Music for Chronic Pain: Attention, Mood and Relaxation While Living With Pain

How can music for chronic pain offer support? The role of music in attention and mood, the limits of the research and practical suggestions for daily life.

Picture a 52-year-old accountant who has been living with back pain for years. Getting out of bed in the morning is one struggle, sitting for long periods at work is another. He goes to his physiotherapy sessions and tries to do his exercises, but the moment he finds hardest is the evening, when everything at home goes quiet and the pain takes over all his attention. One evening his daughter puts on an album by a singer he loved in his youth. The pain does not go away; but for half an hour, the pain stops being the only sound in the room. Music for chronic pain is not a remedy that removes pain; but it can be a support in coping with some of the burdens of living with pain. In this article we look at the ways music may help with long-term pain, what research says on the subject and what it cannot say, how you can use music more consciously in daily life, and what you should be careful about.

Is Chronic Pain Experienced Only in the Body?

Chronic pain refers to pain that lasts for months or continues beyond the expected healing time. Back and neck pain, joint pain, headaches and widespread muscle pain are the most common examples. Although the source of the pain lies in the body, its impact is not limited to the body.

Long-lasting pain often comes together with:

• Sleep problems: Pain makes it harder to fall asleep and stay asleep; lack of sleep, in turn, may reduce tolerance of pain.
• Anxiety: Thoughts such as "Will this pain never go away?" or "Is it getting worse?" can create a state of constant alertness.
• Low mood: Withdrawing from activities you love and losing roles at work and in the family can feed feelings of hopelessness.
• Loneliness and feeling misunderstood: It is hard to explain an invisible pain to others. Comments such as "But you were fine yesterday" or "Maybe it's partly psychological" can leave a person even more isolated.

In this cycle, pain, mood and daily life affect one another. For more detail on the psychological aspects of chronic pain, you can read our article on chronic pain and its psychological effects. Music is an interesting tool because it may touch the links in this cycle that relate in particular to attention, mood and relaxation.

How Can Music for Chronic Pain Offer Support?

Several possible ways in which music may help people living with pain are discussed. These do not mean that music "treats" pain; rather, they are areas in which it may change the experience that accompanies pain.

Shifting the direction of attention

Pain draws attention; in a sense, that is what it is for. But in chronic pain, when attention is constantly locked onto the pain, the pain can feel more dominant and more threatening. Music you love can draw part of your attention in another direction. Following the lyrics of a song, focusing on the sound of an instrument or singing along engages attention more actively.

Supporting mood

Music is connected with pleasure, memory and meaning. For someone who has had to give up many of the things they love because of pain, music can be a source of pleasure that is still within reach. Small improvements in mood may also affect the strength to cope with pain.

Accompanying relaxation

Slow, calm music can accompany breathing and relaxation exercises. Pain often comes with muscle tension, and tension can increase pain. Breathing exercises done to music may help to slow this vicious circle.

Increasing the sense of control

One of the most wearing aspects of chronic pain is the feeling of helplessness. Not being able to predict when it will get worse or when it will ease pushes a person into a passive position. Listening to music you have chosen yourself, at a time you have decided, creates a space of control, however small: "This half hour is mine." You may not be able to choose when the pain comes; but you can choose which song to drink your evening tea to. These small choices are a reminder that life is not entirely run by the pain.

Connecting with others

Pain often makes a person withdraw; invitations are turned down, meet-ups are postponed and the social circle narrows. Music, by contrast, is by nature a shared experience. Listening to the same song with a friend and talking about it, getting out old records as a family, or joining a choir or music group as far as your pain allows can ease feelings of loneliness. When taking part in such activities, it is important not to push yourself, to take part sitting down when needed, or to be able to leave early. The aim is not to ignore the pain, but to make room again, despite the pain, for some of life's shared moments.

What Does Research Say, and What Can It Not Say?

The relationship between music and pain is an area of research; but the findings need to be read carefully.

A Cochrane review examining the effect of music on people with cancer (Bradt et al., 2011) covered 30 studies and 1,891 patients. According to this review, music-based interventions reduced anxiety, and possible positive effects were seen on mood, pain and quality of life. However, for some outcomes the quality of the evidence is low. This review concerns people with cancer; so it would not be right to generalise its findings directly to every kind of chronic pain.

There are also studies on the place of music in other types of chronic pain, such as back pain, fibromyalgia or migraine; but the research on which this article is based did not examine a systematic review specific to these areas. For this reason we do not give an effect size here, and we describe music as a "support being researched" for these conditions.

The shared limitations of research on arts- and music-based approaches also apply to this area:

• A considerable proportion of studies are carried out with small samples.
• Blinding is not possible because participants know they are listening to music.
• Pain and mood are mostly measured on the basis of the person's own report.
• Follow-up periods are short; long-term effects are often unknown.
• The difference between "music therapy" and "listening to music" is not always clear in the studies.

Cochrane defines music therapy as a therapeutic framework plus musical interaction between practitioner and participant; simply listening to recorded music does not fall within this definition. Listening to music on your own at home is a valuable self-care habit; but it is not therapy.

Music does not erase pain; but it can stop pain from being the only sound in the room.

Music for Chronic Pain in Daily Life: Practical Suggestions

If you would like to use music as a supportive tool while living with pain, the suggestions below may give you some ideas. They do not replace your medical treatment or physiotherapy programme; they are small habits that can accompany them.

1. Create your own playlist. Music that you choose and love yourself matters. Playlists presented as "relaxing music" may not suit everyone; a folk song, a fasıl (a classical Turkish music suite) or a pop song from your youth that has meaning for you may be more effective.
2. Prepare different playlists for different needs. A calm list for moments when the pain is intense, a livelier list for times when you need to move, and a winding-down list for before sleep may be useful.
3. Combine it with breathing. To a slow piece, try lengthening your breath in time with the music's tempo. You can use a simple rhythm such as counting four beats as you breathe in and six as you breathe out.
4. Combine it with movement. Doing the exercises your physiotherapist has recommended to music you love can make them more bearable. But do not change the content or intensity of your exercise programme to fit the music.
5. Try active participation. Rather than only listening, accompanying the music, humming or keeping a simple rhythm engages attention more actively. If you have joint pain, take care not to strain yourself when playing an instrument.
6. Support the transition to sleep. Calm music before bed may make it easier to fall asleep. We cover this subject separately in our article on music for sleep.
7. Keep a pain and music diary. Record in short notes which music, at what time, affects your pain and mood and how. After a few weeks you may see more clearly what helps you.

An example of an evening routine

Let us think back to the accountant at the start of this article. After noticing that his pain gets worse in the evenings, he sets up a small routine for himself: after dinner he spends ten minutes doing the stretches his physiotherapist recommended, accompanied by a playlist of folk songs he loves. Then he dims the lights, puts on a few slow pieces and matches his breathing to the music. Before bed he jots a short note in his notebook: "Pain 6/10 today, relaxed a little after the music." Some evenings the routine works, and some evenings the pain overrides everything. But over the weeks he notices that his evenings no longer feel as helpless as they used to. What matters here is not a big, sudden change, but his being able to open up a small space of his own alongside the pain.

Points to be careful about

• Do not ignore the pain. Music can be a support alongside pain; but always tell your doctor about pain that is new, changes in character or gets more severe.
• Watch the volume. Listening at high volume through headphones for long periods can damage hearing.
• Approach exaggerated claims with caution. Claims such as "the frequency that destroys pain" or "pain-free living with 432 Hz" are not supported by scientific evidence.
• Music can trigger a memory. Some songs may bring back the period when the pain began, a loss or a difficult time. If a song like this does not do you good, take it off your list.

The Psychological Burden of Pain: Family, Work and Daily Life

Chronic pain affects not only the person but also those around them. In Turkey, many people carry their pain for a long time, saying "it'll pass anyway"; they hesitate to take sick leave from work, push themselves so as not to fall behind with housework, and do not want to be the one who "complains" in the family. At the same time, the cost of living crisis, workload and family responsibilities reduce the time and energy needed to cope with pain.

Family members also have a role in this process. Neither belittling the pain nor pushing the person entirely into the role of a patient helps. Listening to music together, going to a concert or singing together at home can soften some of the tension that pain brings into a relationship and create shared enjoyable moments.

Expressing yourself is also important for a person living with pain. Some people find it hard to describe their pain; they cannot find the words to answer the question "What kind of pain is it?" Describing what your pain feels like in your mood through a song ("Today I feel like this song"), or listening to a song together with a loved one and sharing what it makes you feel, can build a bridge where words are not enough. This does not show that your pain is not being taken seriously, but that your experience is being shared in another language.

When Should You Seek Professional Support?

Living with pain is a burden that is hard to carry alone. It is wise to seek support from a mental health professional in the following situations:

• If because of pain you have given up most of the activities you love and your life is gradually narrowing,
• If for a long time you have been experiencing sleep problems, intense anxiety or low mood,
• If the pain is markedly affecting your relationships, your work or your family life,
• If thoughts such as "This can't go on" or "There's no point in living" often come to mind,
• If you are having thoughts of harming yourself or ending your life. In that situation, do not wait; in an emergency, call 112 (emergency services).

Psychotherapy does not see chronic pain as something you have "made up in your head"; it aims to support your quality of life by addressing the thoughts, feelings and behaviours that arise while living with pain. Approaches such as cognitive behavioural therapy (CBT) and acceptance and commitment therapy are among the methods used in this area. You can find general information about this process with adults on the individual therapy page. For the medical assessment and treatment of your pain, cooperation with your doctor should continue.

Frequently Asked Questions

What kind of music should I listen to for my chronic pain?

There is no single type of music that suits everyone. In everyday experience, the importance of music that a person loves and that is meaningful to them stands out. You can choose slower pieces for moments when you want to calm down, and livelier pieces for moments when you need to move.

Can listening to music replace my pain treatment?

No. Music is a self-care tool that can be used alongside medical treatment, not instead of it. Always talk to your doctor before making any change to your pain treatment. If you notice that music does you good, you can share this with your doctor too.

When my pain is intense even music bothers me; is that normal?

Yes, this is quite common. At moments when pain is very intense, sound, light and any kind of stimulus can feel disturbing. Choosing silence at such times is also a form of self-care; you can save music for moments when the pain is milder.

• #chronic pain
• #music
• #emotion regulation
• #self-care

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Eda Erkan Alapala

Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.

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