Music Therapy and MusicMedicine - the health supporting power of soundDr. Ralph Spintge MD, PhD

Chairman, Department of Algesiology/Interdisciplinary Pain Medicine, DGS PainCentre, Hellersen Hospital for Sport Injuries, GermanyExecutive Director, International Society for Music in Medicine, Luedenscheid,Germany

Music is a siginificant complementary tool in prevention, therapy and rehabilitation providingmedical and socioeconomic benefits.Substantial and steady progress both in research and clinical application of Music inMedicine has occurred during the last 25 years (ref. 1-7). Added to the 50 years of researchand application of Music Therapy we now have solid evidence that music has reproducableeffects and valuable preventive, therapeutic and rehabilitative properties. We propose todefine the therapeutic use of Music in Medicine as MusicMedicine (one word, 2 capital "M"):MusicMedicine means the scientific evaluation, as well as the practical application of musicalstimuli in prevention, therapy, and rehabilitation, in order to prevent disability or illness, tocomplement usual medical treatment, or to facilitate rehabilitation, always considering theparticular disability or illness, medication and procedures involved in each individual.This approach is much broader as compared to Music Therapy, which especially in centralEurpope is mainly understood as part of psychiatric care or psychotherapy (ref. 8, 9).Actually, considering only this kind of Music Therapy means to neglect the by far larger partof the "market segment" for music: health care in general, including prevention andrehabilitation, even palliative care. In the United States there is a broader approach and thecombined strength of MusicMedicine and Music Therapy working cooperatively with musicproducts industry adds new fields every day.

Applications and research

We use music for:

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prevention (education against low-back-pain, workplace on-site exercise programsagainst over-use-syndromes and fatigue in the use of muscles and tendons),

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therapy (chronic pain syndroms, acute stress and pain in surgery/anesthesia/intensivecare, during labour, sportstherapy after cardiac stroke) and

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rehabilitation (physical therapy after trauma and surgery or stroke, workplacereintegration).So far most scientific research focussed upon music complementing medical procedures.Collaborative studies have been and are still conducted together with several universityhospitals and institutes in Europe, USA, Australia and Japan since 1975. We use music inclinical settings where patients suffer from distress, anxiety, pain and disability. For instancea sequence of clinically controlled studies has been conducted demonstrating the reduction of distress, anxiety and pain through a selection of specific music in various treatment situations

2in anesthesia, surgery, dentistry, obstetrics, pediatrics, geriatrics, pain therapy andrehabilitation. Specific programs for receptive application as well as for enhancement of physical exercises have been designed to match various situations. Effects of music aremonitored through physiological (stress hormones, cardiovascular parameters, vegetativerhythmicity, etc.) clinical (drug consumption, etc.) and psychological parameters (doctor-patient-relationship, subjective treatment outcome, psychological tests, etc.). Cost benefits(reduced drug consumption, shortened duration of hospial stay, doctor-patient-relationship)are evaluated.We use specifically designed programs, which are composed, arranged, recorded, mixed andpresented according to guidelines we elaborated from our practical experiences as well asfrom our research findings. One such program helps to control the activity level and thedegree of cooperation/compliance of patients during unpleasant treatment procedures. Otherprograms offer better self-control against pain, stress and sleep disorders (ref. Schlaf).Designing such programs there are some structural guidelines for receptive musicapplications in medical settings. The most important parameters seem to be musical rhythmand dynamical range. Our impression is that in general rhythm is the most effective musicalstructure in medical settings. A constantly growing number of people are for instanceexperiencing the benefits of Rhythm for Life programs in the United States.Another field where we use specific music programs is long-term rehabilitation. Thoseprograms combine musical stimuli with verbal suggestions and instructions for physicalexercises. The aim is to support and prolong physical rehabilitation programs for instanceafter surgery or trauma or in chronic pain beyond hospital stay (ref. 13). Specific NeurologicMusic Therapy (ref. 14) is a new tool to treat neurologic movement disorders caused by forinstance Parkinson´s disease or stroke.Also music instruments are used by the patients in physical therapy and rehabilitation. Anexample is the socalled "Hanging Xylophone" which I designed to enhance motor exercisesfor patients suffering from a syndrome called "Frozen Shoulder", a pain-induced stiffenedshoulder joint.Making music can be a diagnostic tool. There is a huge variety of applications already welldocumentated in the literature. Only to mention one application which makes use of theadvances in electronic music production: a piano-keyboard or a sound module linked to acomputer via MIDI-interface is a tool to evaluate motor task performance of the body, animportant measure in neurological disorders, focal dystonia, as well as after trauma, and notonly for musicians.

Technical and methodological considerations

The methodology and the technical equipment used to apply music must meet the practicalneeds of every different situation. In the treatment of chronic pain for instance onlyloudspeakers can be used, while in acute pain as in surgery earphones are most suitable. Inchronic pain the music must be free of any guiding rhythmic structure, whereas in acute stresssituations as well as in physical therapy rhythm must be pronounced. The design of instruments used to enable or enhance physical exercises must be specifically adapted to theneeds of the patients and to the goals of the intervention.

3In general, conducting MusicMedicine studies, the standards of research in clinical appliedstudies have to be fullfilled, i.e. state-of-the-art clinically controlled research designs with asolid statistical evaluation must be secured. This can be achievd at best throughmultidisciplinary research groups.

Results

Our experiences and research can be summarized in two major points:medical and economical findings.

Medical effects

Results and practical experiences with about 120 000 patients demonstrate an improvement inpatient care and treatment outcome in 95% of all cases. Stress hormone levels in blood, painperception, electrical brain activity as measured through EEG, drug demand for anesthesiaand pain relief, all show a significantly better outcome for music patients as compared to non-music patients.It is important to note, that we find identical effects in different cultural spheres such asEurope, North America and Japan. However, the selection of music and music instrumentsused needs to be adjusted to socioethnical characteristics.

Economical impacts

Besides the medical advantages there are of course also economic benefits. Through areduction of sedatives usually used to prepare patients for medical treatment such as regionalanesthesia down to 50% of the usual dosage our hospital saves about 3 000.00USD per year.Through shortening the duration of stay on an average of 3 days in an Intensive Care Unit forpremature infants about $3 000.00 per baby per day can be saved.Earlier discharge of elderly patients after eye-surgery saves the costs for 1 day of hospitalcare.Enhancement of general patient compliance during treatment and rehabilitation saves costs,too.

General medicoeconomic aspects

OECD reports as well as several recent national health care surveys provide strong evidenceas to the economic importance of the findings listed above (ref. 10, 11):

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costs for hospital care in percentage of overall health care costs:USA: 41,8% GER: 34,8% GB: 43,6% F: 45,3%

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costs for hospital care in percentage of GNP:USA: 4,6% GER: 3,0% GB: 3,1% F: 3,9%