Tune out pain: Agency and active engagement predict decreases in pain intensity after music listening

Abstract

Music is increasingly being recognised as an adjuvant treatment for pain management. Music can help to decrease the experience of both chronic and experimental pain. Cognitive agency has been identified as a specific mechanism that may mediate the analgesic benefits of music engagement however, it is unclear if this specific mechanism translates to acute pain. Previous attempts to understand the cognitive mechanisms that underpin music analgesia have been predominantly lab-based, limiting the extent to which observed effects may apply to participants' everyday lives. Addressing these gaps, in naturalistic settings, the present study examined the degree to which cognitive agency (i.e., perceived choice in music), music features (i.e., complexity), and individual levels of musical sophistication were related to perceived pain. In an online global experiment, using a randomised between groups experimental design with two levels for choice (no choice and perceived choice) and two levels for music (high and low complexity), a sample of 286 adults experiencing acute pain reported their pain intensity and pain unpleasantness pre- and post-music listening. A bespoke piece of music was co-created with a commercial artist to enable the manipulation of music complexity while controlling for familiarity, while facilitating an authentic music listening experience. Overall, findings demonstrated that increased perceived control over music is associated with analgesic benefits, and that perceived choice is more important than music complexity. Highlighting the importance of listener engagement, people who reported higher levels of active engagement experienced greater decreases of pain intensity in the perceived choice condition, than those who reported lower levels of active engagement. These findings have implications for both research and practice, emphasising the importance of facilitating freedom of choice, and sustained engagement with music throughout music listening interventions.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Experimental procedure.

Participants were randomly allocated to one of four groups: (i) no choice and low complexity track, (ii) no choice and high complexity track, (iii) perceived choice and low complexity track, (iv) perceived choice and high complexity track. In the perceived choice conditions, participants listened to four 2-second music clips and selected which piece of music they wanted to listen to in full. Participants were naïve to the fact that they were listening to different parts of the same song (i.e., the final ‘chosen’ song was predetermined by their randomly assigned experimental condition.

Fig 2. Violin plots of pain scores in each experimental condition.

Plots depict the distributions of pain scores and their changes in response to music in each of the experimental condition.

Fig 3. Residual plots of hierarchical linear models.

Plots depict the relationship between the predicted residual values against the observed values for each model. To depict the choice by active engagement interaction on pain intensity scores plots for each level of choice are shown with model fit depicted according to active engagement. The plot lines fitted to the data are used to illustrate the degree to which the relationship between choice and pain changes depending on different levels of active engagement. The lines illustrate that higher levels of active engagement predict larger decreases in pain intensity in the perceived choice condition. Individual levels of active engagement were also the strongest predictor of decreases in pain unpleasantness.