We will all have felt pain at one time or another in our lives. We all know how pain can affect our physical activities, but it also affects how we feel mentally and emotionally, as well as other health-related factors such as our ability to sleep. This is especially true for those who suffer from chronic pain.
When we have an injury, pain signals travel along specialized nerve fibers and the spinal cord to reach certain parts of our brain. The brain and spinal cord both play a role in signal processing and work together to create pain sensation and perception.
The prevalence and widespread impact of pain on our lives was defined in the 2017 Health Survey for England. Some 34% of respondents reported some level of chronic pain. And of them, 34% reported “high interference” and 66% reported “low interference” with their usual daily activities.
Currently, opioids are often prescribed for acute or end-of-life pain relief, but there is very little evidence that they are helpful for long-term chronic pain. Despite this, from 1998 to 2016, opioid prescriptions increased by 127% in the UK, a trend that has led to greater emphasis on monitoring their use.
And in September 2020, the Medicines and Healthcare Products Regulatory Agency issued stronger warnings about dependence and addiction as risks associated with opioid use.
We are now in a situation where the risks of opioids are clear and yet the need for effective pain management is high. So, are there any alternatives? NICE offers other solutions, including exercise programs, psychological therapy, and other pharmaceuticals.
But several groups of researchers around the world are looking at a totally different method of treating pain: music.
A landmark study by a group of Massachusetts dentists in 1960 revealed the possibility that sound and music can help relieve pain. Researchers played music to patients during 5,000 dental operations and found that it promoted relaxation and the noise directly suppressed pain, with some people not needing local anesthesia or nitrous oxide for relief pain.
More recently, a study by researchers in China has identified the neural mechanisms by which sound can attenuate pain, but so far only in mice. These mechanisms involve the auditory cortex and the thalamus. The auditory cortex is a sound receptor and processor and the thalamus receives and relays various sensory inputs and signals. It is thought that it is the sound pathway that can alleviate pain in mice.
In their experiment, the Chinese researchers played a piece of classical music, a burst of white noise and an unpleasant music arrangement, to mice with inflamed paws. The three sound bites, when played at 50 decibels, about the same volume as quiet conversation, reduce sensitivity to pain – the mice don’t flinch, lick or pull their paws. The key factor in producing the effect seemed to be the volume of the sound rather than the type of sound.
To go further, the researchers then monitored neural activity in the auditory cortex. They found that low-volume sounds blocked communication between the auditory cortex and the thalamus, and thus reduced pain processing in the thalamus.
This exciting new research could provide a foundation for how we might use music in the future to manage pain and the perception of pain. More work is still needed to see if this effect in mice will carry over to humans.
Of course, it is impossible for us to know how mice perceive music and what it means to them. As humans, we have all experienced how inexplicable and unmeasurable nuances and emotions are involved when we listen to music – not just the type of instrument or genre, but the lyrics, rhythm and the pitch, as well as the emotional memories and associations that each piece of music holds dear. Is it possible that these extra layers of sense can increase the analgesic effect in humans?
Music potentially holds so many possibilities for how we feel and perceive pain, and, therefore, excitingly, how we might deal with it.
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