In an effort to mitigate pain caused by contractions during childbirth, Jessica Delfino broke into song. Using a karaoke YouTube video from her husband’s phone, she joined Jimmy Buffett in belting out Margaritaville.
“‘Nibblin on sponge cake,’ I began singing, uncertain, wondering if I was in some sort of labor-induced mania,” Delfino wrote in a story for The New York Times. “I kept going. By the end of ‘stepped on a pop top,’ the waves of torment had somehow diminished. I wasn’t on pain medication, but I felt like I had been transported to a more calm, pleasant place where I wasn’t counting every second of discomfort as I had been. Time seemed to pass more quickly.”
After the experience was over, Delfino researched what actually happened during those transporting moments. She discovered that women “had been singing, humming, chanting, and of course moaning and groaning throughout childbirth for centuries.”
Delfino inadvertently plunged into a subject very much in the forefront of modern medicine. Strategies to manage acute or chronic pain without the use of drugs is the subject of a growing body of scientific inquiry: we are very much in the early innings of this, there is a steep learning curve ahead.
Note: acute and chronic pain are not the same clinical entity. Acute pain is a natural sensation that has a rapid onset, triggered by an underlying cause. When that cause goes away, the pain disappears. Chronic pain, considered a disease state, is ongoing in nature. It lasts longer than six months, past the time of normal tissue healing. As many as 100 million Americans have suffered with it; the National Institutes of Health has labeled it a public health crisis.
Back to Delfino’s case of acute pain. Research has concluded that singing produces physiological benefits which reduce pain. The European Journal of Pain reported the following: “Singing encourages the active use of diaphragmatic breathing, which promotes deep and slow breathing. This diaphragmatic breathing influences a number of important physiological functions, such as the cardiovascular system and the autonomic nervous system.”
Deep breathing increases body relaxation and reduces stress. The Journal also cited studies which documented people with slow breathing patterns had increased pain thresholds and reduced pain sensitivity.
This type of research — the relationship between singing and pain relief — has been spurred by the acceptance of the biopsychosocial model of wellness and medicine introduced by psychiatrist Dr. George Engel in the late 1970’s. Engel’s schemata is highly applicable to the treatment of chronic pain.
Years ago, therapies for pain focused only on the biological components – physicians dealt primarily with the presenting symptom or the underlying physiological cause of the symptom. Drugs, surgery, and physical rehabilitation were the foundational approaches.
Today, thanks to Dr. Engel and others, we understand that there is an integration between three forces which must be considered in pain management: biological, psychological, and social aspects. All three reciprocally influence each other. Therefore, treatment strategies must be multidimensional as well.
In writing about the biopsychosocial modality employed at the Washington University School of Medicine in St. Louis, author Megan Hardie highlighted the holistic nature of treatment: “It demonstrates the importance of maintaining wellness in all aspects of our lives. It also emphasizes the inseparable relationships between these three factors. When one or more of the trio is disturbed, it can have direct and often negative impacts on the others.”
To effectively combat debilitating chronic pain, an interdisciplinary team is required. This team usually consists of one or more physicians, a psychiatrist or psychologist, a physical therapist, and an ongoing caregiver.
Why a psychiatrist or psychologist? Patients in pain aren’t necessarily emotionally disturbed, they suffer physical ailments.
As the American Psychological Association pointed out, chronic pain has the potential to produce a myriad of emotional consequences: anger, anxiety, depression, and suicidal ideation can all be part of the mix. Having professional assistance in understanding the morass of feelings and developing coping strategies are vital elements in this process. Studies show therapeutic intervention can help reduce the intensity of pain.
Chronic pain management can also include progressive muscle relaxation, biofeedback, guided imagery sessions, acupuncture, yoga, meditation, and hypnotherapy. The latter has been used effectively with burn victims.
Chronic pain according to the CDC costs an estimated $560 billion each year in medical costs, lost productivity, and disability programs. It is one of our society’s greatest and most overlooked challenges.
Dr. Steve Knauf told Parade: “There are lots of diseases and conditions out there that can’t be cured, but there are two things about chronic pain that make it different. The first is that pain is largely subjective and the second is the fact that pain is basically invisible, making it difficult for people to understand and give attention to.”