The effect of recorded music on pain endurance (CRESCENDo) - A randomized controlled trial

Introduction: Clarifying the effect of music on pain endurance in an experimental design could aid in how music should be applied during both surgical and non-surgical interventions. This study aims to investigate the effect of music on pain endurance and the involvement of the sympathetic adrenomedullary axis (SAM) and the hypothalamic-pituitary-adrenocortical axis (HPA).Materials and methods: In this randomized controlled trial all participants received increasing electric stimuli through their non-dominant index finger. Participants were randomly assigned to the music group (M) receiving a 20-minute music intervention or control group (C) receiving a 20-minute resting period. The primary outcome was pain endurance, defined as amount milliampere tolerated. Secondary outcomes included anxiety level, SAMaxis based on heart rate variability (HRV) and salivary alpha-amylase, and HPA-axis activity based on salivary cortisol.Results: In the intention-to-treat analysis, the effect of music on pain tolerance did not statistically differ between the M and C group. A significant positive effect of music on pain endurance was noted after excluding participants with a high skin impedance (p = 0.013, CI 0.35; 2.85). Increased HRV was observed in the M-group compared to the C-group for SDNN (B/95%CI:13.80/2.22;25.39, p = 0.022), RMSSD (B/95%CI:15.97/ 1.64;30.31, p = 0.032), VLF (B/95%CI:212.08/60.49;363.67, p = 0.008) and HF (B/95%CI:821.15/ 150.78;1491.52, p = 0.0190). No statistical significance was observed in other secondary outcomes.Conclusions: The effect of the music intervention on pain endurance was not statistically significant in the intention-to-treat analysis. The subgroup analyses revealed an increase in pain endurance in the music group after correcting for skin impedance, which could be attributed to increased parasympathetic activation.

Automated summary

This study aimed to investigate the effect of music on pain endurance and the involvement of sympathetic adrenomedullary axis (SAM) and hypothalamic-pituitary-adrenocortical axis (HPA). The results showed that the effect of music intervention on pain endurance was not statistically significant in the intention-to-treat analysis, but a significant increase in pain endurance was observed in the music group after excluding participants with high skin impedance, possibly due to increased parasympathetic activation.