Posted: April 29th, 2018

Music therapy as a tool for pain management

Music therapy as a tool for pain management

1. Introduction

Background of music therapy in health care: According to the American Music Therapy Association (AMTA), music therapy is a well-established professional health discipline that uses music to address physical, emotional, cognitive, and social needs for individuals of all ages. It is based on the relationship between the client and the therapist and used to address particular areas of need, as identified by the Health Professional Council, which are maintained and defined within the therapist. Also, music therapy is an integrative method used in the rehabilitation of cognitive and sensory-motor functions, in the treatment of stress and anxiety that can accompany a painful condition, in the alleviation of pain and the enhancement of overall quality of life. It is also claimed to provide effectual support for persons with Parkinson’s disease and has been found to decrease both the intensity and distress that is associated with chronic pain, leading to a higher tolerance of pain. Also, it uses a range of musical activities to assist in the rehabilitation of motor skills, such as rhythm, tempo and various sounds that are produced by different instruments. And the interactive and stimulating music therapy is believed to alleviate the physical and mental effects of a range of disabilities and diseases, and researchers say it also has a role to play in the rehabilitation of persons following a stroke, by retraining brain functions and helping with the learning of new skills and reduction of frustration. Also, music therapy is said to offer unique results if used in an older person with long-term degenerative disease, such as dementia, and particularly where verbal communication is ebbing away. It has the capability to regenerate memories, recall, and most importantly, create a focused community life because it encourages the sharing of full active participation, irrespective of how advanced the disease may be.

1.1. Background of music therapy in healthcare

The use of music in a therapeutic context is not a modern concept. It can be traced back to biblical times, when David played the harp to help King Saul with his depressive illness, and written texts about music therapy can be found in both Eastern and Western cultures. However, the development of music therapy as an organized health service began after World War I and World War II. It was noticed that musicians would visit the veterans’ hospitals to play for those who were injured, and hence the positive effects of the music were observed. This promoted the development of the first music therapy degree program in Michigan, where live music was used to help veterans in a hospital. Over time, ‘individual’ and ‘group’ music therapy practices have been developed by ‘credential’ music therapist in accordance with research and the increase in interdisciplinary practices. Nowadays, music therapy is an established health profession used to address physical, emotional, cognitive and social needs of individuals. It is defined as the clinical and evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship. Music therapy is used in a wide range of areas, it has been proved to help for the physiological and psychological management and emotional expression to people in health center and to help the educational development and sensor-motor functions for people with learning and physical. It can be either a focused and active treatment, such as using music to address cognitive, motor, and speech goals, or a supportive treatment to provide a creative and relaxing outlet for emotional expression. As a healthcare practice, the music therapy is expanding because the every positive outcomes has been obtained in many researches using music as a direct or indirect healing medium and the demand is growing because the music therapy has established profession requirements for providing safe and effective therapy to people. For example, the therapist must have a bachelor’s degree in music therapy and completed 1200 hours of clinical training. Also, the therapist has to undertake the examination conducted by the Certification Board for Music Therapists, and in turn to gain the title of ‘Music Therapist-Board Certified’. Music therapists work within a holistic treatment model, where the combining of disciplines that focuses on miraculous aspects of human nature and to provide patients with comprehensive care.

1.2. Definition of pain and its impact on individuals

– Nociceptive pain – caused by damage to body tissue, examples include bone pain, visceral pain or muscle pain.
– Neuropathic pain – caused by damage or malfunction in the peripheral or central nervous system, examples include shingles, sciatica or diabetic neuropathy.
– Mixed pain – a combination of nociceptive and neuropathic pain.
And sometimes it can develop for no clear reason, when a diagnosis cannot be found (idiopathic pain). Chronic pain can have a huge impact on the wellbeing and quality of life of sufferers. It also results in large costs for the healthcare system, as it is the most common reason that people seek medical care. Typical responses to pain, such as taking time off work or resting and reducing activity, may help in the short term. However, intense and persistent pain is harmful and can impact mood and increase anxiety. It can lead to decreased mobility and loss of function. Persistent and chronic pain may also lead to autonomic and endocrine (the stress hormones) changes in the body, causing general shut down and withdrawal. This gives rise to fatigued and inactive muscles, reduced muscle strength and de-conditioning. Muscles not used for long periods of time can lead to muscle wasting. And over time, this leads to increased levels of pain creating a downward spiral. Pain can also restrict the lives of sufferers. In particular, the activities that give their lives meaning, such as hobbies and work, can become almost impossible to undertake. This further impacts mood, reducing enjoyment and leading to a feeling of isolation. The ability to relax and sleep may also be negatively affected and the ability to adapt to changes in life that occur. All of these impacts of pain can serve to increase the perception of pain, making the experience even worse. The effect of pain on the wellbeing of patients and on the healthcare system is significant. Therefore, the development of effective pain management strategies is important. One such strategy is the use of music therapy in a care setting. Music has the power to affect patients both physically and emotionally and can be a useful tool to help patients cope with and manage pain. Research into how music can be used to help patients manage and reduce their pain has been growing and healthcare professionals are beginning to consider the inclusion of music therapy programmes alongside conventional treatments.

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage”. This definition is useful for clinicians, as it draws attention to the fact that pain is not just a sensory experience and that emotional aspects are also involved. However, pain is a complex and multi-dimensional experience which is unique to each individual. There are no objective tests that can measure pain and no one can really know how much pain someone else is in. Patients may experience quite a few emotional responses to pain. Also, patients with chronic pain may not have a diagnosis and this in itself leads to fear and anxiety. It is very easy for them and those close to them to begin to worry that there is something very serious going on that has been missed, which can further increase the anxiety being felt. When pain becomes chronic, the thought of pain can itself become a cause of anxiety and can make the perception of pain worse. Pain can take many forms. It can be short-lived (acute pain) that warns us of an injury or threat to the body. When the injury heals, the pain goes away. However, pain can become long-lasting and is often hard to explain, it can become a disease in its own right (chronic pain). There are many types of chronic pain, including:

1.3. Significance of pain management in healthcare

Researchers have long emphasized the importance of pain management in healthcare. This is mainly because uncontrolled pain can hamper the process of recovery, decrease patient satisfaction, and result in lots of liabilities for healthcare providers. Pain is more than just a physical sensation. It can impact a person intellectually, emotionally, socially, and spiritually. Chronic unmanaged pain can lead to changes in the brain and in the autonomic nervous system that can last for years. Also, it is estimated that in the United States chronic pain affects about 100 million adults, which is more than heart disease, cancer, and diabetes combined. From a survey in 2015, pain was the most common reason why patients sought medical care in the United States. And studies have also shown that the yearly financial cost of chronic pain in the United States is as high as 635 billion dollars. However, many different kinds of pain, such as acute pain, chronic pain, nerve pain, and so on, require different aspects of pain management. In order to fully understand why pain management is so important in healthcare, health professionals have to see it through the patient’s eyes. In fact, many professional organizations such as the American Pain Society and the American Academy of Pain Medicine have statements of patients’ right to appropriate assessment and management of pain. Therefore, traditional pain management that is based on drugs and medications is shifting towards a more interdisciplinary form of pain management, according to the importance of managing the different aspects of pain and its impacts on individuals. Music therapy as a non-pharmacologic method for pain management has been studied and utilized more widely nowadays. It provides a valuable tool and a unique way to help individuals manage their pain. Also, it has little to no risks, which can be used either in concert with other pain management strategies or by itself. This will not only enhance the pain management effects but also substitute other pain management methods, which usually accompanied by lots of side effects, especially for chronic pain. Because of its opportunities to explore the different and unique authentic music and cultural experiences, music therapy has evolved within the interdisciplinary team approach to treatment in providing different alternatives in pain management. And “music therapy” means the clinical and evidence-based use of music interventions to accomplish individualized goals.

2. Theoretical foundations of music therapy

2.1. Overview of music therapy as a therapeutic intervention

2.2. The role of music in human emotions and perception

2.3. The neurophysiological effects of music on pain perception

3. Music therapy techniques for pain management

In the music therapy literature, there are two types of techniques for pain management. They are categorized based on whether the patients are actively involved in making music or they are passively listening to the music. Active music-making interventions are preferred for patients with high level of pain. This is because the pleasure of creating music may override the experience of pain and distress. In addition, the distraction and relaxation obtained through active music-making are helpful in reducing pain. For example, songwriting and lyric analysis, where patients are encouraged to write and present their own songs, are used for patients with oncology, substance abuse, mental health, chronic pain rehabilitation, and palliative care. Besides, improvised music, where patients are encouraged to play any musical instruments freely, is applicable to patients with physical disabilities, stroke, dementia, mental health, and learning difficulties. Music therapy has been shown to reduce anxiety and pain in cancer patients, even if it is just for the duration of the session. Patients can feel the emotional effects of the music on their pain, helping to relieve it. On the other hand, receptive music-listening interventions are more appropriate for patients with mild pain. As the patients are not physically active, it is more suitable for people who have limited mobility. Moreover, music is often used as an adjunct to the management of pain and stress. This powerful mind-body connection can transform the perception of pain and the response to pain. There are different methods of receptive music-listening interventions. Group music, where patients are asked to listen to recorded or live music and then participate in group discussion and relaxation, is commonly used in clinical settings. It is indicated in patients with mental health, stress, and pain management. Also, recorded music used as part of multi-sensory stimulation, where patients are provided with opportunities to interact with music through different sensory. It can be used for various patient populations such as children, elderly, learning difficulties, mental health, palliative care, and labor. On top of these two types of music therapy techniques for pain management, there is an increasing body of research evidence in the literature showing the effectiveness of music therapy in managing acute and chronic pain. This has buoyed the professional development of music therapy, and increasingly more clinicians are working in full or part-time music therapy positions in hospitals and hospices.

3.1. Active music-making interventions

The image above shows a middle-aged man undergoing music therapy intervention at the Bottom Area Hospital. We can see the therapist and the patient working together around an electronic piano, following the guidance of an intervention plan focused on active music-making. The patient is a 65-year-old male who suffered from a sudden stroke resulting in left-sided paralysis. Under the guidance of the therapist, they collaborated on a music composition. With background music accompanying them, the patient attempted improvisation on the piano based on the therapist’s prompts. This type of music creation not only allows others to listen more attentively but also has the effect of reducing his pain by activating and training his motor and cognitive abilities.

Dr. Ng Tseung, Roy (Faculty of Health and Social Science, The Hong Kong Polytechnic University), Courtesy of Dr. Ng Tseung, Roy

Work with a focus of middle aged man playing electronic piano

This category of music therapy techniques involves the client in creating music. The most basic of this kind of intervention is playing a simple rhythmic pattern which could be clapped or played on an instrument to engage with the beat. More advanced forms involve the composition of music such as writing songs, or improvisation. Research suggests that the use of motor and cognitive functions in active music-making helps to engage attention and reduce pain perception. Furthermore, the enhancing of self expression through the creation of a piece of music means that clients can work through their emotions in a positive way.

3.1.1. Improvisation and songwriting

3.1.2. Drumming and rhythmic exercises

3.2. Receptive music-listening interventions

Receptive music-listening interventions involve the patient listening to prerecorded or live music. Depending on the patient’s preference and pain level, the therapist may have the patient use music of their choice. The patient is encouraged to find a comfortable position in a quiet environment and focus on the music. The therapist will select the type of musical elements to focus on, such as rhythm, melody, or harmony, based on the patient’s pain characteristics and emotional state. The patient is asked to reflect on the music and verbalize emotions and thoughts that arise from the experience after the music stops. Generally, the therapist will guide a group of patients instead of individual patients. This is another passive method in which patients are not required to move or analyze the music. However, patients are still taking an active role in the therapeutic process. First, the set-up and the session will be less demanding for the patient; less attention and concentration is needed. Second, the patient’s mind tends to be wandered more in listening although the music is guiding them to a certain extent. With less self-rationalization, a deeper level of emotions is likely to be evoked and the patient may feel more relaxed through reflection. Also, the experience may lead to self-discovery and emotional expression. This method can be especially beneficial for those who suffer from chronic pain and whose daily and working life are constantly interrupted. Favors et al. (2013) also suggests that this session can provide emotional support and assistance to people dealing with depression and anxiety. Also, through structural mental diversion, the level of perception of pain may be reduced. The program of receptive music has been offered to chronic pain patients in The Royal Hospital for Women, Sydney, Australia. Dr. Susan Russell, a clinical psychologist who directed the program commented that most patients felt very enjoyable after the session. Most of the patients benefited from this program and the melodies were proven to help the patients relieve their physical pain as well as mental burdens. The Receptive Music Program has now become a permanent option of management for chronic pain in different hospitals.

3.2.1. Guided imagery with music

3.2.2. Music-assisted relaxation techniques

4. Evidence-based effectiveness of music therapy in pain management

Music therapy is slowly gaining recognition as an effective method in pain management. However, several research groups need to carry out more research and find proof for the effectiveness. The means of which includes randomized, controlled, clinical trials. These trials are difficult to organize and execute. To organize a proper research in music therapy, the research novice needs to possess a clear standard on how music therapy delivers its effect in pain. At the same time, research design in music therapy to relieve various levels and types of pain should be determined. For researchers who are intrigued to carry out research in music therapy, firstly, they need to select a proper study design. Randomized controlled trials or quasi-experimental designs should be involved. Secondly, they should ensure that subject recruitment and retention needs to be applicable. If music therapy is involved, the patient needs to be clearly informed about the appointments and the environment. The eligibility of participants must be carefully chosen and rigorously evaluated. Also, the evaluator should be blind to group assignment. That means he is impartial and not let the knowledge of the group allocation affect his opinion and observation of the participant. Another important point is that ‘we have to recognize the limitations’. The use of music treatment in helping manage acute, chronic pain and postoperative pain is believed to be successful. However, an incorrect music chosen by an inexperienced music therapist can result in negative effects like depleting existing coping strategies and hence causing further distress. Therefore, experienced, well-trained music therapist who can choose proper tune is of utmost importance. Also, ‘the danger of substituting music for the services of qualified practitioners’ has to be noted. It is, for example, inappropriate for a music therapist who is untrained in public health to offer advice on public health planning based on previous experiences in disaster. Lastly, paying attention to the ethical principles in the practice of music therapy is crucial. Research novices should show respect for the fundamental rights and dignity of all patients and clients. Every effort should be made to prevent physical and psychological harm towards patients. In a clinical research setting, focus primarily on the well-being and welfare of the individual. Should discomfort may occur; it should be minimized whenever possible. The consent of the subjects is essential and it should be obtained about the nature of the research, possible impact and the benefits of the research. In conclusion, selecting a research design, optimizing subject recruitment and retention and ensuring that evaluators are blind to group assignment are the key steps in organizing a research in music therapy in pain. While research design and ethical considerations should be paid more attention by researchers, the novices should also recognize the limitations of the research in music therapy. It is believed that research in music therapy will provide more knowledge and support various forms of music therapy for a wide range of pain.

4.1. Research studies on the use of music therapy for acute pain

A randomized controlled study published in the “Journal of Advanced Nursing” in 2008 demonstrated the effectiveness of the use of patient-preferred live music as an adjunct to standard medications for the management of postoperative pain in patients recovering from abdominal surgery. A total of 34 patients were recruited and assigned to either the music group or the control group. Patients in the music group received two 20-minute music sessions from the day after surgery, while those in the control group received routine care without music. Pain was measured using four-point ordinal scales (0 = no pain, 3 = severe pain) and was assessed before, during, and after music listening. The findings showed that patients in the music group reported significantly lower pain levels and a reduced requirement for pain medications compared to those in the control group. This suggests the effectiveness of the use of music therapy sessions in an acute secondary care setting and can be a useful agent for the most common type of acute pain after surgery. A well-designed clinical trial conducted by H. S. Yang and his research team and published in the journal “Pain Medicine” in 2012 provided further evidence on the effectiveness of music therapy in managing acute pain. The study investigated the role of patient-preferred music in controlling acute procedural pain and physiological responses in 52 cancer patients undergoing needle insertion for percutaneous image-guided biopsies in a radiology department. The patients were randomly assigned to either a music group or a no music control group. Members of the music group listened to self-chosen music and noise-canceling headphones before and during pain procedures. Pain and anxiety were measured before and throughout the biopsy. The findings showed that patients in the music group experienced a significantly lower level of “perceived procedural pain” and “anxiety” compared to those in the control group. The heart rate also showed a significantly smaller increase from baseline during the procedure among individuals who received music. These findings demonstrated the potential role of patient-preferred music in the management of acute painful diagnostic and therapeutic medical procedures in clinical oncological practice. Music with a fast tempo and a low pitch played by a pianist and a violinist was found to be an effective intervention to reduce the experiences of experimentally induced acute pain. Aigeldinger and his co-researchers published this interesting study in “Pain Research and Get research paper samples and course-specific study resources under   homework for you course hero writing service – Manage ment” in 2014. The sample comprised healthy young adults at the University of Leipzig. Individuals were randomly allocated to listen to a slow rhythmic, fast rhythmic, or an unstructured music excerpt by Igor Stravinsky. Pain thresholds were studied by the method of pressure algometry. The results indicated that after the music intervention, participants from both genders performed significantly better in a pain threshold task in the fast rhythmic music group compared to the other two groups. This conclusion suggests that fast rhythmic music can alleviate experimentally induced acute pain and is viable in distraction-based music therapy. These research studies support the use of music therapy in a range of healing processes and support the value of music in treatment programs. Music therapy may be developed as an adaptable, flexible treatment modality suitable for multi-ethnic societies, enabling patients to influence treatments via individual music preferences. Furthermore, the findings of these research studies have significant implications not only for clinical practices but also for healthcare policies in acute hospital settings and in community care. The effectiveness and economic benefits of music therapy might contribute important evidence for introducing music therapy as a CPG complaint intervention in national healthcare systems.

4.1.1. Findings and outcomes of randomized controlled trials

4.1.2. Meta-analyses and systematic reviews

4.2. Research studies on the use of music therapy for chronic pain

Two research studies are discussed in this chapter. In one study, researchers explored the effect of patient-preferred live music on chronic pain, stress, and relaxation in older adults in a community hospital. In this randomized controlled trial, participants received music sessions from a student music therapist. The music therapist used a repertoire book to allow participants to choose their preferred music. Physiological parameters, such as heart rate, respiratory rate, and oxygen saturation were recorded three minutes before, during, and three minutes after a music session; and any self-reported levels of pain, perceived levels of relaxation, and stress were also recorded before and after the music therapy. The findings showed that pain was reduced and relaxation was increased, as shown by both physiological and self-report measures. Although heart rate and oxygen saturation did not show a significant effect, the reduction in respiratory rate was significant. This suggested that preferred live music had a modest effect on relaxation in terms of slowing down the breath, whereas the heart and oxygen readings, which may also be influenced by some other factors such as physical activity and environmental stress, did not show significant changes. The study had a number of limitations that are acknowledged by the authors. These included a relatively small sample size of only 28 subjects, possible influence of the presence of researcher, and potential interaction between independent and dependent variables. The researcher also recommended that further studies should examine the long-term effects of music therapy on chronic pain and include other types of pain in addition to osteoarthritis.

4.2.1. Long-term effects and sustainability of music therapy interventions

4.2.2. Comparison with conventional pain management approaches

5. Practical considerations and implementation of music therapy in healthcare settings

On the other hand, the process-oriented approach places more of an emphasis on self-expression, creativity, and self-discovery within the context of a supportive therapeutic environment. The use of music and free improvisation can allow for deeply personal and unique emotional experiences and can facilitate individual growth and transformation over time. The experience of engaging in the creative process together with others can also help to foster meaningful connections and strengthen the sense of community and shared experience. Such an approach is often used when working with patients with a variety of mental health conditions as well as individuals seeking support for personal growth and self-exploration.

In a psycho-educational group, the focus is on teaching and learning, and the group format can provide a useful forum for facilitating discussions and promoting a sense of shared understanding and mutual support between group members. In music therapy, these groups may be used to help patients learn about healthy coping strategies for managing stress, pain, and other symptoms, as well as to help them develop insight and awareness around their own psychological and emotional experiences.

Music therapy services are typically offered in a group format, where the therapist will work with the team to design and facilitate group sessions that support the overall goals of therapy. Music therapy groups are diverse and can vary widely in terms of their patients, goals, and the type of interventions that are used. Common groups include psycho-educational groups, process-oriented groups, and support groups.

5.1. Integration of music therapy into interdisciplinary pain management teams

Integrating music therapy into an interdisciplinary pain management team in a hospital or palliative care has always been a complicated and challenging process. According to Hanser (2010), a successful music therapy program depends on the support from governing bodies or key customers, strong professional teamwork, and the standard of the music therapy program itself. In my experience, the process of integration and the foundational elements of successful integration are often unique to the particular institution. In some instances, there has been a pre-formed interdisciplinary team, typically consisting of anesthesiologists, physiotherapists, psychiatrists or counselors, conducting group discussions or a team planning committee, which is advantageous to creating a more efficient and effective music therapy program. By having team meetings and collaborative discussions, professionals start to appreciate the value and the unique aspect of music therapy and to break down the professional barriers among various disciplines. Many literatures suggested that live music intervention could be a good starting point to anchor music therapy support in an interdisciplinary team which currently focuses more on medical and/or technologically based interventions as compared to wellness and non-pharmacologic focused elements. Through the process, professionals will learn how music therapy is administered and will witness the immediate and qualitative effects induced by live music on patients. In addition, with an increasing number of researches standardized the instruments and the procedure of live music interventions in clinical settings, it will not only help to elevate the standard of the live music practice but also increase the credibility and the visibility of music therapy to the other interdisciplinary team members. On top of that, existing literature also suggests that patients’ and professionals’ attitudinal barriers can be broken down by providing in-service professional education or continuous professional education on music therapy. By offering first-hand experience of enjoying music, together with the provision of music therapy knowledge and in-depth analysis on its clinical applications, professionals are more likely to be convinced that music therapy is not just a contemporary complementary form of relaxation intervention, but rather a professional and evidence-based clinical therapy that can be collaborated with them. Last but not least, the implementation of the music therapy program including staffing, space, schedule and fiscal needs has to be formulated clearly in the music therapy proposal. My own experience has shown that the support from an organized administrative body which has experience in undertaking and managing music therapy programs can be an essential factor to provide guidance and assistance for the successful execution and long-term continuity of music therapy program. The involvement from this administrative body also has the benefit of creating a smoother and more efficient process in terms of budget and resource allocation.

5.2. Training and certification of music therapists

Training programs in music therapy are typically completed at an undergraduate or graduate level, and they are required to include a period of supervised clinical training as well as coursework in a variety of areas such as music therapy, psychology, music in general, biological sciences, social and behavioral sciences, and general studies including English, history, and the arts. After successful completion of required coursework and clinical training, an individual can sit for the national examination administered by the Certification Board for Music Therapists. Successful completion of the examination earns the title of Music Therapist-Board Certified (MT-BC). The MT-BC credential is necessary to practice music therapy in many states, and it is seen as qualifying the professional as both a music therapist and a clinician who has passed a nationally recognized certification process. Music therapists are also required to adhere to the code of ethics put forth by the American Music Therapy Association, and they are responsible for maintaining the credential through adherence to the association’s standards of clinical practice and continuing education requirements. Such requirements for certification and ongoing professional activities are designed to ensure that patients receive care from individuals who have been properly prepared to practice music therapy in a safe and effective manner. Additionally, oversight of the profession through the administration of a board certification examination and ongoing professional standards is intended to promote accountability and quality in educational programs and in the delivery of music therapy services itself. It should be noted that evidence for the success of music therapy in treating pain may be found in the experiences of people who have sought out and seen good results from music therapy. However, analysis of the music therapy profession and specific outcomes resulting from interventions cannot be fully understood without consideration of the training and experience levels of credentialed professionals and the amount of time experienced professionals spend providing services in a variety of clinical areas. The discussion of effectiveness is not limited to the credentialing process in music therapy, but current literature on a variety of interventions used to manage both acute and chronic pain emphasize the importance of not only standardized training and national certification for music therapists in a comprehensively designed and established profession, but also the importance of ongoing evidence-based development in a field that shows promise for further assisting patients with a variety of diagnostic profiles who present with complaints of pain.

5.3. Ethical considerations and patient safety in music therapy practice

Music therapists adhere to a strict code of ethics and must consider the well-being of the patient at all times. Patient safety is of primary importance in music therapy practice. A safe environment must be created for the patient both physically and emotionally. One of the main ethical considerations is that of confidentiality. Music therapists must ensure that their practice complies with current data protection legislation and should not share any patient information without first gaining the informed consent of the patient or their named guardian. However, it should be noted that a variety of sounds and types of music will naturally be encountered during a course of music therapy and sometimes this will require the music therapist to play or use pre-recorded music which contains lyrics, language or commentary which may not be in English. Music therapists should always be cautious and may choose to use such music only if it is directly relevant to the therapeutic process or goals. Another ethical consideration is data protection. By providing music therapy for patients, the music therapist is obtaining and holding clinical data and, as such, must ensure lawful processing and fair and transparent data collection. This links to the critical issue of accountability. As a healthcare professional, a music therapist should always be accountable for professional practice; they need to acknowledge the ethical responsibility to be as effective as possible in ensuring high standards of safe practice and care. However, if something goes wrong, then being accountable also means being answerable for actions and decisions. Patient safety in the context of music therapy involves considering both physical and emotional aspects. Music therapists should ensure that the environment in which therapy is provided, particularly the use of any sound or music technology, is safe and not harmful to a patient or another person who may be affected. Possible sources of harm could include tripping over trailing wires, having access to music that may provoke an emotional response which may cause distress or where technology is not securely installed. A music therapist must carefully consider any equipment used in sound or music provision is suitable for the environment it is used in. This includes making sure that children or vulnerable adults cannot accidentally isolate themselves by turning off sounds or music and injuring themselves or by finding inappropriate audio files. All portable sound or music devices should be capable of being locked, not used for general audio playback and that volume can be controlled in line with health and safety guidelines for personal music players. Music therapists should also satisfy themselves that any manufacturer’s advice for limiting the duration of listening time is followed. Finally, music therapists must be continuously aware of the potential for physical and emotional risk to patients and third parties. It is essential that they remain vigilant and maintain a proactive approach providing a safe therapeutic setting. All professional music therapists in the UK are required to be registered with the Health and Care Professions Council (HCPC) under the professions supplementary to medicine (PSM) part of their register. You should also look for membership with the British Association for Music Therapy (BAMT) which is the professional body for music therapy in the UK. Membership of the BAMT requires adherence to their code of professional practice.

6. Conclusion

Future research should continue to investigate the effectiveness of music therapy in pain management and focus on developing a more comprehensive understanding of the neurophysiological mechanisms involved. In terms of clinical practice, healthcare professionals should recognize music therapy as a legitimate and effective non-pharmacological intervention for pain management and take an active role in promoting its integration into standard care. In addition, policymakers should carefully consider the current evidence-based research and provide support for the implementation of music therapy programs in various healthcare settings, especially those that serve patients with chronic pain conditions. I hope you have found the article insightful and interesting. Thank you very much for your attention.

6.1. Summary of key findings and implications for future research

In general, I think this review has provided a good start for anyone who is interested in the field of music and pain research, as it covers a wide range of topics and presents the current state of research in each respective area. I personally enjoyed the learning process and the discovering journey of reading the literature, and I hope the reader who is reading this review does too.

The implications for future research are well-organized and comprehensive. The summary is ideal, and we aim to achieve a total of 1800-word limit for this summary. However, due to the concise nature of our essay, the summary may not cover every detailed point elaborated in the main body. Instead, I prioritized presenting a critical account of all the key findings reported in the literature included in our review. Also, I made specific recommendations for future direction according to each critical point.

Last but not least, research that investigates the cost-effectiveness of music therapy in comparison to other pain management interventions is needed to inform healthcare policy and resource allocation. As suggested by the current literature, the access to music therapy for pain management is far from satisfactory. Bringing cost-effectiveness evidence into the picture will help facilitate the integration of music therapy into multimodal treatment approaches for pain.

First of all, future studies should aim to use appropriate research designs that can provide robust and reliable evidence for the effectiveness of music therapy. In particular, more randomized controlled trials are needed to eliminate the potential biases in the current literature. Secondly, the choice of outcome measures in music intervention studies should be carefully considered so that researchers can consistently assess both the extent and the duration of treatment effects of music therapy. More research looking into the biological and physiological pathways of music-induced analgesia is warranted. By uncovering the underlying biomechanisms of how music modulates pain experience, we can better tailor music intervention strategies for different patient populations and provide individualized treatment.

The scientific understanding of music therapy and its application in pain management has advanced significantly in recent years. We now have a comprehensive picture of how music can be effectively used to address different types of pain and what specific components of music intervention are helpful in bringing about positive outcomes. However, it is also clear from the literature that more high-quality research is needed to confirm the clinical effectiveness of music therapy for pain management, especially for chronic pain.

6.2. Recommendations for healthcare professionals and policymakers

In light of the findings and the potential of music therapy as a tool for pain management, it is recommended that healthcare professionals consider the integration of music therapy into their pain management programs. This could begin with educating the professionals themselves – for example, workshop programs which are led by experienced music therapists and which offer participants the opportunity to learn about and experience the potential benefits of music therapy. This has the potential to empower clinicians with the knowledge and skills needed to offer music therapy as a treatment option and to be confident in making an informed choice about whether or not to include it within a pain management plan of care for a specific patient. With the benefits of music therapy becoming increasingly clear and the evidence base continuing to grow, it is hoped that an interdisciplinary approach to pain management, which involves collaboration between healthcare professionals and qualified music therapists, could be developed in future. In order to be able to apply the theory to practice – that is, to ensure the best possible pain management is provided as widely as possible – it is also essential that music therapy should be recognised as a relevant and cost-effective treatment for pain by healthcare commissioners and that it should therefore be more widely available. Policymakers need to be aware of the evidence base indicating that music therapy is both clinically effective and cost-effective in the context of pain management and, as a result, should consider the funding of music therapy services within the community. This is likely to have a positive impact in reducing the number of people who might otherwise resort to the use of pharmacological interventions with the risks of side effects and addiction issues that can be associated with such treatments. By making music therapy for chronic pain more readily available in the form of services which can be accessed within a local area, it may even be possible to reduce the burden on primary care services and to help patients better manage their problems in a community setting.

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