Put Down the Painkillers and Strike Up a Tune

So far, 2016 has seen the passing of some iconic performers. January was a particularly tough month in that regard; making their debut on eternity’s grand stage that month—in whichever flavor of the afterlife you prefer—were David Bowie (69), Eagles’ Glenn Frey (67), Jefferson Airplane’s Paul Kantner (74), and Alan Rickman (69). And that was just the beginning. In the following months were Keith Emerson (71), Merle Haggard (79), and most recently, Prince (57).

Upon autopsy, the manner of Prince’s demise was determined to be an accidental self-administered overdose of the opioid fentanyl. The drug is usually prescribed for cancer treatment, but it can be made illegally—which certainly spiced up the news, as it was unclear whether Prince had a prescription for fentanyl.

Prince’s death certainly added fuel to the raging fire of America’s growing opioid abuse epidemic. It isn’t only heroin doing the damage, either. According to the American Society of Addiction Medicine, a record 18,893 overdose deaths were related to prescription pain relievers in 2014 (compared to 10,574 heroin overdoses). Fentanyl in particular grabbed the spotlight, as the drug is 25 to 50 times more potent than heroin, and 50 to 100 times more potent than morphine. “Opioid abuse and addiction have taken a devastating toll on American families,” said U.S. Food and Drug Administration (FDA) Commissioner Robert M. Califf, M.D. “We must do everything we can to make new, innovative treatment options available that can help patients regain control over their lives.”

Near the end of May, a medication-assisted treatment (MAT) option emerged in the form of Probuphine, the first buprenorphine implant to maintain treatment of opioid dependence. Before the FDA’s approval, Probuphine was only available as a pill or film placed under the tongue or inside of the cheek. The implant form seeks to benefit patients struggling with adherence by promising a six-month treatment without the hassle of daily medication. The implant itself is comprised of four, one-inch rods implanted under the skin on the inside of the forearm, and can only be performed by a healthcare professional certified through the Probuphine Risk Evaluation and Mitigation Strategy (REMS) program.

Expanding the availability of MAT options like Probuphine is an integral part of the FDA’s opioid action plan, which was developed earlier this year. Among the strategies put forth were working more closely with its advisory committees before making critical product and labeling decisions; enhancing safety labeling; requiring new data; and seeking to improve treatment of both addiction and pain. “We are determined to help defeat this epidemic through a science-based and continuously evolving approach,” Califf said when the FDA first announced the plan in February. “This plan contains real measures this agency can take to make a difference in the lives of so many people who are struggling under the weight of this terrible crisis.”

Of course, medication alone can’t solve the underlying causes of opioid dependence. Treatments like the Probuphine implant are meant to be used in conjunction with counseling and behavioral therapies to combat opioid abuse disorder. Interestingly enough, a “behavioral therapy” that the late Prince was quite familiar with could play a huge role in halting opioid dependence—listening to or playing music.

As I’m sure you’re wondering, it isn’t merely “good vibes” distracting patients from pain; there are a number of studies that have linked music therapy with effective pain management. One such study, published in Pain Management Nursing in March 2014, evaluated the efficacy of classical Turkish music played to 30 patients with neuropathic pain hospitalized in an Algology clinic. Each patient received an hour of therapy, and had pain scores taken both before and after the intervention. After six months of data collection, not only were the patients’ mean intensity scores lower, but the decrease was also progressive over the 30th and 60th minutes, indicating a cumulative dose effect.

We’ve known the effects for a while, so one has to wonder why the strategies haven’t yet been employed for opioid dependence. To further illustrate the healing powers of music, both a 1997 study published in Music Therapy Perspectives and a 2006 study published in the Journal of Advanced Nursing determined that providers can teach patients with nonmalignant chronic pain how to use music to enhance the effects of analgesics; decrease pain, depression and disability; and promote feelings of power.

Thus, it seems music therapy could be an effective treatment supplement at any stage in the process. Since it can enhance the effects of analgesics, fewer opioids can be taken overall to manage the pain, reducing the risk of dependence. It might even be able to replace medication completely in cases where the pain to manage is less intense.

And that’s only when listening—as any performer will tell you, putting pain into noise can be quite the cathartic experience. (There’s a reason the “brooding musician” trope exists, after all.) Aggressive sounds or melancholy harmonies can often release pain in a way that renders painkillers unnecessary. Perhaps with the next headache, in lieu of aspirin, listen to your favorite song. Sing along if you’re daring—at worst, you’ll cause someone else pain.