The Effects of Music on Neuromodulation of Pain Responses

The Effects of Music on Neuromodulation of Pain Responses Mark Jude Tramo, MD PhD

Disclosure

Nothing to Disclose

Learning Objectives  Review a recent randomized-controlled clinical trial whose results indicate that music can decreased pain and stress in premature infants following blood sampling via heel-stick  Discuss candidate neuromodulatory mechanisms mediating music’s effects in these patients  Develop neurobiologically-based hypotheses that could account for the beneficial effects of music

Apollo

Ἀπόλλων, Apóllōn, Ἀπέλλων, Apellōn

God, Music & Healing Director, Choir of The Muses Son of Zeus & Leto Brother of Hermes (Mercury) Father of Asclepius

Asclepius

Delphic Hymn

Oracle at the sanctuary of Apollo in Delphi. c. 725 BCE

Music Therapy Today Large number of anecdotal reports accrued over centuries about music’s ability to ameliorate pain and suffering across a wide range of ages, diseases, and clinical settings  Growing body of evidence for music’s efficacy based on randomized-controlled clinical trials, including pain

Tramo et al 2011 Music & Medicine

Heart Rate

Population Data (N=13) • Increase 19% (p=.02) • 8/13 (62%) >160 bpm

Heart Rate

Single-Patient Data (Test Group)

Tramo et al 2011 Music & Medicine

PHYSIOLOGICAL RESULTS

(No Music)

Heart Rate

Lullabies • 6% decrease (p=.25) • 3/6 (50%) decrease by ≥10 bpm

• 17% decrease (p=.02) • 6/7 (86%) decrease by ≥10 bpm

BEHAVIORAL RESULTS  Data from 9 infants  8/9 cried during heel-stick  4/4 stopped crying during lullabies  2/4 stopped crying without lullabies

Tramo et al 2011 Music & Medicine

Music Improves Dopaminergic Neurotransmission: Demonstration Based On The Effect Of Music On Blood Pressure Regulation

Sutoo & Akiyama Brain Research 2004

Sutoo & Akiyama Brain Research 2004

Dopamine Intensity Music >NonMusic in CPl (p <.01)

No Music

Mozart, Adagio from Divertimento No.7 in D Major, K. 205, played repeatedly for 120 min Sutoo & Akiyama Brain Research 2004

Neuroanatomical-chemical Model For The Effect Of Music On Increased Heart Rate Caused By Pain Pain

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Increased Sympathetic Tone

Activation of Auditory CNS with Music Calmodulin-Dependent Increase in Tyrosine Hydroxylase Activity in Lateral Caudate-Putamen Increased Dopamine Concentration in Lateral Caudate-Putamen D2 Receptor Binding Decreased Sympathetic Tone

Acknowledgements

Miiriam Lense MS

Inst for Music & Brain Sci Vanderbilt Univ

Caitlin Van Ness MST Inst for Music & BrainSci

Jonathan Cronin MD

Harvard Medical School Massachusetts General Hosp

The Institute for Music & Brain Science www.BrainMusic.org

Jerome Kagan PhD Harvard University

Margaret Settle RN

Massachusetts General Hosp

Verne Caviness MD PhD Inst for Music & BrainSci Harvard Medical School Massachusetts General Hosp