Music as Medicine

  Two complementary, yet somewhat different, approaches to the use of music in medical settings are currently in practice: music therapy and music medicine. Both music therapy and music medicine rely on the inherent therapeutic possibilities of music to relieve stress and pain and promote well-being, yet each has essential distinguishing features.

     Music medicine is typically used by medical personnel as an adjunct to various medical treatments and it often represents an attempt to provide a non-pharmacological intervention for stress, anxiety and pain for the medical patient. Examples of music medicine interventions include background music in waiting rooms or other areas of the hospital, musical programs available via headphones for the patient in the cardiac intensive care unit or prior to surgery. Music medicine interventions rely primarily upon receptive music experiences (listening to music) involving pre-recorded music selected by either the medical staff or by the patient from available programs. Music stimuli may include a wide range of music in a variety of genres and styles, low frequency sounds, specially composed music or various combinations.

Music therapy also referred as medical music therapy or creative music therapy in its approach to medical patients always involves a therapeutic process, a trained music therapist and a relationship that develops through the music and process. Perception of emotion in music is a skill that appears early in life. Recent data suggests that music plays an important role in emotion communication and regulation between care-givers and infants. There is current evidence to show that premature babies exposed to womb sounds and music, in the form of lullabies sung by their mothers, gain weight faster and they are discharged earlier from neonatal intensive care units compared to babies not listening to music(1).

    

     Very recent research studies have shown that music can partly replace some of the drugs used to introduce anesthesia and sleep during operations and it can also be used to treat pain as a complement to standard pain killer agents⁽²⁾. A neurochemical approach to music listening has recently suggested that the objectively measured effects of music on hemodynamic parameters like arterial pressure are associated with molecular changes on opiate receptors and cytokine processes.

Greek edition of a book on the healing aspects of music and modern clinical applications of music therapy and music medicine. Inclusive in this book a CD which uses classical music to introduce relaxation and reduce stress (INFO HEALTH 2003).

    

  Recent work from the Dept. of Cognitive Neuroscience, McGill University, Montreal Canada has suggested that musical perception and musical performing abilities can be maintained in the presence of cerebrovascular attacks which have caused impairment of speech so aphasia can occur without amusia and vice versa. Studies using PET scan have shown that although specialized brain pathways associated with musical perception have been destroyed however, the ability of music to introduce emotions (happy-sad) can be maintained in the presence of inability to recognize the melody of very familiar and simple tunes eg happy birthday to you. Up to now research data is suggesting that emotional appreciation of music is subserved by a distinct neural pathway that requires cortical mediation. Cortical mediation appears to involve the right hemispheric structures with a possible contribution of the left frontal lobe regions⁽³⁾.

     Clinical studies have also shown that selected music can be used to relieve stress and offer relaxation in cardiovascular patients during their stay in the coronary care unit. This observed relaxing effect of music is associated with beneficial changes in heart rate and/or arterial pressure. Arterial pressure or heart rate lowering induced via music listening has been associated with a significant reduction in the levels of stress related neurohormones like nor-epinephrine, cortisol and ACTH⁽⁴⁾.

Very recent research data from the Department of Cardiology at the Onassis Cardiac Surgery Center, Athens, Greece has shown that in patients with neurocardiogenic syncope listening to relaxing music decreases stress and arousal during head-up tilt table testing and alters the response to the tilt test. This ability of music to change the outcome of tilt testing was associated with a normalization of the neuroendocrine response to head-up tilt in patients with recurrent episodes of vasovagal attacks.(5),(6)

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     There is strong evidence arising from many research studies that music can be used as a complementary diagnostic and therapeutic tool in many medical conditions. The therapeutic effects of music are currently used in modern medicine as either music therapy or as complementary treatment in the setting of receptive music therapy and music medicine. Important advances are expected in the near future due to further flourishing of brain imaging technologies and motivation for understanding the biological foundations of music is very high in the scientific community. [Athanasios Dritsas (*) MD, FESC, cardiacmusic.gr].

    REFERENCES

     (1) Dileo C. Introduction to music therapy and medicine: Definitions, theoretical orientations and levels of practice. In Music Therapy & Medicine, Theoretical and Clinical Applications, eds American Music Therapy Association (1999), pp 1-10.

     (2) Zhang XW, Manyande A, Tyan YK, Yin P. Effects of music on target-controlled infusion of propofol requirements during combined spinal-epidural anesthesia. Anesthesia 2005;60:990-4.

     (3) Peretz I. Listen to the brain: a biological perspective on musical emotions. In Music and emotion, eds Juslin and Sloboda, Oxford University Press, 2001, pp 105-134.

     (4) Byers JF. Effects of music intervention on noise annoyance, heart rate and blood pressure in cardiac surgery patients. Am J Crit Care 1997;6:183-191.

     (5) Dritsas A, Leftheriotis D, Karabela G et al. The effect of relaxing music on the stress dimension and the response to tilt test in vasovagal patients. Eur Heart J 2004;24 (suppl):574

     (6) Kostopoulou A, Dritsas A, Theodorakis GN et al. Effect of music listening during head up tilt in neurocardiogenic syncope. Eur Heart J 2006; 27(suppl):186.

 

(*)   Born in Athens 1960. Studied medicine in the University of Athens, qualified as an MD (1984). Specialized in Cardiology, he worked as registrar in the Dept. of Cardiology at Guy’s Hospital London (1987-1990). He worked as Research Fellow in Cardiology (1990-1994) at Hammersmith Hospital, Royal Postgraduate Medical, London. He has published scientific papers in high citation impact factor journals (Lancet, Journal of American College of Cardiology, American Journal of Cardiology, British Heart Journal, Pacing and Clinical Electrophysiology etc) on subjects like cardiac arrhythmia, pacing, and cardiomyopathies.    In addition to medicine he has studied harmony, counterpoint and composition in Athens with professors K. Kydoniates and G. Ioannides and also took seminars on composition in UK. He has composed works for piano, chamber music, songs on modern Greek poetry, music for movie documentaries and also for full symphony orchestra.

     His works have been presented in live concerts and recorded by National Radio 3, performed by groups of musicians members of the Orchestra of Colours (founded by M. Hadjidakis) and the National Symphony Orchestra of Greek Radio-Television (ERT). In Greece he was the first to introduce music as a clinical therapeutic tool in hospital practice (at the Onassic Cardiac Surgery Center) and he researches on music-medicine studying the hemodynamic and neuroendocrine effects of music in cardiac patients. He made a radio production (1999-2001) for Greek National Radio 3 under the title The Magic Flute during which he commented and presented music on the subject of the healing power of music. He is a member of the Hellenic Society of Cardiology, Fellow of the European Society of Cardiology (FESC), member of the American Association of Music Therapy (AMTA), International Society of Music in Medicine (ISMM). He has released the following CDs with his music: STRING IMAGES (chamber music for flute and strings, MUSICA VIVA 2002, Athens), HYDATOGRAFIES-WATER COLORS (chamber music for 1-8 instruments, PROTASIS MUSIC, Athens 2004), TWO CHILDREN STORIES FOR NARRATOR AND CHAMBER ORCHESTRA (LYRA, Athens 2005). He has also produced CDs with work related to music therapy applications like THERAPEUTIC SOUNDS OF THE WORLD (a selection of pieces from classical and ethnic music indicated for the treatment of stress) produced by the well known Greek newspaper Eleutherotypia and MORFEAS-A sleep CD (Info Health eds, Athens 2005) in which the colaboration with the American anesthesiologist Dr. Fred Schwartz produced womb sounds and music which are utilized in order to introduce relaxation and sleep. He is also the author of a book titled MUSIC AS MEDICINE (Athens, 2003, eds. Info Health, Greek edition) in which all aspects of music therapy and music medicine are presented and discussed with emphasis on clinical applications of music in modern medicine. He is also the editor of the books MUSICAL ACTIVITIES AS THERAPEUTIC TOOL (eds. National Institute of Research, Athens 2003) and ART AS THERAPY (Eds. National Institute of Research, Athens 2004).
dritsas thanasis