Music as an Adjunct to Opioid-Based Analgesia

Abstract

Epidemic increases in opioid use in the USA and globally highlight the need for effective adjunctive therapies to opioid-based analgesia. Given the shortcomings of behavioral adjuncts to opioid-based pain treatment, an urgent need exists for pain-related behavioral interventions that resonate with broad patient populations, can be delivered confidentially in any environment, and can incorporate new content automatically. Understanding the potential for automated behavioral therapies like music therapy in modulating the experience of pain may unlock methods to transition patients to lower doses of pharmacologic therapy or provide alternatives to opioids during acute exacerbations of pain. This manuscript describes the neurologic mechanism of action, theoretical basis, and potential applications of personalized music as a smartphone-based mHealth intervention for acute and chronic pain management.

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References

  1. 1.

    Rudd RA, Aleshire N, Zibbell JE, Gladden RM. Increases in drug and opioid overdose deaths—United States, 2000–2014. MMWR Morb Mortal Wkly Rep. 2016;64:1378–82.

    Article  PubMed  Google Scholar 

  2. 2.

    Chang H-Y, Daubresse M, Kruszewski SP, Alexander GC. Prevalence and treatment of pain in EDs in the United States, 2000 to 2010. Am J Emerg Med. 2014;32:421–31.

    Article  PubMed  Google Scholar 

  3. 3.

    Dart RC, Severtson SG, Bucher-Bartelson B. Trends in opioid analgesic abuse and mortality in the United States. N Engl J Med. 2015;372:1573–4. Massachusetts Medical Society

    Article  PubMed  Google Scholar 

  4. 4.

    Gilson AM, Ryan KM, Joranson DE, Dahl JL. A reassessment of trends in the medical use and abuse of opioid analgesics and implications for diversion control: 1997–2002. J Pain Symptom Manag. 2004;28:176–88.

    Article  Google Scholar 

  5. 5.

    Cherkin DC, Sherman KJ, Balderson BH, Cook AJ, Anderson ML, Hawkes RJ, et al. Effect of mindfulness-based stress reduction vs cognitive behavioral therapy or usual care on back pain and functional limitations in adults with chronic low back pain: a randomized clinical trial. JAMA. 2016;315:1240–9.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Turner JA, Anderson ML, Balderson BH, Cook AJ, Sherman KJ, Cherkin DC. Mindfulness-based stress reduction and cognitive behavioral therapy for chronic low back pain: similar effects on mindfulness, catastrophizing, self-efficacy, and acceptance in a randomized controlled trial. Pain. 2016;157:2434–44.

    Article  PubMed  Google Scholar 

  7. 7.

    Drzymalski DM, Tsen LC, Palanisamy A, Zhou J, Huang C-C, Kodali BS. A randomized controlled trial of music use during epidural catheter placement on laboring parturient anxiety, pain, and satisfaction. Anesth Analg. 2017;124:542–7.

    Article  PubMed  Google Scholar 

  8. 8.

    De Silva AP, Niriella MA, Nandamuni Y, Nanayakkara SD, Perera KRP, Kodisinghe SK, et al. Effect of audio and visual distraction on patients undergoing colonoscopy: a randomized controlled study. Endosc Int Open. 2016;4:E1211–4.

    Article  PubMed  PubMed Central  Google Scholar 

  9. 9.

    Dubé L, Le Bel J. The content and structure of laypeople’s concept of pleasure. Cognit Emot. 2003;17:263–95.

    Article  Google Scholar 

  10. 10.

    Mas-Herrero E, Zatorre RJ, Rodriguez-Fornells A, Marco-Pallarés J. Dissociation between musical and monetary reward responses in specific musical anhedonia. Curr Biol. 2014;24:699–704.

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Babikian T, Zeltzer L, Tachdjian V, Henry L, Javanfard E, Tucci L, et al. Music as medicine: a review and historical perspective. Altern Complement Ther. 2013;19:251–4.

    Article  Google Scholar 

  12. 12.

    West ML. The Babylonian musical notation and the Hurrian melodic texts. Music Lett. 1994;75:161–79.

    Article  Google Scholar 

  13. 13.

    Conrad C. Music for healing: from magic to medicine. Lancet. 2010;376:1980–1.

    Article  PubMed  Google Scholar 

  14. 14.

    Salimpoor VN, Benovoy M, Larcher K, Dagher A, Zatorre RJ. Anatomically distinct dopamine release during anticipation and experience of peak emotion to music. Nat Neurosci. 2011;14:257–62.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Menon V, Levitin DJ. The rewards of music listening: response and physiological connectivity of the mesolimbic system. NeuroImage. 2005;28:175–84.

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Knutson B, Burgdorf J, Panksepp J. Ultrasonic vocalizations as indices of affective states in rats. Psychol Bull. 2002;128:961–77.

    Article  PubMed  Google Scholar 

  17. 17.

    Mantione M, Figee M, Denys D. A case of musical preference for Johnny Cash following deep brain stimulation of the nucleus accumbens. Front Behav Neurosci. 2014;8:152.

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    van den Bosch I, Salimpoor VN, Zatorre RJ. Familiarity mediates the relationship between emotional arousal and pleasure during music listening. Front Hum Neurosci. 2013;7:534.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Blum K, Chen TJH, Chen ALH, Madigan M, Downs BW, Waite RL, et al. Do dopaminergic gene polymorphisms affect mesolimbic reward activation of music listening response? Therapeutic impact on Reward Deficiency Syndrome (RDS). Med Hypotheses. 2010;74:513–20.

    CAS  Article  PubMed  Google Scholar 

  20. 20.

    Chanda ML, Levitin DJ. The neurochemistry of music. Trends Cogn Sci. 2013;17:179–93.

    Article  PubMed  Google Scholar 

  21. 21.

    Garza-Villarreal EA, Jiang Z, Vuust P, Alcauter S, Vase L, Pasaye EH, et al. Music reduces pain and increases resting state fMRI BOLD signal amplitude in the left angular gyrus in fibromyalgia patients. Front Psychol. 2015;6:1051.

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Stefano GB, Zhu W, Cadet P, Salamon E, Mantione KJ. Music alters constitutively expressed opiate and cytokine processes in listeners. Med Sci Monit. 2004;10:MS18–27.

    CAS  PubMed  Google Scholar 

  23. 23.

    Lee JH. The effects of music on pain: a meta-analysis. J Music Ther. 2016;53:430–77.

    Article  PubMed  Google Scholar 

  24. 24.

    Mallik A, Chanda ML, Levitin DJ. Anhedonia to music and mu-opioids: evidence from the administration of naltrexone. Sci Rep. 2017;7:41952.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Goldstein A. Thrills in response to music and other stimuli. Physiol Psychol. 11 ed. Springer-Verlag. 1980;8:126–9.

    Article  Google Scholar 

  26. 26.

    Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–8.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Melzack R. Stress-induced analgesia. Pain. 1985;22:101.

    Article  Google Scholar 

  28. 28.

    Roditi D, Robinson ME. The role of psychological interventions in the management of patients with chronic pain. Psychol Res Behav Manag. 2011;4:41–9.

    Article  PubMed  PubMed Central  Google Scholar 

  29. 29.

    Hole J, Hirsch M, Ball E, Meads C. Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis. Lancet. 2015;386:1659–71.

    Article  PubMed  Google Scholar 

  30. 30.

    Bradt J, Dileo C, Shim M. Music interventions for preoperative anxiety. In: Bradt J, editor. The Cochrane database of systematic reviews, vol. 63. Chichester: Wiley; 2013. p. CD006908.

    Google Scholar 

  31. 31.

    Liu Y, Petrini MA. Effects of music therapy on pain, anxiety, and vital signs in patients after thoracic surgery. Complement Ther Med. 2015;23:714–8.

    Article  PubMed  Google Scholar 

  32. 32.

    Wang Y, Tang H, Guo Q, Liu J, Liu X, Luo J, et al. Effects of intravenous patient-controlled sufentanil analgesia and music therapy on pain and hemodynamics after surgery for lung cancer: a randomized parallel study. J Altern Complement Med. 2015;21:667–72.

    Article  PubMed  Google Scholar 

  33. 33.

    Beaulieu-Boire G, Bourque S, Chagnon F, Chouinard L, Gallo-Payet N, Lesur O. Music and biological stress dampening in mechanically-ventilated patients at the intensive care unit ward—a prospective interventional randomized crossover trial. J Crit Care. 2013;28:442–50.

    Article  PubMed  Google Scholar 

  34. 34.

    Eckhouse DR, Hurd M, Cotter-Schaufele S, Sulo S, Sokolowski M, Barbour L. A randomized controlled trial to determine the effects of music and relaxation interventions on perceived anxiety in hospitalized patients receiving orthopaedic or cancer treatment. Orthop Nurs. 2014;33:342–51.

    Article  PubMed  Google Scholar 

  35. 35.

    Fauerbach JA, Lawrence JW, Haythornthwaite JA, Richter L. Coping with the stress of a painful medical procedure. Behav Res Ther. 2002;40:1003–15.

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Nilsson U, Unosson M, Rawal N. Stress reduction and analgesia in patients exposed to calming music postoperatively: a randomized controlled trial. Eur J Anaesthesiol. 2005;22:96–102.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Liu Y, Bartlett N, Li L, Lv X, Zhang Y, Zhou W. Attitudes and knowledge about naloxone and overdose prevention among detained drug users in Ningbo, China. Subst Abuse Treat Prev Policy. 2012;7:6.

    Article  PubMed  PubMed Central  Google Scholar 

  38. 38.

    Wang S-M, Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth Analg. 2002;94:1489–94. tableofcontents

    PubMed  Google Scholar 

  39. 39.

    Wallston KA. The validity of the multidimensional health locus of control scales. J Health Psychol. 2005;10:623–31.

    Article  PubMed  Google Scholar 

  40. 40.

    Leardi S, Pietroletti R, Angeloni G, Necozione S, Ranalletta G, Del Gusto B. Randomized clinical trial examining the effect of music therapy in stress response to day surgery. Br J Surg. 2007;94:943–7.

    CAS  Article  PubMed  Google Scholar 

  41. 41.

    Meymandi A. Music, medicine, healing, and the genome project. Psychiatry (Edgmont). 2009;6:43–5.

    Google Scholar 

  42. 42.

    Chai PR, Babu KM, Boyer EW. The feasibility and acceptability of Google Glass for teletoxicology consults. J Med Toxicol. 2015;11:283–7. Springer US

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  43. 43.

    Chai PR, Carreiro S, Innes BJ, Rosen RK, O’Cleirigh C, Mayer KH, et al. Digital pills to measure opioid ingestion patterns in emergency department patients with acute fracture pain: a pilot study. J Med Internet Res. 2017;19:e19.

    Article  PubMed  PubMed Central  Google Scholar 

  44. 44.

    Carreiro S, Fang H, Zhang J, Wittbold K, Weng S, Mullins R, et al. iMStrong: deployment of a biosensor system to detect cocaine use. J Med Syst. 2015;39:186.

    Article  PubMed  PubMed Central  Google Scholar 

  45. 45.

    Carreiro S, Wittbold K, Indic P, Fang H, Zhang J, Boyer EW. Wearable biosensors to detect physiologic change during opioid use. J Med Toxicol. 2016;12:255–62.

    CAS  Article  PubMed  Google Scholar 

  46. 46.

    Skolnik AB, Chai PR, Dameff C, Gerkin R, Monas J, Padilla-Jones A, et al. Teletoxicology: patient assessment using wearable audiovisual streaming technology. J Med Toxicol. 2016;12:358–64.

    Article  PubMed  Google Scholar 

  47. 47.

    Carroll KM, Onken LS. Behavioral therapies for drug abuse. Am J Psychiatry. 2005;162:1452–60.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Dr. Boyer is supported by the National Institutes of Health 1K24DA037109. Dr. Carreiro is supported by the National Institutes of Health KL2 TR001455-01. Ketki Karanam and Marko Ahtisaari are co-founders of the Sync Project.

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Correspondence to Peter R. Chai.

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Chai, P.R., Carreiro, S., Ranney, M.L. et al. Music as an Adjunct to Opioid-Based Analgesia. J. Med. Toxicol. 13, 249–254 (2017). https://doi.org/10.1007/s13181-017-0621-9

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Keywords

  • Music
  • Opioids
  • Pain
  • mHealth
  • Behavioral medicine