The Effect of Singing on Pain Management with Orthopedic Chronic Pain Patients
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The Effect of Singing on Pain Management With Orthopedic Chronic Pain Patients A Thesis Presented to the Faculty of Hahnemann University Graduate School In Partial Fulfillment of the Requirements for the Degree Master's of Creative Arts in Therapy by Kelley A. Lyon Creative Arts in Therapy Department June, 1988 HAHNEMANN UNIVERSITY GRADUATE SCHOOL Thesis Approval Jhis is to certify that the thesis presented to us by 7/5^ //A*/ A-frfr^. on the x'/ day of 'ZLl. , 19 / in partial fulfillment of the requirements for the degree of M ?C£^r f CO has been examined and is acceptable in both scholarship WdVliterary quality. COMMITTEE MEMBERS SIGNATURES , Chairman Pi 'v. i JQJLJU MV> {yujj^j^ ^ /fjpis, Md 1 Abstract This study investigated the effect of personalized singing programs on pain management with adult chronic orthopedic pain patients. The hypothesis was that the subjects would experience significant levels of pain reduction while practicing a self-directed singing program, and an even more significant level of pain reduction while working directly with the researcher; as compared to subjects who did not participate in the singing program. A total of 4 subjects were used, 2 who sang and 2 who did not (due to lack of accumulated data, one of the control patients' contribution was void). Subjects ranged in age from 30 to 60 years. The main measurement consisted of the McGill Daily Home Recording Card. Pre and post experimental questionnaires, included in a descriptive case material section, were also used for the 2 subjects participating in the singing program. Due to the small sample size, and diversity of symptoms, responses and problems in the method of scoring, no statistically significant results were obtained. The subject not in the singing program experienced higher levels of pain intensity than did the subjects who sang. Due to differences in diagnosies and lifestyles between the subjects, meaningful comparisons were difficult to make. It appeared that the singing program had no adverse effects on the 2 subjects. 11 Both of the subjects who sang said that they would like to continue singing and using music as a means of therapy. In general, the information gathered from the subjects7 personal responses, although not statistically measurable, supported the approach. Ill Dedication This study is dedicated to all those who suffer from life's aliments, like myself, and to all those who taught me that the beauty in this world outweighs the bad. "When I listen to the music of life, I am able to join in the dancing", (Katherine Long). IV Acknowledgements I would like to thank my family, who have supported me from the beginning, Kathleen Sweeny and Michel in P.T., the P.T. patients who made this study possible, my committee members and supervisors, Marion Sung and the whole Shenandoah crew, my music teachers, (I remember you all), my doctors who kept me going, and to all of my cherished friends who are scattered near and far but still close in my heart. V LIST OF TABLES Table Page 1. Subject #1 Results: Pre-experimental questionnaire 37 2. Week 1 Baseline graph 38 3 . Week 2 Treatment graph 39 4. Week 3 Reversal Baseline graph 40 5. Week 4 Final Treatment graph 41 6. Post-experimental questionnaire 42 7. Subject #2 Results: Pre-experimental questionnaire 43 8. Week 1 Baseline graph 44 9. Week 2 Treatment graph 45 10. Week 3 Reversal Baseline graph 46 11. Week 4 Final Treatment graph 47 12. Post-experimental questionnaire 48 13. Subject #3 Results: Week 1 49 14. Week 2 50 15. Week 3 51 16. Week 4 52 TABLE OF CONTENTS Page ABSTRACT i DEDICATION iii ACKNOWLEDGEMENTS iv LIST OF TABLES V Chapter 1. Introduction 1 2 . Literature Review 7 The Problem 7 Assessments 8 Where To Go For Help 10 Pain Management 10 Music Therapy and Pain Management 14 The Physiology of Nerve Pathways 17 The Physiology of Musical Stimuli 18 The Physiology of Hearing 19 The Physiology of Vocal Production 20 The Brainstem: Where Music and Pain Meet 21 The Gate Theory of Pain 22 Psychological Effects of Music 24 Modern Researchers Views on Singing 27 3 . Methods and Procedures 29 Subjects 29 Design 29 4. Results 35 Overall Results 35 Descriptive Case Material 53 5. Discussion of Results 60 Problems 62 Practical Implications 63 Suggestions for Further Research 65 6. Summary and Conclusions 67 REFERENCES 69 APPENDIXES 76 CHAPTER I INTRODUCTION National surveys show that nearly one third of the American population have persistent or recurrent pain. Insurance company estimates reach 70 billion dollars a year spent on medical costs for workman's compensation, due to injuries on the job or related symptoms. Pain is the number one reason why people see a doctor and take medication (Wallis, 1984). Perhaps the most complicated dimension of being sick, the chronic pain experience is a constellation of side effects that include physical tension, emotional distress and depression, loss of communication skills, a distorted sense of time, and a limited range of mobility. It is not possible to separate the physical from the emotional. When one is afflicted with a physical problem, emotional stress is present. Orthopedic pain patients who suffer from various musculoskeletal problems such as "bad backs" or "arthritic conditions" deal with varying degrees of pain every day. Chronic pain can lead to physical and emotional fatigue, which in turn can create more pain. There are two factors to be considered within the "pain experience". First, there is the patient's physiological pain levels. This pain can either be chronic or acute, and is often complicated by associated muscle tension. Secondly, there is the patient's effective response to the pain. Anxiety, fear, and depression can make the pain 1 seem more severe. Research has found that effecting change in either of these areas can improve the patient's self- image and worldview by making the pain experience more tolerable (Bloom, 1987). Pain patients often seek relief in the form of conventional drug therapy or physical therapies. These methods often provide only temporary relief and can be a burden financially. Music therapy is a novel form of therapy. By using music entrainment techniques, the patient's perception of time is shortened due to the pleasurable occupation. At the very least, music serves as a distraction from the obsessive, self-centered thoughts that pain can inspire (Bloom, 1987). One advantage of music training (specifically singing) is that it can be done at home or in an environment wherever the patient has privacy. Music may have several healing capacities with chronic disease patients. It can be used to establish a therapeutic relationship for multiple types of intervention. Music can facilitate muscle relaxation. It can address repressed emotions. Furthermore, music can match the patient's pain imagery at the level of least resistance and guide them toward a more positive outlook about their health (Rider, 1987). One possible explanation of how music can help eliminate some of the distress caused by the pain experience is the "gate-control" theory, which is discussed later on in this paper. This theory states that only a limited amount of 2 sensory information can be processed by the nervous system at any given moment. A patient's perception of pain can be eliminated or reduced when there is competition from inputs to other sensory modalities (Wallis, 1984). Possible explanation for obtaining results in the treatment of pain is the relaxation created by the use of music and imagery. This technique partially shifts dominant control from the left hemisphere of the brain (primarily responsible for verbal, sequential, and logical thought processes), to the right hemisphere which functions in a more nonverbal, holistic manner. Through relaxation, stress factors are reduced and the body's natural physiological defenses are possibly strengthened (Bloom, 1987). There are at least three neurophysiological processes that may be triggered by music: First, because music is nonverbal, it can move directly through the auditory cortex directly to the limbic system, then the midbrain network that governs most of our emotional experience as well as basic metaboic responses. Secondly, music may be able to activate the flow of stored memory material across the corpus collosum, a collection of fibers connecting the left and right sides of the brain, and helps the two to work in harmony. And third, music may be able to excite calling agents, called peptides or stimulate endorphines, natural opiates secreted by the hypothalmus that produce a feeling akin to being in love (Bloom, 1987). 3 The second component of the healing process involves the patient's attitudes and feelings about his/her health. The individual may become more optimistic and experience more positive interactions with others and the environment by using music (Godley, 1987). Psychologically, an individual relates sound to a past experience, or creates new mental engrams or pictures to represent what is heard. Finally, a personalized response (thought, feeling, or behavior) emerges. Thus, some sounds evoke pleasant memories, feelings, thoughts and behaviors, while other tend to remind us of past pain, embarrassment, and fear. There are a great many facets through which sound can determine behavior; such as loudness, pitch, frequency and timbre. How we individually process and associate specific sounds with past or current learning determines what behaviors will follow. It has been shown that certain sounds can facilitate memory, reduce pain, and evoke feelings (Buffington, 1987). Few modern researchers have investigated the specific therapeutic uses of singing and pain control. However, there are some contemporary pioneers in the field, who will be quoted later on in the literature review, that are working to combine old techniques with today's technology.