The effect of recorded music on pain endurance (CRESCENDo) - A randomized controlled trial

Ryan Billar; Pablo Kappen; Sepehr Mohammadian; Corinne van den Berg; Yolanda de Rijke; Erica van den Akker; Joost van Rosmalen; J Marco Schnater; Arnaud Vincent; Clemens Dirven; Markus Klimek; René Wijnen; Johannes Jeekel; Frank Huygen; Jitske Tiemensma

doi:10.1016/j.ctim.2023.102969

The effect of recorded music on pain endurance (CRESCENDo) - A randomized controlled trial

Complement Ther Med. 2023 Oct:77:102969. doi: 10.1016/j.ctim.2023.102969. Epub 2023 Aug 12.

Authors

Affiliations

¹ Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands. Electronic address: r.billar@erasmusmc.nl.
² Department of Neurosurgery, Erasmus Medical Center, Rotterdam, the Netherlands.
³ Department of Anesthesiology, Center for Pain Medicine, Erasmus Medical Center, Rotterdam, the Netherlands.
⁴ Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, the Netherlands.
⁵ Department of Pediatric Endocrinology, Erasmus Medical Center, Rotterdam, the Netherlands.
⁶ Department of Biostatistics, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, the Netherlands.
⁷ Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, the Netherlands.
⁸ Department of Neuroscience, Erasmus Medical Center, Rotterdam, the Netherlands.

PMID: 37579996
DOI: 10.1016/j.ctim.2023.102969

Abstract

Introduction: Clarifying the effect of music on pain endurance in an experimental design could aid in how music should be applied during both surgical and non-surgical interventions. This study aims to investigate the effect of music on pain endurance and the involvement of the sympathetic adrenomedullary axis (SAM) and the hypothalamic-pituitary-adrenocortical axis (HPA).

Materials and methods: In this randomized controlled trial all participants received increasing electric stimuli through their non-dominant index finger. Participants were randomly assigned to the music group (M) receiving a 20-minute music intervention or control group (C) receiving a 20-minute resting period. The primary outcome was pain endurance, defined as amount milliampere tolerated. Secondary outcomes included anxiety level, SAM-axis based on heart rate variability (HRV) and salivary alpha-amylase, and HPA-axis activity based on salivary cortisol.

Results: In the intention-to-treat analysis, the effect of music on pain tolerance did not statistically differ between the M and C group. A significant positive effect of music on pain endurance was noted after excluding participants with a high skin impedance (p = 0.013, CI 0.35; 2.85). Increased HRV was observed in the M-group compared to the C-group for SDNN (B/95%CI:13.80/2.22;25.39, p = 0.022), RMSSD (B/95%CI:15.97/1.64;30.31, p = 0.032), VLF (B/95%CI:212.08/60.49;363.67, p = 0.008) and HF (B/95%CI:821.15/150.78;1491.52, p = 0.0190). No statistical significance was observed in other secondary outcomes.

Conclusions: The effect of the music intervention on pain endurance was not statistically significant in the intention-to-treat analysis. The subgroup analyses revealed an increase in pain endurance in the music group after correcting for skin impedance, which could be attributed to increased parasympathetic activation.

Keywords: Anxiety; Hypothalamic-pituitary-adrenocortical axis; Music; Pain endurance; Stress; Tolerance.

Publication types

Randomized Controlled Trial

MeSH terms

Anxiety / therapy
Heart Rate / physiology
Humans
Music Therapy*
Music*
Pain
Pain Threshold