In a world increasingly reliant on pharmaceuticals for pain relief, a pioneering study from Indonesia offers a resonant alternative: the healing power of sound. For patients recovering from lower limb surgeries like knee replacements or fracture repairs, listening to Quranic recitation (Murottal) or classical music can significantly reduce postoperative pain, according to a new randomized controlled trial published in the Journal of Pain Research.
The research provides scientific evidence for what many cultures have intuitively understood—that certain sounds can soothe not just the mind, but the body’s physical suffering.
The Burden of Pain and the Search for Alternatives
Indonesia faces a significant challenge with bone fractures, leading Southeast Asia with an estimated 1.3 million cases annually. Effective pain management after the necessary surgeries is crucial. Poorly controlled pain hampers rehabilitation and can evolve into chronic, debilitating conditions. While painkillers are effective, their long-term use carries risks of side effects, dependency, and other complications.
“This necessity drives the search for complementary, non-pharmacological interventions,” explains lead researcher MM Rudi Prihatno from Jenderal Soedirman University. “Therapies that are adaptable to local culture and beliefs, like Murottal for a predominantly Muslim population, are particularly valuable.”
The Science of Sound and Pain
The study involved 33 patients undergoing elective lower extremity orthopedic surgery under spinal anesthesia. They were randomly divided into three groups:
- Group A: Received standard care plus listened to Murottal.
- Group B: Received standard care plus listened to classical music.
- Group C (Control): Received standard care only, with no music therapy.
The interventions were played 30 minutes before and 30 minutes after surgery. Pain levels were measured using the standard Numeric Rating Scale (NRS—where 0 is no pain and 10 is the worst imaginable pain) at 4 hours post-surgery. Researchers also measured levels of Interleukin-6 (IL-6), a blood marker associated with inflammation and stress.
Striking Results: Music Soothes the Pain
The findings were clear and encouraging. Both the Murottal and classical music groups experienced a statistically significant reduction in their pain scores, while the control group reported no change.
Table 1: Reduction in Post-Surgical Pain Scores (NRS)
| Group | Intervention | Average Pain Score Before | Average Pain Score After | Pain Reduction? |
|---|---|---|---|---|
| A | Murottal + Care | 5.63 | 3.27 | Yes, Significant |
| B | Classical Music + Care | 6.00 | 4.00 | Yes, Significant |
| C | Standard Care Only | 6.63 | 6.63 | No Change |
The data shows that both sound therapies were equally effective in reducing pain perception, with no significant difference between the Murottal and classical music groups. This suggests the benefit may come from the general therapeutic qualities of structured, harmonious sound rather than a specific cultural or religious content.
How Does It Work? The Biological Symphony
The study reaffirms the known neurobiological pathways of music therapy:
- Neurological Distraction: Engaging auditory pathways can “distract” the brain’s pain-processing centers, reducing the perception of pain signals from the body.
- Relaxation Response: Soothing music can stimulate alpha brain waves, promoting relaxation, reducing muscle tension, and lowering stress hormones like cortisol.
- Endogenous Pharmacy: It can trigger the limbic system to release endorphins and enkephalins—the body’s natural opioid-like painkillers—creating a sense of well-being and blocking pain receptors.
- Autonomic Regulation: Music helps calm the sympathetic nervous system (responsible for “fight-or-flight”) and enhances the parasympathetic system (“rest-and-digest”), lowering heart rate and reducing anxiety that often amplifies pain.
An Unexpected Finding: The Inflammation Puzzle
While effective for pain, the sound therapies did not significantly lower levels of IL-6, the inflammatory biomarker measured in this study. This is a crucial finding. It indicates that the pain relief achieved likely works primarily through the central nervous system (affecting the brain’s perception of pain) rather than by reducing local tissue inflammation at the surgical site.
“This dissociation is fascinating,” notes Prihatno. “It tells us that music therapy is a powerful psychophysiological modulator. It manages the experience of pain without altering this specific inflammatory pathway. For comprehensive care, it should complement, not replace, medical treatments that target inflammation.”
Table 2: Key Takeaways for Patients and Healthcare Providers
| Aspect | Implication & Encouraging Message |
|---|---|
| Effective Pain Relief | A simple, safe, and low-cost method to significantly improve patient comfort after surgery. |
| Cultural Adaptability | Therapy can be tailored using either universally accepted classical music or culturally specific spiritual recitations, enhancing patient acceptance. |
| Non-Drug Alternative | Reduces reliance on analgesics, minimizing risks of side effects and dependency, especially valuable for long-term pain management. |
| Integrative Care | Works best as part of a multimodal pain strategy alongside standard medical care, not as a standalone replacement. |
| Patient Empowerment | Gives patients an active, accessible tool to participate in their own recovery process. |
Limitations and Future Harmonies
The researchers acknowledge limitations, including the small sample size and the short duration of the intervention. The personal musical preferences and prior experiences of patients were not analyzed, which can influence effectiveness. Future studies with longer listening periods, larger groups, and measurements of other biomarkers like cortisol or endorphins are needed.
Conclusion: A Resonant Call for Integrative Medicine
This Indonesian trial strikes a powerful chord in modern healthcare. It rigorously demonstrates that integrative, holistic approaches have a definitive place in clinical settings. In an era of polypharmacy, offering patients the option to use the timeless, side-effect-free “medicine” of sound is a step toward more humane and personalized care.
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