Capturing the Patient’s Attention

Dr. Richard Fratianne, from “Art and Medicine,” produced by Kerrie Hillman, Studio 360, December  10, 2010:

The problem is music therapy is not compensated by either governmental programs or private insurance policies, because there just isn't very much science in music therapy — yet. And so, I thought that it might be interesting to see if we could prove the value of music therapy in the burn center where pain and anxiety are really very, very high.

A burn injury is so profound that it effects every part of the person. It's not only physical and emotional, but it's an intellectual challenge and there's a spiritual threat because patients don't recognize who they are anymore. They don't feel the same. They don't look the same. Oftentimes they feel ashamed of how they look and they're so afraid. We chose burn patients because the pain is so severe and the anxiety is so high that we thought if we can prove that music therapy can actually have a positive effect in these patients, then we can rest assured that it's going to work in every patient.

Obviously, we can give pain medication, we can give sedatives and tranquilizers, but if it's a really painful dressing change there's no way you can relieve all of the pain except under anesthesia and you can't anesthetize a patient two or three times a day. The body won't tolerate it.

Music requires and integration of many parts of the brain. There's the motor part that's the physical response to playing or tapping to the rhythm of music. Then there's the limbic system, the emotional response to hearing music that brings forth feelings and thoughts and ideas. But also there's rhythm, there's tempo, there's melody — all of these things have to be integrated at the same time to appreciate music. It's amazing how the brain can do this.

The reason we need a professional music therapist to intervene in these painful procedures is that by their training they're able to capture the patient's attention. We call that entrainment. It is actively involving the patient in the musical experience. Because when their mind is diverted to participating in the therapy, they cannot think about the pain.

The earlier research just asked the patient before and after a musical experience, “Do you feel better yet?” That doesn’t really prove anything. It’s only when you’re dealing with patients like we’re dealing with in the burn unit that you can clearly identify changes in their response with music therapy. And we have done that.

One of our latest studies is utilizing the measurements of a stress hormone which is one of the products of the adrenal gland in response to stress. We know when patients are highly stressed these levels go up. And we’re measuring to see whether music therapy can actually depress those levels of the hormone. And our initial studies have shown that.

What we’re doing is new. We know that. And that’s why it’s exciting, because it is new. But the music can have a calming effect on people. How it works is still being discovered.