Music as Medicine

Music is a fundamental attribute of the human species. Virtually all cultures, from the most primitive to the most advanced, make music. It's been true through history, and it's true throughout an individual's lifespan. In tune or not, we humans sing and hum; in time or not, we clap and sway; in step or not, we dance and bounce. The human brain is hardwired to distinguish music from noise and to respond to rhythm and repetition, tones, and tunes. The auditory nerve transmits the electrical signals of music and other sounds to the auditory cortex in the temporal lobe. Studies using magnetic resonance imaging and positron emission tomography scans suggest that nerve networks in different parts of the brain bear primary responsibility for decoding and interpreting different properties of music.1Stewart L. von Kriegstein K. Warren J.D. et al.Music and the brain: disorders of music listening.Brain. 2006; 129: 2533-2553Crossref PubMed Scopus (239) Google Scholar For example, a small area in the right temporal lobe is essential to perceive pitch, which forms the basis of melody (patterns of pitch over time), chords (multiple pitches that sound at the same time), and harmony (2 or more melodies at the same time). Another nearby center is responsible for decoding timbre, the quality that allows the brain to distinguish between different instruments that are playing the same note. The cerebellum processes rhythm, and the frontal lobes interpret the emotional content of music. And music that's powerful enough to be "spine tingling" can light up the brain's reward center, much like pleasurable stimuli ranging from alcohol to chocolate. Although every healthy human brain can perform all the complex tasks needed to perceive music, musicians' brains are, so to speak, more finely attuned to these tasks.2Munte T.F. Kohlmetz C. Nagert W. et al.Superior auditory spatial tuning in conductors.Nature. 2001; 409: 580Crossref PubMed Scopus (102) Google Scholar Physicians, too, may have a particular affinity for music. Notable physician-musicians include Hector Berlioz, Fritz Kreisler, Aleksandr Borodin, Theodor Billroth, Albert Schweitzer,3Cerda J.J. Art in medicine: musicians, physicians and physician-musician.Trans Am Clin Climatol Assoc. 1993; 104: 228-234PubMed Google Scholar and Jeffrey Tate. Classical orchestras composed of doctors and medical students perform regularly in Boston, Los Angeles, Philadelphia, and Houston.4Ofri D. Thoughts on a G string.Lancet. 2009; 373: 116-117Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar Many surgeons play music in their operating rooms to enhance concentration and focus, and many practitioners rely on music for relaxation, stimulation, and pleasure. Music is important for many physicians—but can doctors use music to promote the health and well-being of their patients? A variety of studies suggest the answer may be yes. Some are blinded, randomized trials, but most are relatively small and brief. Still, they present an interesting group of observations. The most highly publicized influence of music on the brain is the so-called Mozart effect. A 1995 report found that listening to Mozart improved performance on IQ tests.5Rauscher F.H. Shaw G.L. Ky K.N. Listening to Mozart enhances spatial-temporal reasoning: towards a neurophysiological basis.Neurosci Lett. 1995; 185: 44-47Crossref PubMed Scopus (314) Google Scholar Unfortunately, subsequent research found that the purported benefit was minimal and short-lived.6Steele K.M. Dalla Bella S. Peretz I. et al.Prelude or requiem for the "Mozart effect".Nature. 1999; 400: 826-827Crossref PubMed Scopus (142) Google Scholar Still, learning to play music in childhood enhances neuroplasticity, resulting in certain structural changes and functional improvements that persist into adulthood.7Hyde K.L. Lerch J. Norton A. Musical training shapes structural brain development.J Neurosci. 2009; 29: 3019-3025Crossref PubMed Scopus (585) Google Scholar, 8Skoe E. Kraus N. A little goes a long way: how the adult brain is shaped by musical training in childhood.J Neurosci. 2012; 32: 11507-11510Crossref PubMed Scopus (102) Google Scholar, 9Zuk J. Benjamin C. Kenyon A. et al.Behavioral and neural correlates of executive functioning in musicians and non-musicians.PLOS One. 2014; 9: e99868Google Scholar Playing music is more complex and demanding than simply listening, but listening may enhance cognitive function in the elderly10Hars M. Herrmann F.R. Gold G. et al.Effect of music-based multitask training on cognition and mood in older adults.Age Ageing. 2014; 43: 196-200Crossref PubMed Scopus (72) Google Scholar, 11Satoh M. Ogawa J. Tokita T. The effects of physical exercise with music on cognitive function of elderly people: Mihama-Kiho project.PLOS One. 2014; 9: e25230Google Scholar and improve quality of life and possibly cognition in dementia.12Vasionte I. Madison G. Musical intervention for patients with dementia: a meta-analysis.J Clin Nurs. 2013; 22: 1203-1216Crossref PubMed Scopus (93) Google Scholar Music listening can assist cognitive recovery, elevate mood,13Sarkamo T. Tervaniemi M. Laitinen S. et al.Music listening enhances cognitive recovery and mood after middle cerebral artery stroke.Brain. 2008; 131: 866-876Crossref PubMed Scopus (563) Google Scholar and boost muscular function14Colfrancesco E.M. The effect of music therapy on hand grasp strength and functional task performance in stroke patients.J Music Ther. 1985; 22: 129-145Crossref Scopus (17) Google Scholar after certain strokes. Singing has been used to help aphasic patients recover speech.15Schlaug G. Marchina S. Norton A. From singing to speaking: why singing may lead to recovery of expressive language function in patients with Broca's aphasia.Music Percept. 2008; 25: 315-323Crossref PubMed Scopus (163) Google Scholar Music-based training can improve gait and balance in elderly people at risk for falling16Trombetti A. Hars M. Herrmann F.R. et al.Effect of music-based multitask training on gait, balance, and fall risk in elderly people.Arch Intern Med. 2011; 171: 525-533Crossref PubMed Scopus (194) Google Scholar; brisk, rhythmic music enhances gait velocity, cadence, and stride length in patients with Parkinson's disease.17McIntosh G.C. Brown S.H. Rice R.R. et al.Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson's disease.J Neurol Neurosurg Psychiatry. 1997; 62: 22-26Crossref PubMed Scopus (508) Google Scholar Music allows people to express their feelings and communicate with others. More than simply expressing emotions, music can alter them; indeed, Tolstoy said that music is the shorthand of emotion, and Congreve explained that music has charms to soothe a savage breast. Few things are more stressful than illness and surgery. Music can reduce stress in these circumstances. Listening to music during cataract surgery reduces intraoperative and postoperative blood pressures and heart rates.18Allen K. Golden L.H. Izzo J.L. et al.Normalization of hypertensive responses during ambulatory surgical stress by perioperative music.Psychosom Med. 2001; 63: 487-492Crossref PubMed Scopus (91) Google Scholar Music also reduces sedative requirements in patients undergoing urologic procedures under spinal anesthesia19Ayoub C.M. Rizk L.B. Yaacoub C.I. et al.Music and ambient operating room noise in patients undergoing spinal anesthesia.Anesth Analg. 2000; 100: 1316-1319Crossref Scopus (79) Google Scholar and in intensive care unit patients.20Chalan L.L. Weinert C.R. Heiderscheit A. et al.Effects of patient-directed music intervention on anxiety and sedative exposure in critically ill patients receiving mechanical ventilatory support.JAMA. 2013; 309: 2335-2344Crossref PubMed Scopus (188) Google Scholar, 21Conrad C. Niess H. Jauch K.-W. et al.Overture for growth hormone: requiem for interleukin-6.Crit Care Med. 2007; 35: 2709-2713Crossref PubMed Scopus (119) Google Scholar Reduced levels of interleukin-6 and epinephrine may account for this benefit, as well as the lower blood pressures and heart rates associated with some types of music.21Conrad C. Niess H. Jauch K.-W. et al.Overture for growth hormone: requiem for interleukin-6.Crit Care Med. 2007; 35: 2709-2713Crossref PubMed Scopus (119) Google Scholar The body's response to music is influenced by the type of music used. Rapid, march-like rhythms improve the gait of patients with Parkinson's disease.17McIntosh G.C. Brown S.H. Rice R.R. et al.Rhythmic auditory-motor facilitation of gait patterns in patients with Parkinson's disease.J Neurol Neurosurg Psychiatry. 1997; 62: 22-26Crossref PubMed Scopus (508) Google Scholar Tempos that are slow, relaxing, or joyful appear to reduce blood pressure and heart rate and promote vasodilatation, whereas fast, tension-producing music has the opposite effect.21Conrad C. Niess H. Jauch K.-W. et al.Overture for growth hormone: requiem for interleukin-6.Crit Care Med. 2007; 35: 2709-2713Crossref PubMed Scopus (119) Google Scholar, 22Miller M. Mangano C.C. Beach V. et al.Divergent effects of joyful and anxiety-provoking music on endothelial vasoreactivity.Psychosom Med. 2010; 72: 354-356Crossref PubMed Scopus (29) Google Scholar, 23White J. Effects of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction.Am J Crit Care. 1999; 8: 220-230PubMed Google Scholar, 24Bernardi L. Porta C. Sleight P. Cardiovascular, cerebrovascular, and respiratory changes induced by different types of music in musicians and non-musicians: the importance of silence.Heart. 2006; 92: 445-452Crossref PubMed Scopus (347) Google Scholar, 25Bernardi L. Porta C. Casucci G. et al.Dynamic interactions between musical, cardiovascular, and cerebral rhythms in humans.Circulation. 2009; 119: 3171-3180Crossref PubMed Scopus (190) Google Scholar These changes are short-lived, but daily sessions of music-guided slow breathing may produce a sustained reduction in blood pressure not seen with music alone.26Modesti P.A. Ferrari A. Bazzini C. et al.Psychological predictors of the antihypertensive effects of music-guided slow breathing.J Hypertension. 2010; 26: 1097-1103Crossref Scopus (33) Google Scholar Plato believed that music gives soul to the universe, wings to the imagination, and charm and gaiety to life. Gaiety may be beyond the reach of patients with depression, cancer, chronic pain, and terminal illnesses, but music therapy has been able to improve mood and quality of life in these circumstances.27Marantos A.S. Gold C. Wang X. et al.Music therapy for depression.Cochrane Database Syst Rev. 2008; 1: CD004517Google Scholar, 28Siedliecki S.L. Good M. Effects of music on power, pain, depression and disability.J Adv Nurs. 2006; 54: 553-562Crossref PubMed Scopus (127) Google Scholar, 29Bradt J. Dileo C. Groke D. et al.Music interventions for improving psychological and physical outcomes in cancer patients.Cochrane Database Syst Rev. 2011; 8: CD006911PubMed Google Scholar, 30Puetz T.W. Morley C.A. Herring M.P. Effects of creative arts therapies on psychological symptoms and quality of life in patients with cancer.JAMA Intern Med. 2013; 173: 960-969Google Scholar, 31Tsai H.F. Chen Y.R. Chung M.H. et al.Effectiveness of music intervention in ameliorating cancer patients' anxiety, depression, pain, and fatigue: a meta-analysis.Cancer Nurs. 2014; 37: E35-E50Google Scholar, 32Dileo C. Music therapy for end of life care.Cochrane Database Syst Rev. 2010; 1: CD007169Google Scholar Additional research is needed to confirm these apparent benefits and elucidate their mechanisms, but Browning may have provided a clue when he observed that a person who hears music feels his solitude peopled all at once. The ancient Greeks put one god, Apollo, in charge of both medicine and music. Contemporary scientists tell us that music can enhance the function of neural networks, slow the heart rate, lower blood pressure, reduce levels of stress hormones and inflammatory cytokines, and provide some relief to patients undergoing surgery and to those with Parkinson's disease, strokes, heart attacks, depression, and painful chronic illnesses. Arnold Steinhardt, the founding first violinist of the Guarneri String Quartet, said that there seems to be a mysterious and powerful underground railroad linking medicine and music. He wondered if perhaps music is an equally effective agent of healing, and doctors and musicians are part of a larger order serving the needs of mankind.