Effects of active musical engagement during physical exercise on anxiety, pain and motivation in patients with chronic pain

Abstract

The experience of anxiety is central to the development of chronic pain. Music listening has been previously shown to exert analgesic effects. Here we tested if an active engagement in music making is more beneficial than music listening in terms of anxiety and pain levels during physical activity that is often avoided in patients with chronic pain. We applied a music feedback paradigm that combines music making and sports exercise, and which has been previously shown to enhance mood. We explored this method as an intervention to potentially reduce anxiety in a group of patients with chronic pain (N = 24, 20 female and 4 men; age range 34-64, M = 51.67, SD = 6.84) and with various anxiety levels. All participants performed two conditions: one condition, Jymmin, where exercise equipment was modified with music feedback so that it could be played like musical instruments by groups of three. Second, a conventional workout condition where groups of three performed exercise on the same devices but where they listened to the same type of music passively. Participants' levels of anxiety, mood, pain and self-efficacy were assessed with standardized psychological questionnaires before the experiment and after each condition. Results demonstrate that exercise with musical feedback reduced anxiety values in patients with chronic pain significantly as compared to conventional workout with passive music listening. There were no significant overall changes in pain, but patients with greater anxiety levels compared to those with moderate anxiety levels were observed to potentially benefit more from the music feedback intervention in terms of alleviation of pain. Furthermore, it was observed that patients during Jymmin more strongly perceived motivation through others. The observed diminishing effects of Jymmin on anxiety have a high clinical relevance, and in a longer term the therapeutic application could help to break the Anxiety Loop of Pain, reducing chronic pain. The intervention method, however, also has immediate benefits to chronic pain rehabilitation, increasing the motivation to work out, and facilitating social bonding.

Keywords: anxiety; chronic pain; motivation; musical agency; musical feedback; physical activity.

Figure 1

Anxiety loop of pain.

Figure 2

The figure depicts patients’ pain levels as measured on a visual analog scale (1–100 mm) before the intervention.

Figure 3

The figure depicts differences of baseline anxiety scores and the anxiety scores after Jymmin or conventional workout condition as measured with the STAI. A Wilcoxon Signed Rank Test revealed a significant difference between medians of the difference between baseline and the Jymmin condition, and the difference between baseline and the conventional workout condition. Anxiety total scores declined stronger after the Jymmin condition as compared to the conventional workout condition.

Figure 4

The figure depicts baseline anxiety levels of participants.

Figure 5

The figure depicts scores on the motivation through others during the Jymmin or conventional workout condition as measured on a VAS. A Wilcoxon Signed Rank Test revealed significant difference between medians of the Jymmin and conventional workout condition. The motivation through other training partners was significantly higher during Jymmin as compared to conventional workout.

Figure 6

The figure depicts Spearman's correlations of (A) how liking the music during the Jymmin condition correlated with how comfortable they felt within the training group, (B) how much liking the music during Jymmin correlated withy how much they thought Jymmin would be an incentive to exercise despite having pain, and (C) how liking the music during Jymmin correlated with generalized self-efficacy scores after performing Jymmin as measured with the GSE.

Figure 7

Influence of Jymmin on the Anxiety Loop of Pain. Disruptive effect of Jymmin on the depicted loop are indicated by the lightning symbol.