Introduction
Different music-based interventions defined
Specific clinical endpoints studied
Pain
Author, year, type of study | Study population | Music intervention | Control |
N, music group |
N, control group | Results |
---|---|---|---|---|---|---|
Binns-Turner, 2008, RCTa [14] | Breast cancer patients undergoing mastectomy | MM: single session of prerecorded music through headphones (continuously from preoperative through postoperative period). Patients could select from classical, easy listening, inspirational, or new age | iPod and headphones but no music or sounds | 15 | 15 | Significant reduction in self-reported postop pain level by VAS (P = 0.007) |
Danhauer et al., 2010, RCTa [15] | Hematologic malignancy patients undergoing lumbar puncture | MM: prerecorded music through headphones for duration of procedure. Patients could select from classical, harp, general instrumental, nature sounds, country, gospel, and jazz | Standard care | 29 | 30 | No significant reduction in self-reported intra-procedural pain level by VAS (P = 0.771) |
Huang, 2006, RCTa [16] | Adult inpatients with various malignancies | MM: single 30-min session of prerecorded music through headphones. Patients could select from Taiwanese folk, Buddhist, harp, and piano recordings | Bed rest | 62 | 64 | Significant reduction in self-reported pain level by VAS (P < 0.001) |
Nguyen et al., 2010, RCTa [17] | Pediatric leukemia patients undergoing lumbar puncture | MM: prerecorded music through headphones for duration of procedure. Patients could select from either traditional Vietnamese songs or children’s songs | iPod and headphones but no music or sounds | 20 | 20 | Significant reduction in self-reported intra-procedural pain level by VAS (P < 0.001) |
Yonghui et al., 2009, RCTa [18] | Adult inpatients with various malignancies | MM: single 30-min session of unspecified music with unspecified guided imagery | Standard care | 65 | 71 | No significant reduction in self-reported pain detected by numeric rating scale (P > 0.05) |
Gallagher, 2006, single-arm study | Adults with a terminal illnessb in an inpatient palliative care setting | MT: single session of varying length including live performance, listening to prerecorded music, and interactive techniques | None | 126 | 0 | Significant reduction in self-reported pain by VAS, from mean score of 2.7 before the session to mean score of 2.1 after the session (P < 0.001) |
Anxiety
Author, year, study type | Study population | Music intervention | Control |
N, music group |
N, control group | Results |
---|---|---|---|---|---|---|
Binns-Turner, 2008, RCTa [14] | Breast cancer patients undergoing mastectomy | MM: single session of prerecorded music through headphones (continuously from preoperative through postoperative period). Patients could select from classical, easy listening, inspirational, or new age | iPod with headphones but no music or sounds | 15 | 15 | Significant reduction in anxiety detected (P < 0.001). Mean STAI in music group fell from 41.5 to 30.7, while mean STAI in control group rose from 41.9 to 49.7 |
Bufalini, 2009, CCTa, b [34] | Pediatric cancer patients undergoing invasive procedures (e.g., lumbar puncture, bone marrow biopsy, etc.) | MT: single 15-min session of music listening followed by interactive music making for the remainder of the invasive procedure (all during conscious sedation). For listening phase, patients could select from children’s songs, folk, ethnic, and pop | Conscious sedation alone | 20 | 19 | Significant reduction in anxiety of patients in music group compared to control group at all times throughout procedure by modified Yale Preoperative Anxiety Scale (P < 0.05). STAI-S scores were only measured in the parents of the patients undergoing invasive procedures, in whom no significant difference was found |
Bulfone et al., 2009, RCTa [35] | Breast cancer patients receiving adjuvant chemotherapy | MM: single 15-min session of prerecorded music through headphones while waiting for chemotherapy. Patients could select from new age, Celtic, classical, soundtracks, or nature music | Standard care | 30 | 30 | Significant reduction in anxiety detected (P < .001). Mean STAI in music group fell from 46.2 to 36.3, while mean STAI in control group rose from 43.4 to 44.8 |
Danhauer et al., 2010, RCTa` [15] | Hematologic malignancy patients undergoing bone marrow biopsy | MM: single 20- to 60- min session of prerecorded music through headphones for duration of BM biopsy. Patients could select from classical, harp, instrumental, nature sounds, country, gospel, and jazz | Standard care | 29 | 30 | No significant difference was found in the STAI-S scores between two groups (P = 0.766). However, “patient satisfaction with music was high; 66 % of the patients in the music group said that they very much preferred to listen to music with future biopsies” |
Harper, 2001, RCT a [36] | Adult cancer patients receiving chemotherapy | MM: single 30-min session of prerecorded music through headphones during chemotherapy infusion. Patients were offered a new age recording published by Image Paths Inc., entitled, “Health Journeys: A Meditation To Help you with Chemotherapy” | Standard care | 10 | 10 | Borderline significant reduction in anxiety detected by STAI (P = 0.05). Mean STAI in music group fell from 42.9 to 28.5, while mean STAI in control group rose from 32.3 to 41.7. Although a significant reduction in anxiety was reportedly detected by the Beck Anxiety Inventory (P < 0.01), only BAI values after the intervention (not before) were specified |
Smith et al., 2001, RCT a [37] | Adult cancer patients receiving radiation therapy | MM: multiple 30-min sessions of prerecorded music through headphones during simulation and daily treatments for the duration of therapy. Patients could select from rock and roll, big band, country and western, classical, easy listening, Spanish, or religious music | Standard care | 19 | 23 | No significant difference was found between two groups when mean STAI-S scores were compared. However, post hoc subgroup analysis showed that among patients with baseline state anxiety scores >34, those “patients in the experimental group had a steeper decline [from before until after the intervention(s)] compared to the controls” |
Yonghui et al., 2009, RCTa, c [18] | Hospitalized adult cancer patients with pain | MM: Single 30-min session of prerecorded music with imagery during hospitalization | Standard care | 65 | 71 | Significant reduction in anxiety detected (P < 0.05). Mean STAI in music group fell from 57.9 to 33.8, but mean STAI in control group only fell from 58.6 to 55.9 |
Horne-Thompson and Grocke, 2008, RCT [42] | Adults with a terminal illness in an inpatient palliative care setting (24 out of 25 of which had a diagnosis of cancer) | MT: single 20- to 40-min session conducted by a registered music therapist. Techniques included “playing live familiar music, singing, music and relaxation, music and imagery, improvisation, music-assisted counseling, reminiscence, and listening to recorded music” | Visit from volunteer that either read to, conversed with, or provided emotional support to the patient | 13 | 12 | Significant reduction of anxiety in music group compared to the control group by Mann–Whitney testing (P = 0.005). Eight patients in music group reported a decrease in anxiety of between 1 and 5 points on ESAS scale, while only 1 patient in control group reported a decrease in anxiety of 1 point. Three patients in control group reported increased anxiety after the study interval |
Mood disturbance
Author, year, type of study | Study population | Music intervention | Control |
N, music group |
N, control group | Results |
---|---|---|---|---|---|---|
Beck, 1989, RCTa [58] | Adults with documented cancer-related pain (setting: patients’ homes) | MM: three 45-min sessions of prerecorded music through headphones. Patients could select from classical, jazz, folk, rock, country and western, easy listening, and new age | Listening to 60-cycle hum through headphones | 8 | 7 | No significant difference detected in mean percent change of five-point VAS between groups (P = 0.599). However, “60 % of the subjects [in the music group] demonstrated at least some improvement in mood” |
Cassileth et al., 2003, RCTa [55] | Adults with hematologic malignancy admitted for SCT | MT: median of five 20–30-min sessions (over median of 10 days). Live bedside music therapy was provided by trained music therapist | Standard care | 36 | 33 | Significant improvement in mood detected: Patients in the music therapy group scored 37 % lower on total POMS of mood disturbance (P = 0.01) and 28 % lower in the combined anxiety/depression domains (P = 0.065) |
Duocastella, 1999, RCTa [59] | Pediatric cancer patients receiving inpatient chemotherapy | MT: single 45-min individualized MT session. Sessions included singing, instrument playing, movement to music, and musical games | Single session of non-musical activities led by music therapist | 15 | 15 | No significant improvement in mood detected using five-point Likert scale |
Gallagher et al., 2006, single-arm studyb [5] | Adults with a terminal illness in an inpatient palliative care settingb
| MT: single session of varying length including live performance, listening to prerecorded music, and interactive techniques | None | 123 | 0 | Significant improvement in mood detected: mean self-reported mood disturbance scores improved from 1.8 to 0.7 on a five-point VAS after a single music therapy session (P < 0.001) |
Quality of life
Author, year, type of study | Study population | Music intervention | Control |
N music group |
N control group | Results |
---|---|---|---|---|---|---|
Hanser, 2006, RCTa [57] | Metastatic breast cancer patients (outpatient setting) | MT: three 45-min sessions consisting of live music, improvisation, and songwriting | Standard care | 20 | 22 | No significant improvement in QOL detected using the 136-point FACT-G scale. Although the music group’s mean score rose from 75.4 to 78.9, and the control group’s mean score only rose from 82.2 to 83.1, P > 0.05 |
Burns, 2001, RCTa [75] | Adult outpatients with cancer | MT: 10 weekly 90–120-min sessions of the Bonny Method of Guided Imagery and “specially sequenced Western Art” music | Wait-list group | 4 | 4 | No significant improvement in QOL detected using 100-point QOL-Cancer Scale. Although the music group’s mean score rose from 75.40 to 91.77, and control group’s mean score only rose from 76.02 to 77.85, P > 0.05 |
Hilliard, 2003, RCTa [76] | Adults with terminal cancer (setting: home hospice) | MT: 2–13 weekly/biweekly MT sessions of varying lengths. Techniques included singing, lyric analysis, instrument playing, song parody, planning of funerals, song gifts | Standard care | 40 | 40 | Significant improvement in QOL detected using 280-point Hospice QOL Index-Revised scale (P < 0.05). Music group’s mean score rose from 206.8 to 214.6, while control group’s mean score fell from 188.5 to 177.9 |
Zhong and Gang, 2001, RCTa [77] | Adult cancer patients receiving chemotherapy | MM: twice daily 60-min sessions for 20 days | Standard care | 124 | 136 | Significant improvement in QOL detected using QOL Questionnaire for Chinese patients (P < 0.01). Music group’s mean score fell slightly from 49.2 to 47.2, while control group’s mean score fell from 49.9 to 34.5 |
Relevant advances in neurobiology
Author, year | Description | Findings |
---|---|---|
Becerra et al., 2001 [79] | fMRI was used to examine changes in neural activation due to painful thermal stimuli (delivered to the skin of the left hand through a Peltier-based thermode at 46 °C) in 8 healthy male subjects, who rated their pain levels using a Visual Analog Scale | Two temporal phases of pain response were observed: early and late. During the early phase, increased signal was seen in reward regions such as the left anterior nucleus acccumbens (NAc), the ventral tegmentum (VT), the periaqueductal gray (PAG), the sublenticular extended amygdala (SLEA) of the basal forebrain, and the orbital gyrus. In the late response, decreased signal was seen in the left posterior NAc, while increased signal was seen in classical pain regions such as the thalamus, S1, insula, and anterior cingulate gyrus |
Blood et al., 1999 [110] | PET was used to examine changes in regional cerebral blood flow (rCBF) related to emotional responses to music. Ten musicians were exposed to 6 versions of a novel musical passage varying systematically in degree of dissonance | Subjective pleasantness and unpleasantness ratings were correlated with consonance and dissonance, respectively. Increasing consonance was correlated with increasing activity in the orbitofrontal cortex, frontal polar cortex, and the subcallosal cingulate gyrus. Increasing dissonance was correlated with increasing activity in the precuneus region and the right parahippocampal gyrus |
Blood and Zatorre, 2001 [97] | PET was used to examine changes in rCBF related to “intensely pleasant emotional responses to music” manifesting as piloerective chills measured by electrodermal monitoring. Ten musicians were exposed to self-selected music, control music, amplitude-matched noise, and silence. rCBF values were extracted from individual scans and plotted against chill intensity | Increasing chill intensity was correlated with increasing activity in the left ventral striatum (including the NAc) and dorsomedial midbrain (including the PAG), and decreasing activity in the right amygdala, left hippocampus, and ventral medial prefrontal cortex |
Engel et al., 2009 [82] | This article reviews findings from multiple neuroimaging studies using fMRI, PET, and radioligand binding experiments to investigate anxiety in healthy subjects as well as patients with panic disorder, generalized anxiety disorder, social anxiety disorder, and specific phobias | Enhancement of activity in the amygdala was a very common finding. Enhanced activity was also commonly found in the prefrontal cortex, insula, and the anterior cingulate cortex |
Menon and Levitin, 2005 [98] | High-resolution fMRI was used to examine changes in neural activation due to “passive music listening.” Fourteen non-musicians were exposed to 10 intact samples of music and 10 scrambled samples for control stimuli. Hemodynamic changes were subject to statistical, functional connectivity, and effective connectivity analyses | Passive listening to music resulted in significant activation of multiple specific structures including the NAc, the VTA, and the hypothalamus. Functional connectivity analysis showed that responses in the NAc and the VTA were highly correlated, “suggesting an association between dopamine release and NAc response to pleasant music” |
Nestler and Carlezon, 2005 [85] | This article reviews the mesolimbic dopamine reward circuit in depression. Data from animal studies and some human studies are discussed | The authors discuss how abnormalities in the VTA and NAc may be related to depressive symptoms such as anhedonia, reduced motivation, decreased energy level, etc. Roles of specific proteins, such as the transcription factor cAMP response element binding protein (CREB) and the endogenous kappa-opioid receptor agonist Dynorphin are reviewed |
Pereira, 2011 [106] | fMRI was used to investigate blood oxygenation level dependence (BOLD) responses to musical stimuli that varied according to participant familiarity and preference. Fourteen non-musicians underwent a listening test which consisted of 15 s excerpts from 110 pop/rock songs which they rated by degree of familiarity and preference. During fMRI, the participants were then exposed to 48 excerpts, with 12 excerpts from each of the following categories based upon the listening test results: familiar liked, familiar unliked, unfamiliar liked, and unfamiliar unliked | Familiarity was found to have a greater impact than preference in triggering BOLD responses in the following emotion-related regions: putamen, amygdala, NAc, anterior cingulate cortex, and thalamus |
Salimpoor et al., 2011 [100] | Ligand-based PET was used to estimate dopamine release in the striatum based on the competition between endogenous dopamine and [11C] raclopride for binding to D2 dopamine receptors. Information about the dynamics of dopamine release over time was collected using fMRI. Eight participants were exposed to self-selected pleasurable musical excerpts versus neutral musical excerpts. Electrodermal skin conductance was used to measure piloerective chills while participants provided subjective feedback about degree of listening pleasure | Compared to neutral musical excerpts, pleasurable musical stimuli (concurrently measured by chill intensity and subjective participant ratings) resulted in distinct striatal responses detectable by PET and fMRI. Ligand-based PET data revealed increased endogenous dopamine transmission, as indicated by decreased [11C] raclopride binding potential in the right NAc. fMRI showed increased BOLD response in the right NAc during peak pleasure experience epochs |