music in palliative care
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Music as MedicinePseudopharmacologic Effects on Pain
Current Clinical Use• Since the mid-20th century, music has been used as a
therapeutic intervention for various types of patients:– Those undergoing surgery (administered before, during, or
after)– Cancer– Terminally ill/hospice
• A major commonality is that such patients areexperiencing acute orchronic pain that needsto be alleviated
Examples in Trial Data• Meta-analysis of 30 trials with 1891 cancer patients
found moderate pain reduction: standard mean difference (SMD) = -0.59, P = 0.00031
• Among burn victims, significant decreases in pain before, during, and after dressing changes2
• Among elderly patients with chronic osteoarthritis, less pain in those listening to music compared to those simply sitting quietly3
Questions Raised
The lead author of the meta-analysis stated:“Music is something we use every day, and its powers
can be used in a very targeted way . . .”
The big question is: What are the biological mechanisms by which music reduces [and/or increases the threshold for] pain?
What precisely are the messages sent and receptors targeted that lead to the desired therapeutic outcome?
Sounds are perceived within a range of frequencies and a range of loudness (decibels) transmitted through solids as mechanical waves.
Music is composed of sounds highly organized and structured by musicians using specific elements such as pitch, rhythm, and timbre.
Anatomy of the Ear
Conformons in Outer Hair Cells
As in skeletal muscle fibers, outer hair cells in the ear contain myosin (although a different type), thus acting as a molecular motor after ATP hydrolysis; conformons provide the free energy and genetic information that allow for the function of mechanical amplification in the cochlea.
Molecular Machines/Motor Proteins
Conformons in Inner Hair Cells
“Biopolymers harboring conformons can generate mechanical forces (due to free energy) oriented in a specific direction (due to genetic information) in order to cause goal-directed motions on their environment, including [ . . . ] ions.”
Sensory Afferent Pathway
glutamate↓
auditory nerve ↓
vestibular nerve↓
cranial nerve VIII
PET Scans and CNS Effects
A recent study revealed increased dopamine release/binding when a person listens to music he or she enjoys.
PET scans, using a radionuclide specific for dopamine detection, in particular show increased neurochemical activity.
fMRI scans measure blood flow to areas of increased neuronal activity (includes neurons releasing dopamine).
Information TransmissionForm of Communication
Human language Cell language Music
Organization Word definitions & rules of grammar
Laws of chemistry & physics
Harmony, rhythm, timbre, etc.
Messengers Spoken words & sentences emitted from vocal chords
Exogenous & endogenous molecules
Instrumental or computerized sounds
Outcome Conversations, social interactions, distinctions among languages
Maintain physiological equilibrium or cause changes
Musical compositions performed or recorded
Examples English, Spanish, Chinese
Analgesic sedation, reward system
Genres: classical, rock, electronic
Cell Language Theory Applied to Music
1) music’s vibrational waves inner hair cells opening K+ channels depolarization due to Ca2+ entry pre-synaptic glutamate release post-synaptic excitation of auditory nerve cells vestibular nerve cells cranial nerve VIII cells
2) temporal lobe cells of cerebral cortex dopamine release from ventral tegmental area (VTA) cells of midbrain dopamine binding in nucleus accumbens cells of striatum increased pleasure, reduction in pain perception
Mechanical and chemical changes mentioned previously are determined by dissipative structures reliant on music as an energy source.
Listening to music—like taking a drug—must administered to an individual to have effects; if you don’t listen to music or take a drug in the first place, they obviously can’t cause any biological changes within you.
Taking Drugs : Receiving Phononspho·non (fōnän)n.
quantum (wave-like and particule-like) of acoustic or vibrational energy
mechanical
sensory
dopaminergic
Additional Analgesic Pathways
In addition to the mesolimbic reward pathway, pain reduction may also result from the nigrostriatal motor pathway (see caudate PET).
Happiness and Endorphins
If a song is especially enjoyable for a patient, endogenous morphine may be released, working on pre-synaptic μ-opioid receptors, just like exogenous morphine.