Music therapy helps patients with sickle cell disease cope with pain
According to one patient undergoing treatment for sickle cell disease at University Hospitals Connor Whole Health, pain associated with the disease “feels like someone’s constantly stabbing you, but you’re not dying.”
“You’re just being stabbed over and over for a week or more,” Tasha Taylor, 40, of Cleveland, said in a press release from University Hospitals.
Patients who live with sickle cell disease, an inherited disorder that affects red blood cells, may also be at risk for serious health issues such as anemia, stroke and organ damage. Moreover, severe pain episodes may impede daily functioning and lead to depression.
“Individuals with sickle cell disease experience excruciating pain during vaso-occlusive crises,” Samuel Rodgers-Melnick, MT-BC, a music therapist and integrative health research and data specialist with UH Connor, told Healio. “Often, a numeric zero-to-10 scale does not fully capture the intensity of this pain or its psychological components.”
About 100,000 Americans have been diagnosed with sickle cell disease, which disproportionately affects Black individuals and occurs in approximately one out of every 365 Black or African American births, according to the press release. The disease causes red blood cells to become hard, sticky and C-shaped, hindering blood flow as they travel through small blood vessels.
To address the substantial pain and functional deficits caused by sickle cell disease, Rodgers-Melnick and colleagues at University Hospitals Connor Whole Health have been providing music therapy to hundreds of adults with sickle cell disease for the past decade. In the MUSIQOLS study, they evaluated a six-part music therapy intervention that integrated in-person music therapy sessions with exercises such as music-based breathing, progressive muscle relaxation, imagery and active music-making.
Rodgers-Melnick discussed the study’s results, the power of music in relieving pain, and the increasing role of integrative medicine in a new era of pain management.
Healio: What are some of the symptoms that patients with sickle cell disease experience, and how are these usually managed?
Rodgers-Melnick: Vaso-occlusive crises are very painful and can occur on top of preexisting chronic pain from avascular necrosis, nerve damage or other comorbid pain conditions. The standard of care for managing vaso-occlusive crises should be individualized to each patient based on their pain intensity and prior exposure to analgesics, but typically includes opioid and nonopioid analgesics and hydration. However, pharmacologic approaches are often insufficient to manage the multidimensional pain these patients experience. Thus, further integrative approaches like music therapy are warranted.
Healio: What inspired you to develop this music-based approach to sickle cell disease pain relief?
Rodgers-Melnick: I was introduced to individuals with sickle cell disease during my internship at University Hospitals Cleveland Medical Center in 2012. For my internship project, I facilitated group drumming sessions for adults with sickle cell disease hospitalized for vaso-occlusive crises on an inpatient medical oncology unit. I witnessed the power of active music-making to not only decrease self-reported pain intensity, but also decrease stress, provide an outlet for self-expression and facilitate social support. At the time, no systematic research had investigated the role of music therapy for individuals with sickle cell disease. Thus, my clinical experience, my drive to improve care for these patients, and the opportunity to pioneer the first investigations of music therapy in this population led me and my colleagues to conduct a series of research studies, culminating in the MUSIQOLS study.
Healio: How did you perform this study?
Rodgers-Melnick: We conducted a mixed-methods randomized controlled trial that integrated quantitative and qualitative data and allowed us to enhance our understanding of participants’ daily pain, experience with the music therapy exercises and perceived acceptability of the music therapy intervention. In this study, we examined whether a six-part music therapy intervention was feasible, acceptable and beneficial among 24 patients with sickle cell disease and chronic pain. Participants were randomly assigned to either a six-part, in-person music therapy intervention or a waitlist control group. The intervention involved education and music exercises (music-based breathing exercises, progressive muscle relaxation, imagery and active music-making) personalized to participants’ preferred music genres. Participants completed daily electronic pain diary entries, as well as quality-of-life measures before and after study conditions. We then interviewed the music therapy participants at the conclusion of the intervention.
Healio: Your study showed that patients in the intervention group had improvements in self-efficacy and social function, whereas pain interference and sleep disturbances decreased. What about this intervention do you think produced such improvements?
Rodgers-Melnick: The MUSIQOLS intervention was designed to provide practical music exercises to manage the challenges these participants face in their daily lives. As evidenced by the content of the qualitative interviews, it appears participants gained new self-care skills through the music therapy interventions, which led to improvements in their perceived ability to manage pain from sickle cell disease. When patients experienced pain at home, they could utilize the music exercises in such a way that pain was not as burdensome to their daily lives.
Healio: Does the benefit have anything to do with music having a calming effect?
Rodgers-Melnick: I certainly think that having a tool that can produce a relaxation response is valuable for managing pain and improving sleep. Further research is needed to investigate patients’ physiological responses to MUSIQOLS.
Healio: Do you plan to conduct further research?
Rodgers-Melnick: We plan to continue this research in settings outside University Hospitals to determine whether demonstrated improvements persist at 6 months and 1 year after intervention; whether the use of music exercises influences the use of pain medication; whether early intervention with music therapy influences the development of chronic pain in youth with sickle cell disease; and the comparative effectiveness of music therapy virtually vs. in person. We recently began a quality improvement initiative at University Hospitals to screen youth aged 8 to 18 years with sickle cell disease for chronic pain. We plan to recruit a subset of these patients with persistent or chronic pain for a feasibility study to investigate a virtual MUSIQOLS protocol. These kinds of adaptations will be critical to ensuring the generalizability of MUSIQOLS to other sickle cell disease centers.
Healio: Should music therapy become standard of care in the management of sickle cell disease symptoms?
Rodgers-Melnick: Pain management is changing in the United States. We are moving away from relying solely on pharmacologic approaches and moving toward comprehensive and integrative approaches to treat all dimensions of patients’ pain. Our research over the past 8 years supports the efficacy of music therapy for addressing both acute and chronic pain in adults with sickle cell disease, but more research is needed across integrative modalities to best optimize treatment. Given the complexities of pain in this population, I believe it is prudent to investigate which integrative modalities (music therapy, art therapy, acupuncture, massage therapy and/or yoga) best treat the many dimensions of pain in individuals with sickle cell disease. Through this research, we can develop a standard of care that is both evidence-based and patient-centered.
Music therapy improves ability to cope with pain for patients with sickle cell disease (press release). news.uhhospitals.org/news-releases/music-therapy-improves-ability-to-cope-with-pain-for-patients-with-sickle-cell-disease.htm. Published Feb. 16, 2022. Accessed March 18, 2022.
Rodgers-Melnick S, et al. J Pain Res. 2022; doi:10/2147.JPRS337390.
For more information:
Samuel Rodgers-Melnick, MT-BC, can be reached at samuel.rodgersmelnick@UHhospitals.org.