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Medscape J Med. 2008; 10(1): 20.
Published online 2008 January 28.
PMCID: PMC2258483
Esoteric or Exoteric? Music in Medicine
Claudius Conrad, MD, PhD, Senior Surgical Resident
Claudius Conrad, Massachusetts General Hospital; Harvard Medical School, Boston, Massachusetts Author's email: cconrad1/at/partners.org;
Disclosure: Claudius Conrad, MD, PhD, has disclosed no relevant financial relationships in addition to his employment.
  
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Music has been an essential part of healing since the beginning of cultural history.[1,2] However, the precise physiological mechanisms by which music might achieve this therapeutic benefit have not been elucidated.[36]
We recently completed a study on critically ill, intubated ICU patients to investigate whether a well-defined selection of Mozart music can alleviate stress in critically ill patients, and how this effect might be mediated physiologically. The patients, while off sedation, were exposed to a 1-hour session of slow movements of Mozart's piano sonatas. Before and after the intervention, a defined set of stress hormones, cytokines, and physiologic parameters – such as heart rate and blood pressure – were determined.
We demonstrated that, compared to controls, music significantly reduced the amount of sedative drugs needed to achieve comparable levels of sedation. Simultaneously, among those receiving the music intervention, plasma concentrations of growth hormone rose, whereas those of interleukin-6 and epinephrine fell. The reduction in systemic stress hormone levels was associated with a significantly lower blood pressure and heart rate. Based on these findings, we developed a model of how music might act on neurologic, hormonal, and humoral levels to effect this relaxation.[7,8]
While this study begins to elucidate some of the physiologic mechanisms dictating music's therapeutic benefit, it also raises new questions that warrant further investigation.[911] We do not know whether the observed effect is specific to Mozart music, or perhaps related to the underlying severity of the clinical situation studied. We do not know what mediates the effects of music on clinicians. Allen and Blascovich, for example, have demonstrated surgeons perform mental subtraction tasks faster if simultaneously exposed to self-chosen music.[12]
Thus, future studies are necessary to investigate how this beneficial effect of music can be further integrated clinically, both for patient and for physician.[13,14]
That's my opinion. I am Dr. Claudius Conrad, Senior Surgical Resident, Harvard Medical School, Massachusetts General Hospital.
Footnotes
Reader Comments on: Esoteric or Exoteric? Music in Medicine See reader comments on this article and provide your own.
Readers are encouraged to respond to the author at cconrad1/at/partners.org or to George Lundberg, MD, Editor in Chief of The Medscape Journal of Medicine, for the editor's eyes only or for possible publication as an actual Letter in the Medscape Journal via email: glundberg/at/medscape.net
1. Old Testament. 1 Samuel 16.
2. Kane E. The phonograph in the operating room. JAMA. 1914;62:1829–1830.
3. Cowan DS. Music therapy in the surgical arena. Music Ther Perspect. 1991;9:42–45.
4. Siejka A, Stepien T, Lawnicka H, Krupinski R, Komorowski J, Stephien H. Effect of the growth hormone-releasing hormone [GHRH(1-44)NH2] in IL-6 and IL-8 secretion from human peripheral blood mononuclear cells in vitro. Endo Reg. 2005;39:7–11.
5. Stefano GB, Zu W, Cadet P, Salamon E, Mantione K. Music alters constitututively expressed opiate and cytokine processes in listeners. Med Sci Monit. 2004;10:18–27.
6. Chrousos GP. The hypothalamic-pituitary-adrenal axis and immune-mediated inflammation. N Engl J Med. 1995;332:1351–1362. [PubMed]
7. Conrad C, Niess H, Jauch KW, Bruns CJ, Hartl W, Welker L. Overture for growth hormone: requiem for interleukin-6? Crit Care Med. 2007;35:2709–2713. [PubMed]
8. Paugam-Burtz C, Mantz J. Sedative effects of Mozart's music in the critically ill: enjoy the hormonal symphony. Crit Care Med. 2007;35:2858–2859. [PubMed]
9. Heiser RM, Chiles K, Fudge M, Gray SE. The use of music during the immediate postoperative recovery period. AORN J. 1997;65:777–778. 781–785. [PubMed]
10. Koch ME, Kain ZN, Ayoub C, Rosenbaum SH. The sedative and analgesic sparing effect of music. Anesthesiology. 1998;89:300–306. [PubMed]
11. Wang SM, Kulkarni L, Dolev J, Kain ZN. Music and preoperative anxiety: a randomized, controlled study. Anesth Analg. 2002;94:1489–1494. [PubMed]
12. Allen K, Blascovich J. Effects of music on cardiovascular reactivity among surgeons. JAMA. 1994;272:882–884. [PubMed]
13. Fontaine CW, Schwalm ND. Effects of familiarity of music on vigilant performance. Percept Mot Skills. 1979;49:71–74. [PubMed]
14. Hodge B, Thompson JF. Noise pollution in the operating theater. Lancet. 1990;335:891–894. [PubMed]

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