Tune out pain: Agency and active engagement predict decreases in pain intensity after music listening

Abstract

Music is increasingly being recognised as an adjuvant treatment for pain management. Music can help to decrease the experience of both chronic and experimental pain. Cognitive agency has been identified as a specific mechanism that may mediate the analgesic benefits of music engagement however, it is unclear if this specific mechanism translates to acute pain. Previous attempts to understand the cognitive mechanisms that underpin music analgesia have been predominantly lab-based, limiting the extent to which observed effects may apply to participants’ everyday lives. Addressing these gaps, in naturalistic settings, the present study examined the degree to which cognitive agency (i.e., perceived choice in music), music features (i.e., complexity), and individual levels of musical sophistication were related to perceived pain. In an online global experiment, using a randomised between groups experimental design with two levels for choice (no choice and perceived choice) and two levels for music (high and low complexity), a sample of 286 adults experiencing acute pain reported their pain intensity and pain unpleasantness pre- and post-music listening. A bespoke piece of music was co-created with a commercial artist to enable the manipulation of music complexity while controlling for familiarity, while facilitating an authentic music listening experience. Overall, findings demonstrated that increased perceived control over music is associated with analgesic benefits, and that perceived choice is more important than music complexity. Highlighting the importance of listener engagement, people who reported higher levels of active engagement experienced greater decreases of pain intensity in the perceived choice condition, than those who reported lower levels of active engagement. These findings have implications for both research and practice, emphasising the importance of facilitating freedom of choice, and sustained engagement with music throughout music listening interventions.

Functional Organization of Auditory and Reward Systems in Aging

“…Finally, there was a pronounced effect across all subjects, in which listening to their own self-selected music led to increased connectivity between reward network and auditory regions as compared to other recognizable music within the larger western canon. Agency in music listening is known to be an important factor in health outcomes of music-based interventions (Ruud, 1997; Cassidy & Mcdonald, 2009; Howlin et al, 2022). However, here for the first time, we present direct evidence that agency in song selection leads to increased connectivity of auditory and reward networks.…”

How do people with chronic pain choose their music for pain management? Examining the external validity of the cognitive vitality model

“…At the same time people with chronic pain report that they sometimes feel trapped and as if their personal world is getting smaller. Music listening can be used to help patients maintain a sense of their personal identity ( Saarikallio et al, 2020 ) and a sense of agency, when people are encouraged to choose their own music ( Howlin and Rooney, 2021b ; Howlin et al, 2022 ). Additionally, music listening is a relatively easy activity, and perceived as less effortful compared to other types of cognitive tasks, which could be beneficial when patients may have diminished cognitive resources available due to the experience of chronic pain.…”

A web app-based music intervention reduces experimental thermal pain: A randomized trial on preferred versus least-liked music style

“…A significant correlation between music pleasantness and pain reduction in healthy subjects was reported, suggesting the importance of the emotional valence for music-induced pain reduction ( 31 ). However, in another study also using experimental pain, the authors found that emotional responses were not correlated to the analgesic effects, but that perception of control in the selected music during the experiment and the engagement with music in the subject's everyday life were the most important parameters ( 55 ). Interestingly, antagonists drugs of endogenous dopamine and opioids did not reduce the effect of music analgesia ( 56 ).…”