Opioid painkillers provide little relief for those suffering from chronic pain. Perhaps music is the answer


All of us will have experienced pain at some point 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 specialised nerve fibres and the spinal cord up to reach parts of our brain. Both the brain and spinal cord have a role in processing the signals, and work together to create the feeling and perception of pain.

The prevalence and widespread impact of pain on our lives was set out in the 2017 Health Survey for England. Some 34 per cent of respondents reported some level of chronic pain. And out of them, 34 per cent reported ‘high interference’ and 66 per cent reported ‘low interference’ with their usual daily activities.

Currently, opioids are often prescribed to help acute or end-of-life pain, but there is very little evidence for them being helpful for long-term chronic pain. Despite this, from 1998 to 2016, prescriptions for opioids increased by 127 per cent in the UK, a trend which has led to more focus on the monitoring of their use.

And in September 2020, The Medicines and Healthcare products Regulatory Agency issued stronger warnings about the dependency and addiction as risks of 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 alternatives? NICE offers some other solutions including exercise programmes, psychological therapy and other pharmaceuticals.

But several groups of researchers from across the globe are looking into an entirely different method of treating pain: music.

A landmark study carried out by a group of dentists in Massachusetts in 1960 unearthed the possibility that sound and music could help alleviate pain. The researchers played music to patients during 5,000 dental operations and found that it encouraged relaxation, and that noise suppressed pain directly, with some people not needing local anaesthetic or nitrous oxide for pain relief.

More recently, a study carried out by researchers in China identified the neural mechanisms by which sound can lessen pain – albeit so far only in mice. These mechanisms involve the auditory cortex and the thalamus. The auditory cortex is a receiver and processor of sound and the thalamus receives various sensory inputs and signals and relays them. It is thought this is the sound pathway that can lessen pain in mice.

In their experiment, the Chinese researchers played a piece of classical music, a burst of white noise and an unpleasant arrangement of music, to mice with inflamed paws. All three sound pieces when played at 50 decibels, about the same volume as a quiet conversation, reduced sensitivity to pain – the mice didn’t flinch or lick or pull their paws away. The key factor to producing the effect appeared to be the volume of the sound rather than the type of sound.

Taking this a step further, the researchers then monitored the neural activity in the auditory cortex. They found that the low volume sounds blocked the communication between the auditory cortex and the thalamus, and so reduced the pain processing in the thalamus.

This exciting new research may form a basis for how we could use music in the future for managing pain and pain perception. Further work is still needed to see if this effect in mice will carry over to humans.

Of course, how mice perceive music and what is means to them is impossible for us to know. As humans, we have all experienced how often unexplainable and unmeasurable nuance and emotion is involved when we listen to music – not just the instrument type, or the genre, but the lyrics, the rhythm and pitch, and also the emotional memories and associations that every piece of music holds for us. Is it possible that these added layers of meaning could increase the painkilling effect in humans?

Music potentially holds so many possibilities within it for how we experience and perceive pain, and, therefore, excitingly, how we could manage it.

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