such as music therapy allow for safer options for pain management in the hospitalized patient, especially since many of them are left with poor pain control due to fears of post administration complications.
Along with the benefits of listening to preferred music, researchers sought to evaluate whether characteristics like tempo, harmony, melody, instrumentation, volume, and pitch influence music’s overall therapeutic effect. It was determined that music which is bright, with low intensity and slower tempo has the most positive effect on reported pain level. Furthermore, researchers found that music without lyrics seemed to provide a more substantial response as well.
Overall, the use of music as an adjunct to pain management has been proven effective time and time again. Its ease of use allows it to be initiated in the hospital for acute pain, as well as at home for chronic pain. Implementing music therapy does not solely rest on the responsibility of the hospital staff, doctor, or care provider. The patient or family can discuss and arrange for music to be used as part of their daily regimen. Through earphones, 30 minutes twice a day, patients can enjoy their favorite tunes – preferably slow, low, and bright, with or without lyrics, in order to provide significant non-pharmacological pain reduction and control.
Beck, S.L. The therapeutic use of music for cancer-related pain. Oncol Nurs Forum. 1991 Nov-Dec;18(8):1327-37.
Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018. Accessed [7/20/19] from https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf
Golino, A., Leone, R., Gollenberg, A., Christopher, C., Stanger, D., and Davis, T., et al. Impact of an Active Music Therapy Intervention on Intensive Care Patients. American Journal of Critical Care; January 2019 vol. 28 no. 1 48-55. https://www.aacn.org/education/publications/ajcc/28/1/0048-innovative-approaches-impact-of-an-active-music-therapy-intervention-on-intensive-care-patients?sc_camp=4EBEDCB9869C41A2A97318868B1C7CDC&_zs=FgTSX&_zl=UilT1
Holden, R. and Holden, J. Music: a better alternative than pain? British Journal of General Practice 2013; 63 (615): 536. DOI: https://doi.org/10.3399/bjgp13X673748
Mallik, A. et al. Anhedonia to music and mu-opioids: Evidence from the administration of naltrexone. Sci. Rep. 7, 41952; doi: 10.1038/srep41952 (2017).
Martin-Saavedraa, J.S., Vergara-MendezbIván, L.D., Pradilla, I., Vélez-van-Meerbekeb, A., and Talero-Gutiérrezb, C. Standardizing music characteristics for the management of pain: A systematic review and meta-analysis of clinical trials. Complementary Therapies in Medicine. Volume 41, December 2018, Pages 81-89. https://doi.org/10.1016/j.ctim.2018.07.008
Northwestern University. “Rihanna’s music eases kids’ pain after surgery.” ScienceDaily, 8 January 2015. <www.sciencedaily.com/releases/2015/01/150108130125.htm>.
Ortega, A., Gauna, F., Munoz, D., Oberreuter, G., Breinbauer, H.A., and Carrasco, L. Music Therapy for Pain and Anxiety Management in Nasal Bone Fracture Reduction: Randomized Controlled Clinical Trial. Otolaryngol Head Neck Surg. 2019 Jun 11:194599819856604. doi: 10.1177/0194599819856604. [Epub ahead of print].
Poulsen, Michael J. et al. Music as a Postoperative Pain Management Intervention. Journal of PeriAnesthesia Nursing, Volume 34, Issue 3, 662 – 666.
Featured image courtesy of j4p4n, CC0, via Wikimedia Commons