Medical music to calm the nerves

Dominic Tyer looks at the clinical studies evaluating music as an unconventional but promising treatment for some patients.

“Your doctor knows it keeps you calm,” sang the Beach Boys on Add Some Music to Your Day, from their 1970 album Sunflower.

The advice encased within their transcendent close harmonies and surf-inflected rock and roll may not have been peer-reviewed in any medical sense, but investigations of medical music therapy are nothing new.

Greek physician Hippocrates was among the first to play music for mental health patients in 400 BC and his work would be one of the starting points for the wide qualitative and quantitative research literature base that exists for musical therapy.

More recently, ‘music medicine’ made an appearance at last year’s Frontiers Health conference, which will return to Berlin in November.

At the 2018 event Walter Werzowa, the founder of HealthTunes and Music Vergnuegen, and Klaus Laczika, a physician at the Vienna Medical University, discussed how music could be used as part of a valid and scalable digital therapy.

In doing so they looked at a Mozart clarinet concerto and its effect on respiratory heart rate variability and then the effect of perceived musical rhythm on respiratory pattern.

And medical music continues to be tuneful. Just this month a new study assessed a song that had been created in collaboration with sound therapists to help slow a listener's heart rate, reduce blood pressure and lower levels of the stress hormone cortisol.

Don’t worry baby

Researchers at the University of Pennsylvania found that the piece, said to be the ‘world’s most relaxing song’, is just as good as medication for calming patients facing surgery.

The clinical trial involved 157 patients, randomised to receive the sedative midazolam or listen to Marconi Union’s Weightless series, considered to be some of the most relaxing music available, via noise cancelling headphones.

The trial, published online in Regional Anesthesia & Pain Medicine, showed that music seems to have similar effects as midazolam in reducing anxiety before a peripheral nerve block.

Using State Trait Anxiety Inventory-6 (STAI-6), the team found anxiety scores were similar in both the music and midazolam groups. Patient satisfaction was higher with midazolam, while there were no differences in physician satisfaction scores. For the music group – with its noise-cancelling headphones – both patients and physicians perceived more communication difficulties compared to those taking the drug.

The anaesthetic procedure is done under ultrasound guidance, and designed to numb a specific region of the body, but preoperative anxiety is common and can raise levels of stress hormones in the body, which in turn can affect recovery after surgery.

It is usually treated with a benzodiazepine, like midazolam, but the side effects of these drugs can affect breathing, disturbing blood flow and, paradoxically, increase levels of agitation and hostility. Their use also requires continuous monitoring by a skilled clinician.

The researchers acknowledged that a comparison lasting just three minutes may have been short, but said the period was chosen because that is how long it takes for midazolam to reach peak effectiveness. They also noted that the measure used to assess satisfaction wasn’t a validated scale.

Nevertheless, their findings prompt them to conclude that the song or others like it may be offered as an alternative to midazolam before carrying out a regional nerve block.

“However,” they caution, “further studies are warranted to evaluate whether or not the type of music, as well as how it is delivered, offers advantages over midazolam that outweigh the increase in communication barriers.”

In the meantime, research continues to get around thanks to the likes of the Journal of Music Therapy, British Journal of Music Therapy and the Nordic Journal of Music Therapy.