Disclaimer: This is transcribed using AI. Expect (funny) errors.
Mindy Peterson: [00:00:00] I’m Mindy Peterson, and this is Enhance Life with Music, where we explore all the ways that music can make our lives better. We’ve talked previously on this show about how music can be used as an intervention for pain, but it has been a few years since those conversations. And while many studies show music’s effectiveness in pain reduction, researchers haven’t always understood how and why music helps. So a recent study really caught my attention. Researchers in this study mapped the evidence and identified three key mechanisms that help explain music’s pain relieving effects. Here to tell us about the latest research in this area and what it means for music. Using music to manage pain is the lead on the study Dr. Joke Bradt. Doctor Bradt is Professor and Director of the PhD program in Creative Arts Therapies at Drexel University. She is a board certified music therapist and a leading researcher in music therapy and pain management. She has completed several NIH funded clinical trials in this space. Doctor Bradt leads the NIH funded Music4Pain Research Network and is internationally recognized for advancing the science of music based approaches for pain management. Welcome to Enhance Life with Music, Joke.
Joke Bradt: [00:01:30] Thank you so much, Mindy. Thank you for having me. Looking forward to this conversation.
Mindy Peterson: [00:01:35] Yes, I know we’ve been connected on LinkedIn for quite some time, and I always appreciate seeing your posts and what you’re up to. So it’s fun to actually meet virtually here on this call. Listeners can just hear the audio, but we get to see each other as well. So that’s really lovely. Before we discuss your research, give us a little context. I know that you’ve noted that researching how music affects pain may sound simple, but it’s actually very challenging. So explain why this subject is more challenging than one may think so we can fully appreciate the rest of the conversation.
Joke Bradt: [00:02:11] Yeah, I appreciate that question. And I want to also clarify that what this project was about is not to find out if music therapy reduces pain. So we were not looking at the efficacy because that has already been demonstrated. But what we don’t understand very well yet is how music does that. How does music help reduce pain? And, um, so this project was really to look was a scoping review, looking at all the research to date that has tried to answer that specific question. So the how question and yeah, it is, it might seem simple, right? But it is a difficult question. And I think it’s so challenging because both music as well as the experience of pain, are two very complex phenomena, right? Sure. How we hear music, how we perceive music, how we interpret music, what meaning we assign to music is going to look different for each person, depending on their relationship with that given piece of music or with music in general. Right? So how you and I might listen to a same piece of music and perceive it might be very different. You might find it annoying, I might find it pleasurable, you might have associations with it, and I don’t. Or, you know, opposite. So music in and of itself. And then of course, music as the stimulus is also so complex, right? I mean, there’s so many different pieces of music ranging from very simple music to very complex music. So that is one challenge. And then pain. The pain experience in and of itself is also a very challenging thing to study, especially when the pain is chronic. There are so many factors that influence how much pain we perceive. And so, as you probably know, with you and I get very similar injury, we might report very different levels of pain. And isn’t that wild? Right. But it’s because so much goes into creating that experience for pain. So put these two very complex things together and it makes it challenging to answer that question.
Mindy Peterson: [00:04:20] Totally makes sense. Yes. In the most recent study that we’re referring to, you and your team identified three mechanisms that contribute to music’s reduction of pain. Tell us what those three mechanisms are.
Joke Bradt: [00:04:36] Yeah. And to be fair, there were many more things that these studies looked at. But of the 57 studies that we included, many of them, you know, one study looked at this, another study looked at that. So we were kind of the three mechanisms that I’ll talk about are the three things for which we have converged evidence, meaning multiple studies pointed to the role of that. So, um, the first one, which I hope won’t, um, surprise the listener is the positive emotional valence that a piece of music might have for you. What that means is, in simple terms, how much do you enjoy listening to that piece of music? So the enjoyment of the music seems to play a central role, so much so that it seems to be much more important than specific musical features, such as the genre or, you know, the the mood that the music might evoke. And that makes sense because, for example, some studies have looked at whether happy music is more effective at reducing pain than sad music. And the answer to that is no, it it’s kind of a mixed bag. It all depends again on how much you enjoy the music, and a sad piece of music might be really enjoyable, right? So that is that seems to be really, uh, central. So a big misconception is that people think they need to be listening to classic music or, and it’s not, it’s really the music that you enjoy related to that was music preference.
Joke Bradt: [00:06:06] So several studies showed that when people listen to music that they prefer, uh, or that they get to select as the music that they would like to listen to the most, that also plays an important role. And that makes sense because of course, when you, uh, you’re gonna prefer music that you enjoy listening to. So the two are really connected, but what we, we don’t quite know yet is the following. So when you select music in a given moment as music that you would like to prefer listening to, that’s going to be associated or influenced by factors in that particular moment. It might be the mood that you’re in or the situational context in which you find yourself. So certain days you might have a preference for certain music, and other days you might want to listen to different types of music. So music preference is kind of connected to autobiographical memories or personal meaning or situational context. And that is something we need to kind of dig in a little more like do these additional, what we call self-referential associations further amplify the pain reducing effects of the music that you like to enjoy listening to? Okay.
Mindy Peterson: [00:07:20] So just to clarify, was that the second mechanism?
Joke Bradt: [00:07:23] No, that’s I was just going to say so that is all related. So kind of this enjoyment of music, but this music preference is kind of intertwined with that, if you wish.
Mindy Peterson: [00:07:33] Okay. So that first mechanism is basically, do you find that music enjoyable or inherently appealing basically to you individually? Yes. Okay.
Joke Bradt: [00:07:43] Got that correct. Yeah. And so the second mechanism, which I was really excited about as a music therapist, because as a music therapist, we use a lot of active music making in our sessions, not just listening to music. So the second mechanism was sensorimotor synchronization. And that means coordinating your movements with music rhythm. So what that looked like, and these were all, by the way, laboratory studies. So studies that use healthy volunteers. They were being asked to either tap along or drum along to some music while they were being exposed to an experimental pain stimulus maybe.
Mindy Peterson: [00:08:25] So this.
Joke Bradt: [00:08:25] Is.
Mindy Peterson: [00:08:25] Moving with the music.
Joke Bradt: [00:08:27] Moving with the music, but pretty, I will say in the lab experiments, limited movement, sometimes just tapping with a finger. One study actually looked at participants drumming along with music.
Mindy Peterson: [00:08:40] And so they don’t need to be doing a flamenco dance or anything. No. You know, some fairly minimal.
Joke Bradt: [00:08:45] And we can talk later about the limitations of these laboratory studies. But in one of the studies they did EEG measurement. And of course, you cannot be doing flamenco dancing while you connect. And nowadays that is actually possible. But in this study, people were staying in their seat just drumming along. Anyway, what this study showed that when people synchronized to music compared to when they just listened to music without synchronizing their movement, or they just tap or drum without music again. So no opportunity for synchronizing, but still doing the movement. What this study showed is when you synchronize your movement to the music, that that greatly amplifies the pain reducing effects of music. So yeah, much more so passive listening or just listening to music. It also has pain reducing effects, but when you play along, it amplifies these effects.
Mindy Peterson: [00:09:46] Okay. And that movement, like you said, just so listeners are really catching this, it can be tapping along, it can be drumming along on you with your hand or tapping a foot.
Joke Bradt: [00:09:56] Yeah, exactly. Or it could be just tapping on the table or on your legs. You know, we all have body percussion instruments that we can use, right? Like you can just tap along. Uh, but yeah, the one study was just tapping along with the foot, I believe, and the drumming was just on a single drum surface, but it could be drumming along on a tabletop, for example.
Mindy Peterson: [00:10:15] Okay. And if you’re actually making the music yourself, like playing an instrument or singing, I’m assuming that automatically qualifies.
Joke Bradt: [00:10:24] That would automatically qualify, although very interesting. You raise that point. There were no studies that looked at active music making in terms of like, you know, playing the piano along or playing an instrument along. There was one study that asked participants to sing along. And that that study also found that when you sing with the music, that that was better at reducing the pain than when you just listened to music. And as music therapists, we see that all the time in our practice. We very rarely ask somebody to just sit there and listen. We actively engage people in music making in our sessions, you know? Sure. So I find it a very interesting finding because I, we see that in our practice, but to actually have some research show backing up and say, yeah, that seems to be a real thing. And we also think that when we know from research outside of the pain literature, that when people synchronize their movement, for example, if they play along with a good groove, that people find that when they are able to synchronize, people find that much more pleasurable. So there’s something probably about, well, we know from outside of the pain literature, we know that this activates the reward circuitry in your brain. We also know the reward circuitry plays an important role in pain management. So now we need to bring these two streams of knowledge together if you wish. And these studies are beginning to do that.
Mindy Peterson: [00:11:55] Wonderful. So that was the second mechanism was synchronization active engagement moving along with music. Tell us about the third mechanism.
Joke Bradt: [00:12:04] The third one had to do with cognitive agency. And what that looked like is in some studies, the researchers manipulated whether or not you could select the music that you listened to or how much control you had over the music. Yeah. So some of these studies were quite complex to trying to manipulate this, what they call cognitive agency. And when people were given the choice or the control over the music, then we saw much better effect pain reducing effects. In one of my own studies where we didn’t experimentally manipulate this, but in a clinical study where we looked at whether people felt, where we measured how much control people felt they had over the pain. So it’s called pain related self-efficacy. So how much are you able to do things in spite of the pain? How much control do you have over the pain that increased because of the music therapy sessions? And the more that that increased, so the more in control that people felt, the less pain they reported. So there’s something about this cognitive agency, whether it’s through music selection or other ways that you can feel more in control over the pain. In my study, it was because we taught participants music based strategies to use for pain management. So that concept of cognitive agency seems to be playing an important role as well.
Mindy Peterson: [00:13:34] I could see that being the case. I mean, pain is scary and it makes you feel like you’re not in control. So anything that increases your sense of agency or control or self-efficacy, I would think would have some sort of a reassuring component to it. It’s so fascinating to see research kind of confirm some of these things. Talk to us a little bit about the type of pain that was studied in these studies that you were looking at, because acute pain and chronic pain, I imagine, are very different experiences. Does music’s ability to influence pain look different when you have someone who’s living with pain for months or years versus acute pain?
Joke Bradt: [00:14:17] Yeah. So unfortunately, we don’t know the answer to that because the majority of the studies included in this review looked at acute pain. Most of these studies were conducted with healthy volunteers in laboratory settings where an experimentally induced stimulus was applied, which means they might have gotten electric stimuli or putting their hand in an ice bucket. You know, it’s called a cold pressure test or things like that. While they listen to music and then they measure, you know, whether listening to music helps reduce the pain more than if they’re being asked to just sit in silence during that pain induction. Or maybe they’re comparing it with other types of stimuli. There were some studies that looked at chronic pain, but not a lot. So in one of our in our conclusions, we actually wrote that we recommended that we need much more research with people who experience chronic pain. Because even though doing research with healthy volunteers in a highly controlled context is certainly mechanistically very informative, we do know that pain processing looks quite different in individuals with chronic pain, for example, due to central sensitization, which is when the nervous system undergoes actual structural, functional and chemical changes due to the prolonged pain that makes people more sensitive to pain or react differently to pain stimuli.
Joke Bradt: [00:15:52] So it is really important that the initial research I think, is done in these laboratory settings, because it helps us to standardize the pain stimulus. It helps us to, you know, control a lot of things when somebody when you shift that research to people with chronic pain, it becomes much more complex because on a given day, when somebody comes into the lab to do the study, they might or they might not have pain, they might have a lot of pain, they might have a little bit of pain. So it’s very, it’s much more challenging to do research with people with chronic pain. But We need to we need to take that challenge. Because if we don’t now start extending that research to actual clinical populations again, efficacy wise, that is definitely being done. I’m really talking about this mechanistic type of research. If we don’t extend it to people with chronic pain, then we don’t know what we’re finding in acute pain or a healthy volunteer population, if that even applies to people with chronic pain.
Mindy Peterson: [00:16:54] We often hear that music can distract us from pain. Is the research suggesting that music is just distracting, or is it doing more than simple distraction? Is it actually influencing the brain’s processing of pain in ways that might last beyond the time that we’re actually listening to or engaging with the music?
Joke Bradt: [00:17:14] Yeah, you are correct that we often, or in you read often as a reason why music helps with pain reduction. Very often you hear that it’s because music helps you relax and music helps you distract, you know, so that you don’t focus on your pain. And the studies actually showed that distraction in and of itself is not sufficient to explain the pain reducing effects of music. For example, some studies compared pleasant music with unpleasant music. Unpleasant music is distracting as well, but yet it doesn’t reduce pain at all. We also had a few studies where music was played before the onset of the pain stimulation. So again, these were laboratory studies. People came in. They first were asked to, for example, listen to 5 or 3 minutes of music. Music stopped. Then the experimenter applied to pain stimulus. And what we saw is that in people who first received the music listening, they reported less pain during the pain stimulation than people who didn’t get to listen to music before. So that means that music is doing something different, right, than just distracting. Because during the pain stimulation, there was no music, so nothing to distract. Now, to be fair, of course music can grab attention, and grabbing somebody’s attention must contribute to the pain. Reducing effects like sometimes you can feel very absorbed right into music, and you enter in what we kind of call a state of flow or flow state. And so we think that that does play an important role. But I think distraction in and of itself is not good, not good enough. It’s probably much more listening to music that you really enjoy. So that reward circuitry gets activated. You feel good that that is what’s helping or actively playing along with the music.
Mindy Peterson: [00:19:11] Why do you think music does have such a powerful ability to influence something as fundamental as pain? What is it about music that’s giving you access to that pain processing system in the brain.
Joke Bradt: [00:19:25] Yeah. I think because pain is such a complex experience and it’s influenced by so many different things. So pain is not just a sensory perception of whatever happened at the periphery of your body. Let’s say you get a cut in your finger. There’s many other things that influence how much pain you’re going to experience. And that is, for example, your mood, your cognitive state, other things like whether your reward circuitry is activated by something in the environment. So there’s many different things that influence how much pain you experience and how you experience the pain. Music is able to influence a lot of those things at the same time. So music can influence your mood. Music can influence how stressed you feel or how relaxed you feel, which is also important for pain management. So I think music is just that type of wonderful experience that can influence many influential factors simultaneously.
Mindy Peterson: [00:20:30] Do you think that repeatedly engaging with those mechanisms that you mentioned can produce longer term changes in how the brain processes pain is especially? Well, I was going to say, especially for people living with chronic pain, but I know you said that wasn’t the focus of the studies.
Joke Bradt: [00:20:48] Yeah. Yeah, unfortunately not yet. And actually very few, almost no studies looked at the kind of long term impact of activating these mechanisms. So we we really need studies that look more at the long term impact. So we don’t really know the answer to that question yet. But there was one study, I remember that asked participants to select music that they would like to use during the the laboratory pain experiment and ask them to frequently listen to it the week prior or to I forget the time period, but for some time prior to the lab day. And the more people listen to the music prior to coming in, the greater pain reducing effects that particular music piece had. So that’s just listening to music. But we know, of course, from the literature that engaging in music, playing music, listening to music does do all kinds of wonderful things with your brain. So we need to look more at kind of these long term impacts, for sure.
Mindy Peterson: [00:21:54] Well, one thing that I would find encouraging about this topic is if patients are experiencing pain reduction through music, they can sort of learn how to use music as a tool themselves, as a coping mechanism, a coping tool for their pain. If they find that, oh, this type of music is really helpful for me, or utilizing it in this way or at this time is really helpful for me. It’s different than getting a prescription where you’re dependent on somebody else to write the prescription, and then you take this pill. It feeds off that self efficacy concept where it’s, this is a tool I can use when I want to in the way that I find helpful. So I would, I know you’re a researcher, but you’re also in the field practicing as a clinician anecdotally, do you see that to be the case that some of your patients realize, oh, I can learn to use this on my own in between sessions as a tool?
Joke Bradt: [00:22:55] Yeah, absolutely. So in my studies, we typically do mixed methods research. So we interview people afterwards to learn about their experience of engaging in music therapy, how it helped them, how it may not have helped them, what suggestions they have for improving the protocol that they participated in. And what we hear all the time across all of our studies is that people say things like, wow, I listen to music 24 over seven a day. I never thought of using music in this particular way. I never thought that I could use music purposefully to help me with my pain. We encourage our participants to sing along, hum along with music, and we practice that in the sessions. And patients actually often in these interviews point to the humming as one of the most important things they learned and what they use most frequently to help with pain. And it’s something you can take your voice anywhere. You can hum anywhere.
Mindy Peterson: [00:23:56] Exactly.
Joke Bradt: [00:23:56] You can do it very softly.
Mindy Peterson: [00:23:58] Barrier to access there. Yeah.
Joke Bradt: [00:24:00] Yeah. So I actually want to go back for a moment to your earlier question about the impact of music and chronic pain. There were I forgot to mention there were a few studies that are brain imaging studies that looked at the effect of music on people with fibromyalgia, and they found that when people with fibromyalgia listened to music, that it might help to restore normal functional connectivity in regions of the default mode network, which is a system that is typically active during self-referential thoughts, or when you’re just thinking about yourself or maybe ruminating. So, so.
Mindy Peterson: [00:24:41] So daydreaming.
Joke Bradt: [00:24:42] Daydreaming, yeah.
Mindy Peterson: [00:24:43] Letting your mind wander.
Joke Bradt: [00:24:44] Exactly. Just kind of the automatic things that your brain does when it’s not focused, you know, on a particular task.
Mindy Peterson: [00:24:52] You’re doing dishes and your brain doesn’t really have to focus on that. Whatever’s going on during that time is default mode network.
Joke Bradt: [00:24:58] Yeah, yeah, yeah. So in people with fibromyalgia, we know that that connectivity is often disrupted. Some of the connectivity is disrupted, possibly because they’re engaging a lot in, um, intrusive kind of self-focused rumination because the intense pain kind of constantly demands their attention. And to focus on that and following music exposure, they so they looked at the default mode network connectivity before and after listening to music and after people with fibromyalgia listen to music, their connectivity resembles much more that of healthy controls, which seem to suggest that there is some kind of shift in neural processing from kind of rumination or attention on, on the pain they feel in their body, which is, of course, very real and very intrusive to more than extrinsic, extrinsic processing of the music. And in the end, that seems to reduce their subjective experience of pain.
Mindy Peterson: [00:26:04] So these are changes in the brain that can be seen in brain images. Right?
Joke Bradt: [00:26:09] Exactly, exactly.
Mindy Peterson: [00:26:11] So this is using functional MRI.
Joke Bradt: [00:26:14] Yep. Indeed.
Mindy Peterson: [00:26:15] Okay. Yeah, yeah.
Joke Bradt: [00:26:17] And some of the brain imaging studies showed that music seems to be kind of um, how will I say influence the pain experience from two ways. It seems to influence very early processing of the pain stimulus so early on in the brain. And it also seems to influence the more top down pain regulation that have to do with cognition and mood. And what we already talked about earlier.
Mindy Peterson: [00:26:42] Mhm. Well, I know we’re running out of time here, but talk to us about the practical applications of this study. What is this change about how we think about music in pain?
Joke Bradt: [00:26:54] Yeah. Practical applications from a research perspective is we still have a lot of work to do. But from a user perspective, people listening to this, I would say a few actually very simple things. One is that if you want to begin to use music to manage your pain, listen to music that you enjoy. Don’t let people or your provider or whomever tells you, maybe you should listen to Mozart or to classical music. It really should be music that is in your repertoire. Actively engage with the music. Play along, sing along, tap along, hum along. You know, do something active. And again, you know, select a music that you would enjoy the most on a particular day and to know that that can shift from day to day. Um, so those would be kind of my most important, most important advice. Yeah. Takeaways.
Mindy Peterson: [00:27:49] Yes. If you could erase one misconception that people have about music and pain based on everything you’ve learned in your research, what would you want to change?
Joke Bradt: [00:28:01] I think this whole misconception that gets repeated over and over in the literature, and that is, music reduces pain because it relaxes you and it because it distracts you. It is much more complex than that. And also, if we look at a lot of studies that are out there that are done by non-music therapists, like maybe nurses or other health doctors or other healthcare provider surgeons, you know, there are so many studies out there looking at the effect of music on pain. So often these studies use classical music with no justification at all. And there’s no reason to think that that type of if you love listening to classical music, great. But if you don’t love classical music, it is not going to help you much.
Mindy Peterson: [00:28:49] Sure. I just heard a story recently about someone who was on their deathbed in hospice care. A music therapist was working with them and asked if there was any specific song or music that they wanted to hear, and this was an older person, and that person requested AC, DC and not what this therapist was expecting and just asked, do you mind telling me why? That’s what you want to hear? And he said, I’ve always loved this music. My wife hates it, so I’ve never really listened to it. And this is my chance. So, you know, you never know what people will want to listen to. And I totally understand what you’re saying. Don’t assume that classical music is what’s going to work for everybody. For some people, yes, it will, but you’re your own N of one. Do what works for you. There’s no one size that fits all when it comes to music preferences, especially for pain perception. But regardless of the context, I find that that is a constant in any topic that we’re talking about. Music. When I talk with researchers and educators and health practitioners, it’s always the same. There’s no one size fits all.
Joke Bradt: [00:30:06] Exactly.
Mindy Peterson: [00:30:07] Well, as you know, yoga. I ask all my guests to close out our conversation with musical ending a coda by sharing a musical tool that you wish more people knew about. This could be a book, a blog, an app, a therapeutic tool, or anything that enables you to enhance your life with music. Do you have a tool that you can tell us about in closing today?
Joke Bradt: [00:30:28] Yeah, I think it’s what we already talked about. You know, when you want to use music for pain management, again, use music that you enjoy. Play along with it and just let the music do its work.
Mindy Peterson: [00:30:43] And it can be as simple as humming along, tapping on your chest, tapping on a desk, tapping your foot. And if you’re mobile enough and have the ability to do more dance, whatever. Go for it.
Joke Bradt: [00:30:57] Exactly.
Transcribed by Sonix.ai