7 - Neuronal Effects of Music Entrainment versus Preferred Music in Three Patients with Chronic Cancer Pain as Measured via EEG and LORETA Imaging

¹Rowan University, Glassboro, NJ, USA. ²Anglia Ruskin University, Cambridge, United Kingdom. ³Temple University, Philadelphia, PA, USA. ⁴University of Arizona, Tucson, AZ, USA. ⁵Rutgers Behavioral Health, South Woods State Prison, Bridgeton, NJ, USA

Purpose
Treating chronic pain requires an individualized approach to account for the various biopsychosocial factors and needs of patients, particularly those that cannot be adequately addressed by available medication alone. Many patients and practitioners have turned to modalities such as music as an intervention. Though several metanalyses and systematic reviews indicate music is effective for alleviating pain and reducing opioid use, this research also lacks consideration of cognitive mechanisms underlying music as an analgesic. Music therapists use interactive and passive interventions for pain, and the cognitive mechanisms for interactive interventions have not yet been investigated with imaging. Previous studies examining EEG and LORETA in patients with chronic pain discovered an overactivation of high theta (6-9Hz) and low beta (12-16Hz) power in central regions. MEG studies with healthy subjects correlating evoked nociception ratings and source localization described delta and gamma changes according to two music interventions. Using similar music conditions with chronic pain patients, we examined EEG in response to two different music interventions for pain. To study this process in-depth we conducted a mixed-methods case study approach, based on three clinical cases.
Methods
Effectiveness of personalized music therapy improvisations (entrainment music-EM) versus listening to preferred music on chronic pain was examined with 16 participants. Three patients were randomly selected for follow-up EEG sessions three months post-intervention, where they listened to recordings of the music from the interventions provided during the initial research. To test the difference of EM versus preferred music, recordings were presented in a block design: silence, their own composed EM (depicting both “pain” and “healing”), preferred (commercially available) music, and a non-participant’s EM as a control. Participants rated their pain before and after the EEG on a 1-10 scale. We conducted a detailed single case analysis to compare all conditions, as well as a group comparison of entrainment-healing condition versus preferred music condition. Power spectrum and according LORETA distributions focused on expected changes in delta, theta, beta, and gamma frequencies, particularly in sensory-motor and central regions.
Results
Intentional moment-by-moment attention on the sounds/music rather than on pain and decreased awareness of pain was experienced from one participant. Corresponding EEG analysis showed accompanying power changes in sensory-motor regions and LORETA projection pointed to insula-related changes during entrainment-pain music. LORETA also indicated involvement of visual-spatial, motor, and language/music improvisation processing in response to his own EM which may reflect active recollection of creating the EM with the therapist. Group-wide analysis showed common brain responses to personalized entrainment-healing music in theta and low beta range in right pre- and post-central gyrus.
Conclusions
We observed somatosensory changes consistent with processing pain during entrainment-healing music that were not seen during preferred music. These results may depict top-down neural processes associated with active coping for pain.