Portal de Periódicos da CAPES

Music for Health

2022; Lippincott Williams & Wilkins; Volume: 17; Issue: 9 Linguagem: Inglês

10.2215/cjn.04320422

1555-905X

Niloofar Nobakht, Mohammad Kamgar, Robert M. Bilder, Ehsan Nobakht,

Diverse Music Education Insights

Music: The Food for Life Music has been a constant part of human life since the prehistoric era. Archaeologists discovered primitive flutes made of bone and ivory from 43,000 years ago. As a powerful tool to express emotions, music has been used in the daily life of human beings for aesthetic pleasure, expressing love, compassion, fear, and faith; for worship; and for relaxing and healing purposes. Mothers used humming to console their crying babies. Shamans tried to treat people's illnesses with rhythmic incantation. Hippocrates, the founding father of rational medicine, and Plato are reported to have supported using music for soothing patients. The Persian philosopher Farabi (870 ce) addressed the therapeutic effects of music in his essay "Meanings of the Intellect." Farabi states that "music promotes good mood, moral education, emotional steadiness and spiritual development" (1). In the modern era, complementary to conventional pharmacologic treatment, music is still an appealing tool, but its potential remains to be clinically proven. A renewed interest in health implications of music as a safe, nonpharmacologic, and inexpensive remedy could set the stage for clinical trials and widespread use, if proven effective. It is noteworthy to mention that there is a distinction between music therapy and using music as a tool for health purposes. Music therapy is generally offered by certified and trained professionals, however, music may have benefits even without the involvement of an expert practitioner. Musical Physiology From a mechanistic standpoint, a learned cognitive response appears to be involved in music effectiveness. A patriotic song can create a sense of togetherness and boost the morale in times of crisis. The stimulated emotional response, with its associated learning, is rooted in the individual's memory and is, in part, achieved without conscious awareness, similar to the learning process that takes place in unborn babies who experience their mother's heartbeats (2). Music can increase dopamine and serotonin activities (3) and modulate responses at the cellular level, including via epigenetic mechanisms (4). Mind and Body The effect of music on mind and body has been demonstrated in a diverse range of patient populations, such as those with mental and neurologic disease, cancer, heart disease, lung disease (even for patients requiring mechanical ventilation), and those undergoing surgery. As an example, a meta-analysis of 72 randomized trials for use of perioperative music showed an association of music with modest reductions in patient-reported postoperative pain and anxiety, reduced analgesia, and greater patient satisfaction (5). Despite potential favorable effects and being easily accessible, music is generally underused in the health care setting. Millions of patients, especially those with a very high psychosocial burden such as patients with chronic conditions like CKD (6), may benefit from music. Anxiety, depression, and sleep disorders have an overwhelming effect on individuals with kidney disease undergoing hemodialysis, leading to lower quality of life (QOL). The prevalence of mood disorders, such as depression, in the CKD population is unacceptably high. Depression is associated with adverse outcomes, including higher mortality in patients with CKD (6). Psychosocial interventions, such as cognitive behavioral therapy, probably reduce depressive symptoms in patients on dialysis (7). The potential effect of music in patients with CKD remains largely unexplored. Therefore, given the potential positive effect of music on depression (8), using music may be beneficial in the CKD population (Figure 1). Exposure to music appears to reduce pain and improve patient satisfaction in those requiring extracorporeal shockwave lithotripsy treatment and during hemodialysis access cannulation. Music can play a role in easing the pain and fear of self-canulation, which is an important barrier for starting patients on home hemodialysis. To our knowledge, there is no comprehensive cost-effectiveness analysis examining the effect of music therapy in patients with kidney disease, however, studies in other clinical settings showed that music therapy could save costs (9).Figure 1.: Music may have potential benefits on depression, pain management, anxiety, and quality of life in patients with kidney disease.Music for Chronic Illness Increasingly, the importance of symptom management in patients with CKD to achieve wellness and have a good QOL with kidney disease has been recognized. To implement a patient-centered approach in patients with CKD, we should focus on the management of the unpleasant symptoms that patients experience such as fatigue, anxiety, insomnia, depression, pain, pruritus, poor appetite, and nausea. The burden of these symptoms may vary depending on different types of CKD, such as persistent back pain in polycystic kidney disease or neuropathy in patients with diabetes. The exact underlying biologic etiology of these unpleasant symptoms is poorly understood; however, these symptoms may share an underlying cause, such as kidney disease and comorbidities, side effects from pharmacologic and dialysis therapies, or a combination of these factors. The complex etiology of these symptoms warrants a holistic approach. To make research relevant to patients, caregivers, and clinicians, the Standardized Outcomes in Nephrology initiative has been introduced to establish a set of core outcomes, including patient-reported outcome measures, across the spectrum of kidney disease for research trials. These outcomes should be included in future trials to evaluate the effectiveness of music. Future Directions We need studies to evaluate the clinical outcomes associated with changes in stress. Offering music during dialysis was shown to lower salivary cortisol levels. Small studies have shown potential benefits of music on depression symptoms and QOL in patients on dialysis (10). In addition to the need for conducting conventional randomized trials to evaluate the short- and long-term effect of music in patients with kidney disease, an individualized approach of applying music is an attractive idea. Machine-learning algorithms can be used for patients on dialysis to match the patient's preference to the desired clinical response. Relaxing music may have an effect that differs from that of stimulating dance music. Widespread use of music in health care will lead to accumulating evidence that may unravel the potential benefits of music as an underappreciated tool. With advancements in technology, the way that music can be consumed is also evolving; for example, virtual reality applications can change how individuals, including those with hearing impairment, experience music. Having a multidisciplinary perspective to music within academic institutions and facilitating communication between the technology industry and the health care industry would provide the opportunity to benefit from technology innovations in the health care setting. Investigators from different disciplines, such as nephrology, psychology, neurology, pain management, and palliative care, in concert with patients with kidney disease can collaborate to develop a holistic approach using music to treat the collection of debilitating symptoms affecting the patients. In addition, establishing dialogues, such as having shared grand rounds with experts in art, engineering, information technology, and artificial intelligence, can spark collaborative innovations in the field. We need more controlled studies investigating music genres, duration, and even new modalities, such as virtual reality devices, self-selected music through a personal portable device, or special music channels dedicated to our patient population. It is also important to account for differences within populations, such as cultural background and socioeconomic demographics, ethnicity, age, race, and sex, when interpreting study findings and music intervention. Currently, there are a limited number of studies within the scope of CKD and the use of music. In addition to conventional pharmacologic treatment, music can play a complementary role as an affordable, nonpharmacologic therapeutic tool to improve QOL and, potentially, reduce morbidity and mortality in patients with CKD, which will reach several millions of our population within the next few decades. Disclosures R.M. Bilder reports having ownership interest in Amgen, Cisco Systems, Constellation Brands, and Johnson & Johnson and having consultancy agreement with, and receiving honoraria from, Atai Life Sciences, DBA VeraSci, and NCT Holdings. M. Kamgar reports receiving honoraria from, and serving on a speakers bureau for, AstraZeneca, Aurinia Pharmaceutical, GlaxoSmithKline Pharmaceutical, and Otsuka Pharmaceutical; receiving a research grant for Genzyme; and having consultancy agreements with Otsuka Pharmaceutical. E. Nobakht reports receiving honoraria from, and serving on a speakers bureau for, AstraZeneca; having consultancy agreements with AstraZeneca and Personalized Medicine Care Diagnostics Laboratory; serving as medical director for Fresenius Medical Care and as medical director for Somatus; being employed by, and having ownership interest in, Personalized Medicine Care Diagnostics Laboratory; and having patents or royalties for a genetic variant panel for kidney transplantation. N. Nobakht reports being the primary investigator in a multicenter, randomized, double-blind, placebo-controlled two stage study to characterize the efficacy, safety, tolerability and pharmacokinetics of GZ/SAR402671 in patients at risk of rapidly progressive autosomal dominant polycystic kidney disease with Sanofi for the past 24 months. N. Nobakht reports that her spouse has served on speakers bureaus for AstraZeneca, Aurinia, and Otsuka. Funding None.