Music interferes with expectation-induced pain modulation: a controlled cross-over experimental study

Music reduces pain and anxiety in various contexts, but the possible effect on pain anticipatory mechanisms remains unclear.

This study examines the effects of a standardized musical intervention (Music Care) on pain perception and on pain modulation induced by expectations of low or high pain.

Healthy participants were tested in an experimental study using a crossover design involving the musical intervention counterbalanced with an active auditory control condition (audiobook) and a silent control condition. Pain perception was assessed using contact heat stimulation, and expectations were manipulated using prestimulus anticipatory cues signalling high or low pain.

Perceived pain intensity, measured using a visual analog scale, was decreased during the music intervention and the audiobook compared to silence (P's < 0.001). Music was more effective than the audiobook control, especially at the higher pain stimulation level (P < 0.001). Anticipatory cues modulated pain and anxiety in the expected direction across all conditions (P's < 0.001). Music and the audiobook produced comparable reduction in (1) expectation-induced (1a) hypoalgesic and (1b) hyperalgesic effects (all P's < 0.005) and in (2) pain anticipatory anxiety (all P's < 0.05). Overall, music was more effective than the active auditory control to reduce pain but both forms of auditory distraction partly blocked the modulatory effects of low and high pain expectations.

This study highlights the multiplicity of processes contributing to music-induced analgesia and suggests that music may help improve pain management in the context of high pain expectation and anxiety. However, music may also interfere with pain-relieving strategies involving the induction of low pain expectations.