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Music as Medicine: research into the impact of music on pain perception using heart rate monitoring

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The Music as Medicine Foundation Erasmus MC investigates the possibility of implementing music as treatment and pain relief in healthcare. It has now been scientifically proven that music can help reduce pain in patients after operations. In the CRESCENDO study, the BioCheck system is used to measure the heart rate. Researchers Pablo Kappen, Ryan Billar and Sepehr Mohammadian, in collaboration with the anesthesia department, coordinate this project: “We will investigate how exactly the relationship between music and pain perception works and why.”

Kappen: “It appears that music has a pain-reducing effect after operations: patients use painkillers or other pain medication less after the operation. However, there are different types of pain. For example, you have small or large wounds, pain in your stomach or on your leg. These types of pain are different from each other. It is therefore difficult to quantify exactly how effective music is in reducing pain.”

“It is also not yet clear whether the pain-reducing effect is in the experience of pain (patients actually feel less pain) or that the experience remains the same but that the music works more likediversion, making the pain more manageable. In collaboration with the anesthesia department, we are trying to clarify that distinction during the CRESCENDO study,” Kappen explains.

Controlled pain delivery

The experiment is carried out in a controlled setup with 70 healthy and adult volunteers who administer a pain stimulus to themselves. For this purpose, an electrode is attached to the finger. During the first test phase, the subject presses the mouse to give himself a shock. This shock increases slowly until the person can no longer sustain it.

Then, in the second phase, the group is divided into two groups: one group listens to music of their own preference and the other group does not listen to music, but sits in a quiet room. During this part the experiment with the shocks is repeated. Kappen: “We want to investigate whether we see a difference in how people can push their pain threshold – for example, do we see that the group that listens to music can sustain the increasing shocks better than the group that does not listen to music?”

Heart rate monitoring with BioCheck

The researchers are not only interested in whether the pain-reducing effect is caused by music, they also want to investigate the exact mechanism behind it. To do this, we look at the two parts of the nervous system: the sympathetic nervous system, which is activated during intensive activity and stress, and the parasympathetic nervous system, which is activated when the body is at rest. A high heart rate is associated with the sympathetic, a low heart rate with the parasympathetic nervous system. A high heart rate is also associated with increased stress.

Kappen: “By looking at heart rate variability, you can measure which nervous system is active based on your heart rate. The greater the variation time between your heartbeats, the more you are in your parasympathetic system and the more you are at rest. We monitor heart rate variability with the BioCheck system: a combination of the heart rate belt that our participants wear during the study that is linked to the BioCheck software.”

During the entire study, heart rate variations are measured with the BioCheck system and then during the second phase it is examined in both groups whether there is a shift towards the sympathetic or parasympathetic compared to the first test phase.

In addition, the role of the stress system in the experience of pain is being investigated. For this purpose, a saliva sample is taken half an hour after the experiment. In the saliva you can find various markers of increased activity in the nervous system, namely the stress hormone cortisol and the enzyme alpha-amylase.

Kappen: “You could argue that music calms people down, allowing them to endure the pain longer, but you would like to be able to objectify that assumption. If people listen to music and are better able to push their pain threshold, is that associated with activating the parasympathetic nervous system? With this research we try to get a better grip on what exactly happens in the body.”

Substantiate the effect of music

The research team expects to ultimately be able to provide supporting evidence for the pain-reducing effect of music. Kappen: “You now notice that music as a treatment is mainly seen as a controversial method. The use of music around operations in particular raises questions: “But how exactly does it work?” Then you notice that you cannot yet give a watertight answer to this.”

The aim of the CRESCENDO study is to gain a better grip on the underlying mechanism and thus remove the ‘fuzziness’. Kappen: “During this research we will see whether we can make the effect of music measurable and objectify it using the BioCheck system. By doing this kind of research, we hope that treatments with music will become clearer (or scientifically proven) for people and that they will be more open to it.”


The CRESCENDO study is funded by the Music as Medicine Fund. Erasmus MC supports the project and contributes to indirect costs. The Music as Medicine project depends on financial donations. The fund is part of the Erasmus MC Foundation.

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