Improvement of pain experience and changes in heart rate variability through music-imaginative pain treatment

Abstract

Music-imaginative Pain Treatment (MIPT) is a form of music therapy addressing pain experience and affective attitudes toward pain. It includes two self-composed music pieces: one dedicated to the pain experience (pain music, PM) and the other to healing imagination (healing music, HM). Our non-experimental study addresses patients with chronic somatoform pain disorders participating in MIPT. The goal is to gain insight into the direct effect mechanisms of MIPT by combining outcome measures on both the objective physiological and subjective perception levels. The research questions are directed toward changes in pain experience and heart rate variability and their correlations. Thirty-seven hospitalized patients with chronic or somatoform pain disorders receiving MIPT participated in this study. Demographic data and psychometric measures (Symptom Check List SCL90, Childhood Trauma Questionnaire CTQ) were collected to characterize the sample. Subjective pain experience was measured by McGill Pain Questionnaire (SF-MPQ), and Heart Rate Variability by 24 h-ECG. Data analysis shows a reduction of reported pain from MT1 = 19.1 (SD = 7.3) to MT2 = 10.6 (SD = 8.0) in all dimensions of the SF-MPQ. HRV analyses shows a reduced absolute power during PM and HM, while a relative shift in the autonomic system toward higher vagal activity appears during HM. Significant correlations between HRV and MPQ could not be calculated. Findings are interpreted as a physiological correlate to the psychological processes of the patients. Future studies with more participants, a control-group design, and the integration of medium- and long-term effects are recommended.

The impact of music-imaginative pain treatment (MIPT) on psychophysical affect regulation – A single case study

“…The long-term impact of MIPT on psychological and physiological well-being cannot be derived from this case report. Also the clinical study in which this patient was participating only gives initial indications of short-term effects ( 1 ). However our findings will later help to better explain treatment successes or failures in the context of a larger clinical study (RCT).…”

“…These questions are central in the single case study of Mrs S., who participated in a clinical study by Metzner et al (2022) (1) with patients suffering from a chronic pain disorder and undergoing psychosomatic inpatient treatment. Rather than presenting outcomes this multi-perspective analysis aims to gain a differentiated insight into the complex impact levels, and their interconnections, that come into effect in MIPT.…”

The psychophysiology of music-based interventions and the experience of pain

“…Lack of variability is associated with stress, anxiety and/or chronic pain, and has been linked to dysregulated parasympathetic activity (Ellis and Thayer, 2010;Tracy et al, 2016;Ginsberg et al, 2022). Although some heterogeneity is evident, analysis of music-related studies that have measured HRV as well respiratory rate and other cardiovascular signs show that music-based interventions increase HRV and can -dependent to some extent on the type of music that is presented (Davis and Thaut, 1989;Knight and Rickard, 2001;Ooishi et al, 2017) -lower heart rate and blood pressure, all indicative of increased vagal tone and enhanced activity in the parasympathetic nervous system (Okada et al, 2009;Koelsch and Jäncke, 2015;Wang et al, 2020;Ginsberg et al, 2022;Metzner et al, 2022;Ting et al, 2022;Cao and Zhang, 2023;Park et al, 2023). These signs of re-balancing of the ANS are often associated with reduced pain perception and often accompanied by a reduction in the stress related hormone cortisol (McKinney, Antoni, et al, 1997a;Grape et al, 2003;Kreutz et al, 2004;Koelsch et al, 2011Koelsch et al, , 2016Ooishi et al, 2017;Fu et al, 2019).…”

“…A systematic review of mindfulness-based stress reduction (MBSR) compared to cognitive behavioral therapy (CBT) suggested MBSR could be applied within CBT or in addition to CBT for reducing pain severity, pain interference and psychological distress in chronic pain (Khoo et al, 2019). Other music therapybased programs involving, for example, cooperative music composition and interaction (Metzner et al, 2022), or a combination of exercise and musical agency (Fritz et al, 2018;Schneider et al, 2022), have also been reported to lessen anxiety and decrease the experience of chronic pain.…”

“…In addition to such differences, there is considerable heterogeneity in study design and analysis when studying the impact of music-based interventions on the perception of acute or chronic pain. Variability encompasses: i. whether the music is part of a designed music therapy program, which can involve not only listening but active participation, composition or improvization (Hauck et al, 2013;Metzner et al, 2022;Schneider et al, 2022), whether the music is selected and administered by a clinician, or whether it is chosen by the individual who is experiencing pain. ii.…”