Music as MedicinePseudopharmacologic Effects on Pain

Current Clinical Use• Since the mid-20th century, music has been used as a

therapeutic intervention for various types of patients:– Those undergoing surgery (administered before, during, or

after)– Cancer– Terminally ill/hospice

• A major commonality is that such patients areexperiencing acute orchronic pain that needsto be alleviated

Examples in Trial Data• Meta-analysis of 30 trials with 1891 cancer patients

found moderate pain reduction: standard mean difference (SMD) = -0.59, P = 0.00031

• Among burn victims, significant decreases in pain before, during, and after dressing changes2

• Among elderly patients with chronic osteoarthritis, less pain in those listening to music compared to those simply sitting quietly3

Questions Raised

The lead author of the meta-analysis stated:“Music is something we use every day, and its powers

can be used in a very targeted way . . .”

The big question is: What are the biological mechanisms by which music reduces [and/or increases the threshold for] pain?

What precisely are the messages sent and receptors targeted that lead to the desired therapeutic outcome?

Sounds are perceived within a range of frequencies and a range of loudness (decibels) transmitted through solids as mechanical waves.

Music is composed of sounds highly organized and structured by musicians using specific elements such as pitch, rhythm, and timbre.

Anatomy of the Ear

Conformons in Outer Hair Cells

As in skeletal muscle fibers, outer hair cells in the ear contain myosin (although a different type), thus acting as a molecular motor after ATP hydrolysis; conformons provide the free energy and genetic information that allow for the function of mechanical amplification in the cochlea.

Molecular Machines/Motor Proteins

Conformons in Inner Hair Cells

“Biopolymers harboring conformons can generate mechanical forces (due to free energy) oriented in a specific direction (due to genetic information) in order to cause goal-directed motions on their environment, including [ . . . ] ions.”

Sensory Afferent Pathway

glutamate↓

auditory nerve ↓

vestibular nerve↓

cranial nerve VIII

PET Scans and CNS Effects

A recent study revealed increased dopamine release/binding when a person listens to music he or she enjoys.

PET scans, using a radionuclide specific for dopamine detection, in particular show increased neurochemical activity.

fMRI scans measure blood flow to areas of increased neuronal activity (includes neurons releasing dopamine).

Information TransmissionForm of Communication

Human language Cell language Music

Organization Word definitions & rules of grammar

Laws of chemistry & physics

Harmony, rhythm, timbre, etc.

Messengers Spoken words & sentences emitted from vocal chords

Exogenous & endogenous molecules

Instrumental or computerized sounds

Outcome Conversations, social interactions, distinctions among languages

Maintain physiological equilibrium or cause changes

Musical compositions performed or recorded

Examples English, Spanish, Chinese

Analgesic sedation, reward system

Genres: classical, rock, electronic

Cell Language Theory Applied to Music

1) music’s vibrational waves inner hair cells opening K+ channels depolarization due to Ca2+ entry pre-synaptic glutamate release post-synaptic excitation of auditory nerve cells vestibular nerve cells cranial nerve VIII cells

2) temporal lobe cells of cerebral cortex dopamine release from ventral tegmental area (VTA) cells of midbrain dopamine binding in nucleus accumbens cells of striatum increased pleasure, reduction in pain perception

Mechanical and chemical changes mentioned previously are determined by dissipative structures reliant on music as an energy source.

Listening to music—like taking a drug—must administered to an individual to have effects; if you don’t listen to music or take a drug in the first place, they obviously can’t cause any biological changes within you.

Taking Drugs : Receiving Phononspho·non (fōnän)n.

quantum (wave-like and particule-like) of acoustic or vibrational energy

mechanical

sensory

dopaminergic

Additional Analgesic Pathways

In addition to the mesolimbic reward pathway, pain reduction may also result from the nigrostriatal motor pathway (see caudate PET).

Happiness and Endorphins

If a song is especially enjoyable for a patient, endogenous morphine may be released, working on pre-synaptic μ-opioid receptors, just like exogenous morphine.