The Impact of Music Therapy on Nociceptive Processing

Chronic pain is devastating to individuals and society. Individuals who experience chronic
pain have poorer health outcomes, utilize increased healthcare resources and have higher
rates of disability. At present, treatment of chronic pain is limited to behavioral
interventions and pharmacologic interventions. Many individuals with chronic pain will use
opioid analgesics at some point in the continuum of pain. Prolonged use of opioid
analgesics--even for durations as short as 3 days puts individuals at risk for nonmedical
opioid use, addiction, and may fuel transitions from oral opioids to heroin.

Outside of the original insult precipitating chronic pain, increasing evidence suggests that
individual factors such as anxiety and catastrophizing are associated with development of
chronic pain and increased painful response to stimuli. It is therefore suggestive that
treating underlying causes of anxiety and catastrophizing may lead to novel adjunctive
therapies to manage chronic pain.

Music is emotive and known to modulate affect. Music that "feels good" has been described to
modulate the dopaminergic and serotonin reward pathways in the brain thereby improving
positive affect. Improved affect counteracts negatively valenced affect like depression,
anxiety, and catastrophizing, and may be able to modulate the individual response to pain.
The purpose of this pilot study is to investigate the acceptability and feasibility of a
smartphone-based app on healthy volunteers.

In order to measure the impact of the music app on individual responses to pain, the
investigators will use quantitative sensory testing (QST) to induce a mild-moderate,
standardized pain stimulus, and measure participants' pain in the absence and presence of
this music intervention. The QST is a 10 minute session that includes a set of sensory tests,
which elicit a mild to moderate painful response, including a pressure pain threshold and
tolerance using a handheld digital algometer, the temporal summation of pain using a set of
weighted pinprick probes, and immersing hand in cold water. Primary outcome will be the
modulation of pain scores by music, and secondary outcomes will include the impact of music
on anxiety and catastrophizing, using brief, validated questionnaires, and whether changes in
these measures of affect mediate any impact on pain processing.

Inclusion Criteria:

- Over 18 years old

- Able to sign English written consent

- No history of chronic opioid use (have an opioid prescription more than 30 days).

Exclusion Criteria:

- Under 18 years old

- Non-English speaking

- Unwilling to undergo quantitative sensory testing

- Hearing loss

- Diagnosis of neuropathy

- History of chronic opioid use (having an opioid prescription more than 30 days).