Music as Medicine and Its Power over Pain
Everyone has those pick-me-up songs that can magically transform their mood (even if only for a few minutes); or maybe it’s that playlist that they turn to when going through a hard time. Turning to music as a form of processing and dealing with emotional pain is a common practice, but would you turn to music if you sprained your ankle? Music’s power to reduce pain goes beyond the psychological, and its healing can go beyond the teenage angst that it heals so well. But what aspects of music are most healing? Furthermore, how does it achieve this magical ability?
A recently published article in Frontiers of Pain claims that not all music has the same power to reduce pain, but that favorite music reigns supreme. As shown in the graphs below, participants’ favorite music has a greater effect at reducing pain intensity and pain unpleasantness than relaxing music, scrambled music, or silence; favorite music additionally elicited more chills, emotional arousal, and music pleasantness (Valevicius et al., 2023). Furthermore, chills was correlated with decreased pain intensity, and both chills and music pleasantness were linked to decreased pain unpleasantness (not shown).
Clearly, something about music being our favorite seems to induce effects that strongly outweigh what music can do on its own. Additionally, the mechanism of this phenomenon seems to depend on, or at least correspond with, chills and music pleasantness. But what is this “something”? The authors suggest it is the dopaminergic mesolimbic pathway. This pathway has been of great interest in studying the pleasantness of musical experience and is related to areas of the brain responsible for pain processing; dopamine has also been implicated in music-induced chills and pleasantness. Although dopamine is commonly discussed in the context of addiction or pleasure, these results implicate this famous neurotransmitter in the magical effects of music. But that is not the end of the story; dopamine plays many parts in the convoluted and complicated conundrum that is our brain, and uncovering its specific role in music-induced analgesia has not made light work.
The dopaminergic system has a complicated but vital relationship with both music and pain. According to a 2019 study examining the effects of a dopamine precursor and a dopaminergic antagonist on music reward, dopamine significantly enhances the pleasurable feeling induced by music (Ferreri et al., 2019). As seen in the figure below, participants given the dopamine precursor had more time reporting high-pleasure, more chills, and were willing to spend more money on the song than when given a placebo or the antagonist. These findings demonstrate a crucial role
for dopamine in music pleasantness and chills. Given the correlation between chills, music pleasantness, and pain reduction found in the previous study, these results support the hypothesis that dopamine may facilitate music-induced analgesia.
The opioidergic system has also been found to be a major player in both pain reduction and in pleasure, and, in some cases, is stimulated by dopamine-stimulating drugs (Ferreri et al., 2019). Furthermore, there is a “hedonic hotspot” containing opioid receptors in the nucleus accumbens (NAc), which is highly implicated in the pleasurable response to music (Ferreri et al., 2019). Cellular studies of the dopamine receptors in this same region have suggested that one type of receptor (the D2 receptor) causes significant pain reduction when activated in the NAc (Li et al., 2019). All these results seem to suggest that music stimulates the dopamine and opioid systems to cause pleasure, chills, and (directly or indirectly) analgesia, with dopamine being a distal origin of pleasure and analgesia and opioids being a more immediate cause.
Despite these studies indicating a causative role of the dopaminergic and opioidergic systems in music-induced analgesia, one study suggests that the effect is entirely due to participant expectations (Lunde et al., 2022). This study used silence, music, and nature sounds combined with an opioid-antagonist, dopamine-antagonist, or inactive agent in order to directly study the effect of these neurotransmitters with pharmacological manipulation. The results revealed that pain expectancy predicted perceived pain independently of the pharmacological agent given. They found that the perceived pain rating did not change across conditions of the pharmacological trials (i.e. even blocking the dopamine and opioid receptors did not change the effect of pain perception). They did find that there was a significant difference in the analgesic effect of music compared to silence and nature sounds, once again confirming the phenomena. The authors interpreted such a result as demonstrating that neither the dopamine or opioid systems were mediating the analgesic effect of music, but rather analgesia was entirely due to the placebo effect. This result certainly contrasts and sheds doubt on previous work showing the importance of dopamine and/or opioid systems in the effect of music, however, the study does not definitively rule out the possibility.
The article itself lists limitations including that the dose of the opioid antagonist may have been lower than previously recommended because of the side effects of the high dose; this limitation opens the possibility that the drug may not have been blocking opioid receptors effectively. Such a conclusion would also agree with the fact that the opioid system is one of the major pathways in expectant placebo-induced analgesia, which could be the phenomenon at play here (Benedetti et al., 2005). Additionally, the study relied on subjective ratings of both pain expectancy and pain perception, which rely on accurate reporting and memory of relative levels of pain. If the conclusions of the study were true despite these limitations, the effect of expectation could contribute to the enhanced analgesia of favorite music, as favorite music would reasonably carry greater expectation of analgesia.
Clearly the mechanisms of music-induced analgesia have yet to be fully understood, but the utilization of music for pain management need not be delayed until such understanding is reached. Music presents a non-pharmacological alternative of pain treatment that is free of allergies and likely has significantly fewer adverse effects. The healing effects of music have already been employed to a great extent in music therapy, benefiting a wide array of patients, but still more can be done to harness the full power of music. More research is needed to understand the phenomenon so as to utilize it to the fullest extent; however, what is clear is that music has great power that is waiting to be unlocked.
References
Benedetti, F., Mayberg, H. S., Wager, T. D., Stohler, C. S., & Zubieta, J.-K. (2005). Neurobiological mechanisms of the placebo effect. The Journal of Neuroscience, 25(45), 10390–10402. https://doi.org/10.1523/jneurosci.3458-05.2005
Ferreri, L., Mas-Herrero, E., Zatorre, R. J., Ripollés, P., Gomez-Andres, A., Alicart, H., Olivé, G., Marco-Pallarés, J., Antonijoan, R. M., Valle, M., Riba, J., & Rodriguez-Fornells, A. (2019). Dopamine modulates the reward experiences elicited by music. Proceedings of the National Academy of Sciences, 116(9), 3793–3798. https://doi.org/10.1073/pnas.1811878116
Li, C., Liu, S., Lu, X., & Tao, F. (2019). Role of Descending Dopaminergic Pathways in Pain Modulation. Current neuropharmacology, 17(12), 1176–1182. https://doi.org/10.2174/1570159X17666190430102531
Lunde, S. J., Vuust, P., Garza-Villarreal, E. A., Kirsch, I., Møller, A., & Vase, L. (2022). Music-Induced Analgesia in Healthy Participants Is Associated With Expected Pain Levels but Not Opioid or Dopamine-Dependent Mechanisms. Frontiers in pain research (Lausanne, Switzerland), 3, 734999. https://doi.org/10.3389/fpain.2022.734999
Valevicius, D., Lépine Lopez, A., Diushekeeva, A., Lee, A. C., & Roy, M. (2023). Emotional responses to favorite and relaxing music predict music-induced hypoalgesia. Frontiers in Pain Research, 4. https://doi.org/10.3389/fpain.2023.1210572
