The Role of Music Therapy in Reducing Post-Operative Stress, Chronic Pain, and Potential Opioid Usage

RESEARCH ANALYSIS

The Role of Music Therapy in Reducing Post-Operative Stress, Chronic Pain, and Potential Opioid Usage

Amogh Nagol, BS

Drexel University College of Medicine

Summary Points

-       Music therapy, a non-pharmacological approach, can reduce postoperative stress and chronic pain by modulating the autonomic nervous system and stimulating the release of dopamine and endorphins.

-       Studies have shown that patients who undergo music therapy require less analgesic medication and report lower pain levels compared to those who do not.

-       Integrating music therapy into clinical practice could diminish opioid reliance, though further research and collaboration among healthcare providers, music therapists, and patients are necessary for effective implementation.

Analysis

Background

Post-operative stress and chronic pain are significant issues that often result in greater dependence on opioids for pain relief. As such, opioids are valuable analgesics that are routinely used to manage chronic pain. Some commonly prescribed examples include morphine, oxycodone, and tramadol (1). Despite their efficacy, prolonged opioid usage can result in dependence, withdrawal symptoms (upon cessation), and tolerance, necessitating increased doses to yield the same analgesic effect, which can potentially lead to overdose and death (2). This overreliance on and misuse of prescription opioids has created a global health crisis, with tens of thousands of annual overdose deaths in addition to the millions of people affected (3). Furthermore, opioid misuse causes an economic burden through healthcare costs, addiction treatment, and criminal justice involvement (4). These reasons highlight the importance of alternative chronic pain treatment options to reduce opioid prescribing and usage. One promising alternative, despite its unconventionality, is music therapy. This research analysis investigates the role of music therapy in reducing postoperative stress, chronic pain, and opioid usage.

Findings

Music therapy shows potential in chronic pain management through multiple therapeutic mechanisms. For instance, music can activate brain regions involved in emotion, cognition, and movement as well as modulate the body's autonomic nervous system (ANS) (5,6). Prior research has shown that music with a slow tempo and regular rhythm can induce relaxation by decreasing the body's sympathetic nervous system (SNS) and increasing the parasympathetic nervous system (PNS). This modulation of the ANS results in physiological changes, such as lowered blood pressure, heart rate, and muscle tension (6,7).

One key aspect of music therapy is its influence on the brain's reward system by stimulating the release of pleasure/pain relief neurotransmitters—dopamine and endorphins—in the brain (8). Dopamine, associated with feelings of reward and pleasure, can result in improved mood and reduced anxiety. Endorphins are the body's natural painkillers that bind to the brain's opioid receptors, reducing pain perception (9,10). This is significant, as opioid medications (morphine, oxycodone, etc.) exert their effects by also binding to opioid receptors in the brain. Thus, by stimulating the release of endorphins and dopamine, music therapy may reduce the need for high-dose opioid prescriptions, allowing for lower dosages instead.

Postoperative stress, as well as chronic pain, critically impacts patient recovery outcomes. Prior studies have shown that music therapy can mitigate these symptoms. A study by Vaajoki et al. (2001) examined how listening to music at different stages (before, during, and after a surgical procedure) can decrease anxiety and influence pain perception levels (11,12). According to the study, patients who listened to music after a surgical procedure required less analgesic medication and reported decreased pain scores compared to those who did not receive music therapy (12). A table comparing pain intensity using the visual analogue scale (VAS) between patients on the third postoperative day is shown below in Figure 1. Given these findings, the non-pharmacological and non-invasive nature of music therapy presents it as an attractive option for managing chronic pain while reducing the risks associated with opioid use.

FIGURE 1: Comparison of pain intensity and pain distress between patients on the third postoperative day

Hospital systems can incorporate music therapy into surgical and recovery areas as part of comprehensive pain management protocols (13). However, successful integration into standard clinical practice requires coordinated efforts among healthcare providers, music therapists, and patients. Music therapists must be trained to assess individual patient needs and preferences to design effective, personalized interventions. Healthcare providers can serve as a bridge between therapists and patients, facilitating the integration of music therapy into routine patient care.

Discussion

To conclude, music therapy offers a non-pharmacological treatment approach to reducing postoperative stress and chronic pain while also minimizing opioid use. Despite promising evidence surrounding music therapy in chronic pain management, there are some practical challenges, and more research is required to establish standardized protocols for integration into current clinical practice. One major challenge is training physicians and music therapists to integrate music therapy into standard care. Additionally, funding and implementation into healthcare systems may require time and further investigation. Particularly, large-scale randomized controlled trials are needed to truly confirm the efficacy of music therapy in different clinical settings. Clinical trials are also needed to identify the most effective types of music and evaluate the efficacy of personalized approaches to music therapy. Interdisciplinary collaboration between researchers, clinicians, and music therapists is crucial for advancing the field and optimizing patient care. Overall, integrating music therapy into standard care protocols may improve patient care by contributing to a more holistic approach to pain management.

References

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7.     Trappe HJ. The effects of music on the cardiovascular system and cardiovascular health. Heart. 2010;96(23):1868-1871. doi:10.1136/hrt.2010.209858

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9.     Levitin DJ, Tirovolas AK. Current advances in the cognitive neuroscience of music. Ann N Y Acad Sci. 2009;1156:211-231. doi:10.1111/j.1749-6632.2009.04417.x

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11.  Nilsson U. The anxiety- and pain-reducing effects of music interventions: a systematic review. AORN J. 2008;87(4):780-807. doi:10.1016/j.aorn.2007.09.013

12.  Vaajoki A, Pietilä AM, Kankkunen P, Vehviläinen-Julkunen K. Effects of listening to music on pain intensity and pain distress after surgery: an intervention. J Clin Nurs. 2012;21(5-6):708-717. doi:10.1111/j.1365-2702.2011.03829.x

13.  Espinoza Curimil NA. Evaluation of the matadoc and comparison of auditory musical, non-musical, and live music therapy stimuli to increase awareness and sense of self in patients with moderate and severe dementia: An exploratory case study. [Order No. 27833032]. Illinois State University; 2020.