1. Music Therapy Pain Management and Entrainment
Cheryl Dileo, PhD, MT-BC
Carnell Professor of Music Therapy
Temple University, Philadelphia

2. Definition of pain
An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage (IASP, n.d.)
Pain is a culturally-defined physiological and psychological experience. Each culture has its own language of distress when experiencing pain. (Calister, 2003)

3. Types of Pain
Acute
Chronic
Procedural
Cancer

4. Pain True Biopsychosocial phenomenon Individual differences
Total pain experience
Pain/Suffering

5. The Experience of Pain
Personal, subjective experience of painful sensations known only to the person with pain
Includes a mental and emotional component in addition to awareness of painful physical sensations
Cannot be objectively measured, confirmed, or disconfirmed by another person

6. LEVELS OF PAIN MANAGEMENT
IN MUSIC THERAPY

7. Why levels of pain management?
Appropriate for Biopsychosocial nature of pain
Addresses wide range of interventions possible in MT based on a range of goals/therapeutic intent
Describes progression of interventions from most basic and symptom-focused to most comprehensive
Appropriate for Incorporating range of patient coping preferences and cultural perspectives Dileo, 2013

8. Why Levels of Pain Management?
Subsumes various theoretical perspectives
Allows various ways for patient to be in relationship to the pain
However,
May be overlap in categories
Same interventions may serve multiple purposes
Dileo, 2013

9. Levels of Music Therapy Pain Interventions
1. Distraction/Refocusing
2. Supportive
3. Cathartic/Expressive
4. Existential
Transformational
Dileo, 2013

10. Distraction/Refocusing
Refocus of attention to another stimulus (strong and/or engaging).
Intent is to avoid or ignore pain
Patient can participate in an active or passive manner
Examples:
Various types of Music Listening (structured by patient and/or therapist)
Instrument playing
Musical Journeys (remove from present)
Music and Imagery experiences (escape situation)
Music as Focal Point

11. Supportive
Intent is to palliate specific symptoms of pain- make pain go away or enhance personal resources for dealing with pain.
Patient can participate actively or passively (most often passively)
Examples:
Song-writing
Music-based relaxation
Music and Imagery
Music Iso
Toning
Vibroacoustics
Music-Based Breath Work
Improvised/Precomposed Music to Hold/Soothe
Dileo, 2013

12. Expressive/Cathartic
Intent: express experience of pain and or emotions and suffering associated with having pain
Patient may participate actively or passively, but most often actively
Patient establishes contact with pain and/or emotions associated with being in pain
Examples:
Instrumental or Vocal Improvisation
Drumming
Song-writing, e.g., blues, rap
Song Improvisation
Dileo, 2013

13. Existential
Focus is on finding meaning in the pain experience within the patient’s life and/or new ways of thinking of/conceptualizing pain
Patient is in touch with the pain experience, the emotions accompanying it as well as the thoughts and interpretations of its meaning
The patient may participate actively or passively
Examples:
Song-writing
Song Discussion
Referential or non-referential Improvisation
GIM
Dileo, 2013

14. Transformational
-Intent is to observe carefully, dialogue with and/or enter into the pain to achieve a relationship with it and sometimes to travel through it.
-There is an awareness of the body, the pain and the emotions related to pain. There is also an awareness of what might heal the pain
Active, passive or combined approaches can be used.
-Examples:
GIM
Music Therapy Entrainment (process)
Dileo, 2013

15. Personal Assessment Own history with pain
Reactions to pain: avoidance, etc.
Reactions to pain in others
Boundaries, rigid, loose
Dileo, 2013

16. MUSIC THERAPY ENTRAINMENT

17. Music Therapy Entrainment
Interactive, music-centered therapy process using improvisation to treat pain
Both active and passive in nature (client participates in variety of ways)
Uses imagery (accepted cross-culturally)
Can address wide range of coping styles (active, passive, problem-focused, emotion-focused, etc.)
Differentiated from other types of MT pain approaches
Involves sensory exploration of pain characteristics
Entrance into pain by therapist and client (Dileo, 2013)

18. Theoretical foundations
Relies on theories in physics regarding pull of one vibrating object on another (tendency to achieve synchrony) (e.g., Pantalleone, 2002)
Iso principle- matching phenomenon musically and then changing music in desired direction (Altschuler, 1948; Rider, 1997; 1985)
Biopsychosocial theory-interrelationship of mind, body, social contexts (Engel, 1977)
Aesthetic theory (Metzner, 2012)

19. Evidence for Music Therapy Entrainment
Chronic upper limb pain
Schwoebel, Coslett, Bradt, Friedman, Dileo (2002)
Acute post-operative pain in children (Bradt, 2010)
Laboratory pain (Metzner, et al., 2012)
End-of-life pain (Clinical observations, Patrick, 2010)
Cancer Pain (Dileo, et al., in preparation for publication, 2013)
Support from EEG and MEG analysis (Metzner, et al.,2012; Dileo et al, 2013)

20. MT ENTRAINMENT
CLINICAL PRACTICE OF

21. Contraindications Psychosis Borderline personality
Physical/emotional fragility
Dementia
Extreme anxiety
Inability to verbalize
Dileo, 2013

22. Stages of Entrainment
1. Assessment: Pain Interview
Dileo, 2013

23. Stages of Entrainment 2. Imaging the Pain as Music
Auditory image of pain
Match music as closely as possible to the pain
Dileo, 2013

24. Imaging What Can Heal the Pain
Auditory image of what can heal
Timbre
Pulse
Tempo
Combination of sounds
Sequence of sounds
Duration of sounds
Match music as closely as possible

25. Stages of Entrainment Confronting the Pain and Letting Go
Patient sits quietly and listens
Improvisation created: sounds of onset of pain, progressing to a peak of pain, and then diminishing of music and movement into healing sounds
Resonance with pain by therapist
Dileo, 2013

26. Stages of Entrainment Healing Interview
Processing of the experience: Feedback on the pain and healing music

27. Evaluation
Did music match pain precisely….if not, what could be changed
Degree of resonance
Delayed responses
Longevity of responses
Does entrainment open up layers of feelings, what has been repressed?
Dileo, 2013

28. HEALING ASPECTS OF ENTRAINMENT
Empathy for pain expressed in various ways
Pain is perceived as external to patient
Pain can be viewed objectively
Dileo, 2013

29. Contact cdileo@temple.edu www.temple.edu/musictherapy