Review of Perioperative Music Medicine: Mechanisms of Pain and Stress Reduction Around Surgery

Abstract

Clinical-experimental considerations and an approach to understanding the autonomic basis of improved surgical outcomes using Perioperative Music Medicine (PMM) are reviewed. Combined surgical, psycho-physiological, and experimental perspectives on Music Medicine (MM) and its relationship to autonomic nervous system (ANS) function are discussed. Considerations are given to the inter-related perioperative effects of MM on ANS, pain, and underlying vagal and other neural circuits involved in emotional regulation and dysregulation. Many surgical procedures are associated with significant pain, which is routinely treated with post-operative opioid medications, which cause detrimental side effects and delay recovery. Surgical trauma shifts the sympathetic ANS to a sustained activation impairing physiological homeostasis and causing psychological stress, as well as metabolic and immune dysfunction that contribute to postoperative mortality and morbidity. In this article, we propose a plan to operationalize the study of mechanisms mediating the effects of MM in perioperative settings of orthopedic surgery. These studies will be critical for the implementation of PMM as a routine clinical practice and to determine the potential limitations of MM in specific cohorts of patients and how to improve the treatment.

Music Therapy as a Form of Nonpharmacologic Pain Modulation in Patients with Cancer: A Systematic Review of the Current Literature

“…The exact process by which this occurs is not fully understood, as music and its interpretation are highly personalized [ 53 ]. However, beyond the known psychosocial aspects that can be relieved with MT, there are a multitude of physical manifestations associated with cancer, many of which are affected not only by emotion, but also by the autonomic nervous system (ANS) [ 54 ]. Sympathetic nervous system (SNS) hyperactivity is highly implicated in the development, maintenance, and metastatic nature of neoplastic growth via the release of epinephrine, norepinephrine, and resultant glucocorticoid secretion [ 54 ].…”

“…However, beyond the known psychosocial aspects that can be relieved with MT, there are a multitude of physical manifestations associated with cancer, many of which are affected not only by emotion, but also by the autonomic nervous system (ANS) [ 54 ]. Sympathetic nervous system (SNS) hyperactivity is highly implicated in the development, maintenance, and metastatic nature of neoplastic growth via the release of epinephrine, norepinephrine, and resultant glucocorticoid secretion [ 54 ]. Overstimulation of β-adrenergic receptors and glucocorticoid secretion through this mechanism creates a highly oncogenic environment, frequently increasing the incidence of tumor formation and spread [ 55 , 56 ].…”

Non-Pharmacological Interventions for Pain Management in Hemodialysis: A Narrative Review

“…By engaging the brain in the processing of musical stimuli, the brain’s capacity to process pain signals may be diminished; this is called the distraction effect [ 59 ]. Listening to pleasurable and comforting music can encourage relaxation and positive emotions, which may relieve pain by reducing stress and anxiety; this is called emotional regulation [ 60 ]. Lastly, through neurochemical modulation, music induces the release of endorphins, which can act as analgesics to minimize pain sensations [ 61 , 62 ].…”

Music in medicine: An overview

“…This parasympathetic cardiac cholinergic output can be quantitated by changes in heart rate variability. 77 The interplay of the sympathetic & parasympathetic autonomic nervous system allows adaptation to stress (everyday challenges/surgery induced) via the hypothalamic-pituitaryadrenal axis leading to the release of corticosteroids and pro-inflammatory factors from the adrenal gland. 78…”