Background & Aims

Music is a potent adjunct in pain treatment, effectively reducing subjective pain levels and perioperative opioid requirements. However, the relationship between the impact of a specific type of music and listeners’ socioeconomic status and personal attributes is still unclear. This is especially relevant given that sociological research indicates that one’s socioeconomic status and personal attributes can have a notable influence on music preferences and perceptions. Current evidence suggests that self-chosen music may provide greater benefits in the context of music-induced analgesia (MIA). However, further research is needed to better understand the influence of music taste differentiation based on socioeconomic status, in interaction with music preferences and the mechanisms underlying its therapeutic effects. Therefore, the aim of this study was to investigate the role of socioeconomic status and personal attributes on MIA.

Methods

This study (MOSART trial) is a collaborative effort between medical and sociological researchers. Healthy female participants will listen to self-, and researcher-chosen music and a control condition in a cross-over randomized-controlled trial design. An informative podcast about ‘flora and fauna’ will serve as a control condition. The primary objective of this study is pain endurance measured by electric stimuli of increasing intensity (to a maximum of 30 mA). Detailed sociological validated questionnaires will be utilized. Considering the previously found notable influence of educational level on music taste formation and its crucial role as a source of socioeconomic differentiation, participants will be stratified based on their level of education. Moreover, anxiety and emotions will be assessed, using validated questionnaires. Measurement of heart rate variability throughout each listening intervention will serve as an objective marker for autonomic function.

Results

Sociological research shows, amongst other things, that music preference is connected to social background characteristics such as gender, ethnicity, cultural capital and socioeconomic status. Moreover, the music people choose can affect their behavior, actions and emotions. As pain is defined as an “unpleasant sensory and emotional experience”, it is expected that different music preferences will influence emotions and thereby also the experience of pain. This study aims to ensure diversity in the study population, diverging from the typically overrepresented highly educated Western cohorts. Exclusively involving women participants intends to create a more homogeneous study group, allowing valid conclusions about factors like socioeconomic status and cultural capital. This choice is crucial as gender differences, both among participants and researchers, are strongly linked to results in pain research and pain perception.

Conclusions

This study will be the first experimental trial which integrates sociological methods in medical research on MIA, which could provide new perspectives in this field. As a result of this collaboration, we hope to answer the question what the effect is of socioeconomic status and personal attributes on MIA. Since pain and music preference are both multidimensional concepts, we believe that only by combining the different disciplinary insights that were consulted during the design of this research protocol we will be able to address the research questions within this field appropriately.

References

[1] CONSORT 2010 Statement, Vol. 2023.

[2] SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials), Vol. 2023.

[3] Heart rate variability. Standards of measurement, physiological interpretation, and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J 1996;17(3):354-381.

[4] Arbeidsparticipatie, Uitgevoerd op verzoek van Ministerie van Sociale Zaken en Werkgelegenheid, Centraal Planbureau, 2018.

[5] Antioch I, Furuta T, Uchikawa R, Okumura M, Otogoto J, Kondo E, Sogawa N, Ciobica A, Tomida M. Favorite Music Mediates Pain-related Responses in the Anterior Cingulate Cortex and Skin Pain Thresholds. J Pain Res 2020;13:2729-2737.

[6] Bartley EJ, Fillingim RB. Sex differences in pain: a brief review of clinical and experimental findings. Br J Anaesth 2013;111(1):52-58.

[7] Basi?ski K, Zdun-Ry?ewska A, Greenberg DM, Majkowicz M. Preferred musical attribute dimensions underlie individual differences in music-induced analgesia. Scientific Reports 2021;11(1):8622.

[8] Bijur PE, Latimer CT, Gallagher EJ. Validation of a verbally administered numerical rating scale of acute pain for use in the emergency department. Acad Emerg Med 2003;10(4):390-392.

[9] Billar R, Kappen P, Mohammadian S, van den Berg C, de Rijke Y, van den Akker E, van Rosmalen J, Schnater JM, Vincent A, Dirven C, Klimek M, Wijnen R, Jeekel J, Huygen F, Tiemensma J. The effect of recorded music on pain endurance (CRESCENDo) – A randomized controlled trial. Complement Ther Med 2023;77:102969.

[10] Bourdieu P. Distinction : a social critique of the judgement of taste / Pierre Bourdieu ; translated by Richard Nice. London: Routledge & Kegan Paul, 1984.

[11] Bradley MM, Lang PJ. Measuring emotion: the Self-Assessment Manikin and the Semantic Differential. J Behav Ther Exp Psychiatry 1994;25(1):49-59.

[12] Bradt J, Dileo C, Myers-Coffman K, Biondo J. Music interventions for improving psychological and physical outcomes in people with cancer. Cochrane Database Syst Rev 2021;10(10):CD006911.

[13] Bryson B. “Anything but heavy metal”: Symbolic exclusion and musical dislikes. American Sociological Review 1996;61:884-899.

[14] Coulangeon P. Cultural Capital. The Blackwell Encyclopedia of Sociology, 2020. pp. 1-3.

[15] Eijck Kv. Social Differentiation in Musical Taste Patterns. Social Forces 2001;79:1163 – 1185.

[16] Fillingim RB, King CD, Ribeiro-Dasilva MC, Rahim-Williams B, Riley JL, 3rd. Sex, gender, and pain: a review of recent clinical and experimental findings. J Pain 2009;10(5):447-485.

[17] Fu VX, Oomens P, Klimek M, Verhofstad MHJ, Jeekel J. The Effect of Perioperative Music on Medication Requirement and Hospital Length of Stay: A Meta-analysis. Ann Surg 2020;272(6):961-972.

[18] Fu VX, Oomens P, Sneiders D, van den Berg SAA, Feelders RA, Wijnhoven BPL, Jeekel J. The Effect of Perioperative Music on the Stress Response to Surgery: A Meta-analysis. J Surg Res 2019;244:444-455.

[19] Goldberg DS, McGee SJ. Pain as a global public health priority. BMC Public Health 2011;11:770.

[20] Gregory J, McGowan L. An examination of the prevalence of acute pain for hospitalised adult patients: a systematic review. J Clin Nurs 2016;25(5-6):583-598.

[21] Hanser WE, ter Bogt TFM, Van den Tol AJM, Mark RE, Vingerhoets AJJM. Consolation through music: A survey study. Musicae Scientiae 2016;20(1):122-137.

[22] Howlin C, Rooney B. Cognitive agency in music interventions: Increased perceived control of music predicts increased pain tolerance. European Journal of Pain 2021;25(8):1712-1722.

[23] Howlin C, Stapleton A, Rooney B. Tune out pain: Agency and active engagement predict decreases in pain intensity after music listening. PLOS ONE 2022;17(8):e0271329.

[24] Ip HY, Abrishami A, Peng PW, Wong J, Chung F. Predictors of postoperative pain and analgesic consumption: a qualitative systematic review. Anesthesiology 2009;111(3):657-677.

[25] Jæger M, Møllegaard S. Where Do Cultural Tastes Come From? Genes, Environments, or Experiences. Sociological Science 2022;9:252-274.

[26] Jaeger MM, Breen R. A Dynamic Model of Cultural Reproduction. Ajs 2016;121(4):1079-1115.

[27] Jia R, Liang D, Yu J, Lu G, Wang Z, Wu Z, Huang H, Chen C. The effectiveness of adjunct music therapy for patients with schizophrenia: A meta-analysis. Psychiatry Res 2020;293:113464.

[28] Kakar E, Billar RJ, van Rosmalen J, Klimek M, Takkenberg JJM, Jeekel J. Music intervention to relieve anxiety and pain in adults undergoing cardiac surgery: a systematic review and meta-analysis. Open Heart 2021;8(1).

[29] Kakar E, Venema E, Jeekel J, Klimek M, van der Jagt M. Music intervention for sleep quality in critically ill and surgical patients: a meta-analysis. BMJ Open 2021;11(5):e042510.

[30] Kappen PR, Mos MI, Jeekel J, Dirven CMF, Kushner SA, Osse RJ, Coesmans M, Poley MJ, van Schie MS, van der Holt B, Klimek M, Vincent A. Music to prevent deliriUm during neuroSurgerY (MUSYC): a single-centre, prospective randomised controlled trial. BMJ Open 2023;13(6):e069957.

[31] Kenntner-Mabiala R, Gorges S, Alpers GW, Lehmann AC, Pauli P. Musically induced arousal affects pain perception in females but not in males: A psychophysiological examination. Biological Psychology 2007;75(1):19-23.

[32] Koelsch S. Brain correlates of music-evoked emotions. Nature Reviews Neuroscience 2014;15(3):170-180.

[33] Kraaykamp G, van Eijck K. The Intergenerational Reproduction of Cultural Capital: A Threefold Perspective. Social Forces 2010;89(1):209-231.

[34] Kühlmann AYR, de Rooij A, Kroese LF, van Dijk M, Hunink MGM, Jeekel J. Meta-analysis evaluating music interventions for anxiety and pain in surgery. Br J Surg 2018;105(7):773-783.

[35] Lee JH. The Effects of Music on Pain: A Meta-Analysis. Journal of Music Therapy 2016;53(4):430-477.

[36] Lizardo O, Skiles S. Cultural Objects as Prisms: Perceived Audience Composition of Musical Genres as a Resource for Symbolic Exclusion. Socius 2016;2:2378023116641695.

[37] Lunde SJ, Vuust P, Garza-Villarreal EA, Vase L. Music-induced analgesia: how does music relieve pain? Pain 2019;160(5):989-993.

[38] Lunde SJ, Vuust P, Garza-Villarreal EA, Vase L. Music-induced analgesia: how does music relieve pain? PAIN 2019;160(5).

[39] Marteau TM, Bekker H. The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI). Br J Clin Psychol 1992;31(3):301-306.

[40] Martin-Saavedra JS, Vergara-Mendez LD, Pradilla I, Vélez-van-Meerbeke A, Talero-Gutiérrez C. Standardizing music characteristics for the management of pain: A systematic review and meta-analysis of clinical trials. Complementary Therapies in Medicine 2018;41:81-89.

[41] McCraty R, Shaffer F. Heart Rate Variability: New Perspectives on Physiological Mechanisms, Assessment of Self-regulatory Capacity, and Health risk. Glob Adv Health Med 2015;4(1):46-61.

[42] McDougall JF, Bailey NGN, Banga R, Linde LD, Kramer JLK. The Influence of Examiner Gender on Responses to Tonic Heat Pain Assessments: A Preliminary Investigation. Front Pain Res (Lausanne) 2021;2:729860.

[43] Mojtabavi H, Saghazadeh A, Valenti VE, Rezaei N. Can music influence cardiac autonomic system? A systematic review and narrative synthesis to evaluate its impact on heart rate variability. Complement Ther Clin Pract 2020;39:101162.

[44] Nagel I, Lemel Y. The effects of parents’ lifestyle on their children’s status attainment and lifestyle in the Netherlands. Poetics 2019;74:101357.

[45] Pastor J, Vega-Zelaya L, Canabal A. Pilot Study: The Differential Response to Classical and Heavy Metal Music in Intensive Care Unit Patients under Sedo-Analgesia. Journal of Integrative Neuroscience 2023;22(2):30.

[46] Raja SN, Carr DB, Cohen M, Finnerup NB, Flor H, Gibson S, Keefe FJ, Mogil JS, Ringkamp M, Sluka KA, Song XJ, Stevens B, Sullivan MD, Tutelman PR, Ushida T, Vader K. The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain 2020;161(9):1976-1982.

[47] Reardon M, Malik M. Changes in heart rate variability with age. Pacing Clin Electrophysiol 1996;19(11 Pt 2):1863-1866.

[48] Rentfrow PJ. The Role of Music in Everyday Life: Current Directions in the Social Psychology of Music. Social and Personality Psychology Compass 2012;6(5):402-416.

[49] Roy WG, Dowd TJ. What Is Sociological about Music? Annual Review of Sociology 2010;36(1):183-203.

[50] Schönfelder M, Hinterseher G, Peter P, Spitzenpfeil P. Scientific comparison of different online heart rate monitoring systems. Int J Telemed Appl 2011;2011:631848.

[51] Sonnett J. Musical Relationships: Intersections of Race, Gender, Genre, and Listening Situation. Cultural Sociology 2020;15(1):44-68.

[52] Spielberger C, Gorsuch R, Lushene R, Vagg PR, Jacobs G. Manual for the State-Trait Anxiety Inventory (Form Y1 – Y2), Vol. IV, 1983.

[53] ter Bogt T, Canale N, Lenzi M, Vieno A, van den Eijnden R. Sad music depresses sad adolescents: A listener’s profile. Psychology of Music 2019;49(2):257-272.

[54] Ter Bogt TFM, Mulder J, Raaijmakers QAW, Gabhainn SN. Moved by music: A typology of music listeners. Psychology of Music 2011;39:147-163.

[55] Umbrello M, Sorrenti T, Mistraletti G, Formenti P, Chiumello D, Terzoni S. Music therapy reduces stress and anxiety in critically ill patients: a systematic review of randomized clinical trials. Minerva Anestesiol 2019;85(8):886-898.

[56] Valevicius D, Lépine Lopez A, Diushekeeva A, Lee AC, Roy M. Emotional responses to favorite and relaxing music predict music-induced hypoalgesia. Frontiers in Pain Research 2023;4.

[57] Vrooman CB, Jeroen; Iedema, Jurjen; Torre, Ab van der. Social en Cultureel Planbureau, Eigentijdse ongelijkheid, Vol. 2023, 2023.

[58] Zhang L, Losin EAR, Ashar YK, Koban L, Wager TD. Gender Biases in Estimation of Others’ Pain. The Journal of Pain 2021;22(9):1048-1059.

Presenting Author

Emy van der Valk Bouman

Poster Authors

Emy van der Valk Bouman, MD

MD

Erasmus Medical Center, Rotterdam, The Netherlands

Lead Author

E-mail

Antonia Becker

Erasmus MC

Lead Author

E-mail

Cecile de Vos

MSc

Erasmus MC

Lead Author

E-mail

Koen van Eijck

prof.

Erasmus University Rotterdam

Lead Author

E-mail

Johannes Jeekel

MD

Erasmus Medical Center, Rotterdam, The Netherlands

Lead Author

E-mail

Julian Schaap

PhD

Erasmus University, Rotterdam, The Netherlands

Lead Author

E-mail

Markus Klimek

MD

Erasmus Medical Center, Rotterdam, The Netherlands

Lead Author

E-mail

Topics

  • Trial Design