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Music Therapy Pain Management and EntrainmentCheryl Dileo, PhD, MT-BCCarnell Professor of Music TherapyTemple University, Philadelphia
Definition of pain
• An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP, n.d.)
• Pain is a culturally-defined physiological and psychological experience. Each culture has its own language of distress when experiencing pain. (Calister, 2003)
Types of Pain
•Acute
•Chronic
•Procedural
•Cancer
Pain
•True Biopsychosocial phenomenon•Individual differences•Total pain experience•Pain/Suffering
The Experience of Pain•Personal, subjective experience of painful
sensations known only to the person with pain
• Includes a mental and emotional component in addition to awareness of painful physical sensations
•Cannot be objectively measured, confirmed, or disconfirmed by another person
IN MUSIC THERAPY
Why levels of pain management?• Appropriate for Biopsychosocial nature of
pain
• Addresses wide range of interventions possible in MT based on a range of goals/therapeutic intent
• Describes progression of interventions from most basic and symptom-focused to most comprehensive
• Appropriate for Incorporating range of
patient coping preferences and cultural perspectives Dileo, 2013
Why Levels of Pain Management?• Subsumes various theoretical perspectives
• Allows various ways for patient to be in relationship to the pain
• However,▫ May be overlap in categories▫ Same interventions may serve multiple
purposes
Dileo, 2013
Levels of Music Therapy Pain Interventions1. Distraction/Refocusing2. Supportive3. Cathartic/Expressive4. Existential5.Transformational
Dileo, 2013
Distraction/Refocusing• Refocus of attention to another stimulus (strong and/or
engaging).
• Intent is to avoid or ignore pain • Patient can participate in an active or passive manner
• Examples:• Various types of Music Listening (structured by patient
and/or therapist)
• Instrument playing
• Musical Journeys (remove from present)
• Music and Imagery experiences (escape situation)
• Music as Focal Point
Supportive
Intent is to palliate specific symptoms of pain- make pain go away or enhance personal resources for dealing with pain.
• Patient can participate actively or passively (most often passively)
• Examples:• Song-writing• Music-based relaxation• Music and Imagery• Music Iso• Toning• Vibroacoustics• Music-Based Breath Work• Improvised/Precomposed Music to Hold/Soothe
Dileo, 2013
Expressive/Cathartic• Intent: express experience of pain and or emotions and
suffering associated with having pain
• Patient may participate actively or passively, but most often actively
• Patient establishes contact with pain and/or emotions associated with being in pain
Examples: • Instrumental or Vocal Improvisation
• Drumming
• Song-writing, e.g., blues, rap
• Song Improvisation
Dileo, 2013
Existential• Focus is on finding meaning in the pain experience
within the patient’s life and/or new ways of thinking of/conceptualizing pain
• Patient is in touch with the pain experience, the emotions accompanying it as well as the thoughts and interpretations of its meaning
• The patient may participate actively or passively
Examples:• Song-writing• Song Discussion• Referential or non-referential Improvisation• GIM
Dileo, 2013
Transformational-Intent is to observe carefully, dialogue with and/or enter into the pain to achieve a relationship with it and sometimes to travel through it.
-There is an awareness of the body, the pain and the emotions related to pain. There is also an awareness of what might heal the pain
Active, passive or combined approaches can be used.
-Examples: GIMMusic Therapy Entrainment (process)
Dileo, 2013
Personal Assessment
•Own history with pain•Reactions to pain: avoidance, etc.•Reactions to pain in others•Boundaries, rigid, loose
•Dileo, 2013
Music Therapy Entrainment• Interactive, music-centered therapy process using
improvisation to treat pain
• Both active and passive in nature (client participates in variety of ways)
• Uses imagery (accepted cross-culturally)
• Can address wide range of coping styles (active, passive, problem-focused, emotion-focused, etc.)
• Differentiated from other types of MT pain approaches▫ Involves sensory exploration of pain characteristics▫ Entrance into pain by therapist and client (Dileo, 2013)
Theoretical foundations• Relies on theories in physics regarding pull of
one vibrating object on another (tendency to achieve synchrony) (e.g., Pantalleone, 2002)
• Iso principle- matching phenomenon musically and then changing music in desired direction (Altschuler, 1948; Rider, 1997; 1985)
• Biopsychosocial theory-interrelationship of mind, body, social contexts (Engel, 1977)
• Aesthetic theory (Metzner, 2012)
Evidence for Music Therapy Entrainment• Chronic upper limb pain
▫ Schwoebel, Coslett, Bradt, Friedman, Dileo (2002)
• Acute post-operative pain in children (Bradt, 2010)
• Laboratory pain (Metzner, et al., 2012)
• End-of-life pain (Clinical observations, Patrick, 2010)
• Cancer Pain (Dileo, et al., in preparation for publication, 2013)
• Support from EEG and MEG analysis (Metzner, et al.,2012; Dileo et al, 2013)
CLINICAL PRACTICE OF
Contraindications
•Psychosis•Borderline personality•Physical/emotional fragility•Dementia•Extreme anxiety•Inability to verbalize
•Dileo, 2013
Stages of Entrainment
•1. Assessment: Pain Interview
Dileo, 2013
Stages of Entrainment
•2. Imaging the Pain as Music•Auditory image of pain•Match music as closely as possible to the
pain
•Dileo, 2013
•Imaging What Can Heal the Pain▫Auditory image of what can heal
Timbre Pulse Tempo Combination of sounds Sequence of sounds Duration of sounds
▫Match music as closely as possible
Stages of Entrainment
•Confronting the Pain and Letting Go▫Patient sits quietly and listens▫Improvisation created: sounds of onset of
pain, progressing to a peak of pain, and then diminishing of music and movement into healing sounds
▫Resonance with pain by therapist
▫Dileo, 2013
Stages of Entrainment
•Healing Interview•Processing of the experience: Feedback
on the pain and healing music
Evaluation
•Did music match pain precisely….if not, what could be changed
•Degree of resonance•Delayed responses•Longevity of responses•Does entrainment open up layers of
feelings, what has been repressed?
•Dileo, 2013
HEALING ASPECTS OF ENTRAINMENT•Empathy for pain expressed in various
ways
•Pain is perceived as external to patient
•Pain can be viewed objectively
Dileo, 2013
