EVIDENCE SPOTLIGHT: Music Therapy for Quality of Life and Chronic Pain in Adults with Sickle Cell Disease
STUDY OVERVIEW
Adults living with sickle cell disease may experience chronic pain, disrupted sleep, reduced social functioning, emotional strain, and difficulty managing symptoms in daily life.
This mixed-methods feasibility study examined whether a six-session music therapy program was practical, acceptable, and potentially beneficial for adults with sickle cell disease and chronic pain.
Twenty-four adults were randomly assigned to either music therapy or a waitlist control group. Participants in the music therapy group attended six individualized sessions led by a board-certified music therapist and received personalized music-based exercises to practice at home.
Compared with the waitlist group, music therapy participants showed significant improvements in sickle cell self-efficacy, pain interference, sleep disturbance, and sickle cell–related social functioning. Interviews also indicated that participants learned new self-management skills and felt better able to cope with pain.
This was a small feasibility study designed primarily to determine whether the program could be delivered successfully. Its clinical findings are promising but preliminary and require confirmation in a larger, fully powered trial.
Music therapy and vibroacoustic therapy are related but distinct
This study evaluated music therapy, not vibroacoustic therapy. Music therapy involves the clinical and evidence-based use of music by a credentialed music therapist to support individualized therapeutic goals.
Vibroacoustic therapy also uses sound, but adds low-frequency vibration that is physically transmitted through a specialized table, chair, mat, or other equipment. This study is included because it provides direct evidence that structured, personalized music-based care may support pain coping and quality of life in adults with sickle cell disease. It does not establish that VAT would produce the same results.
STUDY DETAILS
Study Type: Mixed-methods randomized feasibility study
Participants: 24 adults with sickle cell disease and chronic pain
Age Range: 21–57 years
Mean Age: 32.33 years
Music Therapy Group: 12 participants
Waitlist Control Group: 12 participants
Participant Race: All 24 participants identified as Black
Sex: 15 women and 9 men
Primary Sickle Cell Genotype: 17 participants, or 70.8%, had HbSS
Intervention: Six individualized music therapy sessions with personalized exercises for home use
Session Length: 30–60 minutes
Treatment Period: Six weeks, extended to as many as eight weeks when scheduling conflicts occurred
Average Time Between Sessions: 10.5 days
Music Exercise Length: Average of 10.9 minutes
Provider: Board-certified music therapist trained in cognitive-behavioral approaches for chronic pain
Comparison Group: Waitlist control receiving no music therapy during the initial 10-week study period
Primary Focus: Feasibility, acceptability, self-efficacy, quality of life, coping skills, and daily pain experiences
Study Period: June 2018 through January 2019
Clinical Setting: A large Midwestern hospital in the United States
Trial Registration: NCT03556657
WHAT THEY DID
Participants were recruited through an adult sickle cell clinic, acute care clinic, or inpatient unit. All participants had sickle cell disease, met criteria for chronic sickle cell pain, and had access to a mobile device.
Before treatment, participants completed questionnaires measuring self-efficacy, quality of life, and coping skills. They were also trained to use an electronic pain diary.
Participants then completed pain diary entries twice daily for two weeks. Morning and evening entries recorded pain intensity, pain location, pain characteristics, possible causes, and the effects of pain on sleep, mood, activities, work, school, and social interaction.
After this baseline period, participants entered their assigned study condition.
Music therapy group
Participants received six individualized sessions led by the same board-certified music therapist.
Each session included:
Setting an agenda
Explaining a music-based exercise
Practicing the exercise with the therapist
Processing the participant’s response
Creating or delivering a personalized recording
Assigning daily home practice
The intervention incorporated cognitive-behavioral elements such as pain education, goal setting, relaxation, imagery, breathing, cognitive reframing, anticipating barriers, and self-management planning.
Music exercises included:
Music-based breathing
Progressive muscle relaxation
Guided imagery
Active music making
The music was personalized to each participant’s preferences, including genres such as gospel, hip-hop, R&B, jazz, rock, and soul.
Participants received recordings and handouts through their mobile devices and were encouraged to practice at least once daily. The music therapist contacted them weekly to monitor home use.
Waitlist control group
Participants in the waitlist group received their usual medical care but did not receive music therapy during the initial study period. They were offered music therapy after completing the post-study assessments.
After the intervention or waitlist period, all participants again completed two weeks of daily pain diaries and repeated the self-efficacy, quality-of-life, and coping assessments.
Participants in the music therapy group also completed interviews about the program’s usefulness, acceptability, and effect on their experience of pain.
OUTCOMES MEASURED
The researchers evaluated three primary areas: feasibility, acceptability, and preliminary clinical effects.
Feasibility
They measured:
Recruitment and enrollment rates
Retention
Session attendance
Completion of study assessments
Completion of electronic pain diaries
Frequency of home music-exercise use
Technical and scheduling barriers
Acceptability
Participants were interviewed about:
Their experience of the music therapy sessions
Suitability of session length, timing, and location
Usefulness of the exercises
Effects on pain, mood, coping, and quality of life
Suggested improvements
Self-efficacy
The Sickle Cell Self-Efficacy Scale measured participants’ perceived ability to manage sickle cell symptoms and daily challenges.
Quality of life
The PROMIS-29 measured:
Physical function
Anxiety
Depression
Fatigue
Sleep disturbance
Pain interference
Ability to participate in social roles and activities
The Adult Sickle Cell Quality of Life Measurement Information System measured:
Emotional impact
Pain impact
Social functioning impact
Sleep impact
Coping skills
The Coping Skills Questionnaire for Sickle Cell Disease measured how often participants used different coping strategies.
Daily pain
Electronic pain diaries tracked:
Pain intensity
Maximum daily pain
Pain interference with desired activities
Effects of pain on sleep
Effects of pain on mood
Pain medication use
Use of pain-management strategies
Immediate session symptoms
During music therapy sessions, participants also completed brief pre- and post-session ratings of:
Well-being
Pain
Anxiety
Depression
Tiredness
The paper did not present these immediate session ratings as the principal comparative outcomes of the study.
MAJOR FINDINGS
The program was feasible
Of 28 patients invited to participate:
25 enrolled, producing an enrollment rate of 89%
One participant withdrew before randomization
Twenty-four participants were randomized and completed all pre- and post-test study measures. This represented a 96% retention rate among the 25 participants who initially enrolled.
All participants completed the study assessments, and all 12 music therapy participants attended all six sessions, producing 100% session attendance.
Average pain-diary completion was:
70% during baseline
66% during follow-up
Across reports collected during the six music therapy sessions, home exercise use was described as:
40% used them almost every day
35% used them every day
3% used them more than once daily
12% used them once or twice weekly
10% reported never using them
Self-efficacy improved
Compared with the waitlist group, music therapy participants showed a significant improvement in sickle cell self-efficacy.
The mean change in the music therapy group was 5.42 points, compared with −0.50 points in the waitlist group.
The between-group difference was statistically significant:
p = 0.008
Effect size: d = 1.20
This was a large preliminary effect.
Pain interference improved
Music therapy participants showed a significant improvement in PROMIS pain-interference scores compared with the waitlist group.
The music therapy group’s mean change was −2.10 points, while the waitlist group worsened by 4.30 points.
The between-group difference was statistically significant:
p = 0.016
Effect size: d = −1.06
The between-group result suggests that music therapy may have helped limit pain-related disruption to daily functioning. However, the difference reflected both improvement in the music therapy group and worsening in the waitlist group.
Sleep disturbance improved
Music therapy participants showed a significant improvement in PROMIS sleep-disturbance scores compared with the waitlist group.
The music therapy group improved by −1.49 points, while the waitlist group worsened by 4.63 points.
The difference was statistically significant:
p = 0.023
Effect size: d = −0.99
The ASCQ-Me sleep-impact measure did not show a statistically significant between-group difference, so the sleep findings were not consistent across both sleep measures.
Social functioning improved
Music therapy participants showed significant improvement in the ASCQ-Me social-functioning impact measure.
The music therapy group improved by 2.97 points, while the waitlist group declined by −4.28 points.
The difference was statistically significant:
p = 0.018
Effect size: d = 1.05
Other outcomes did not improve significantly
The researchers did not find significant between-group differences for:
Physical function
Anxiety
Depression
Fatigue
Ability to participate in social roles and activities
ASCQ-Me emotional impact
ASCQ-Me pain impact
ASCQ-Me sleep impact
Coping-skills questionnaire scores
Because many outcomes were tested and no adjustment was made for multiple comparisons, the significant findings should be interpreted cautiously.
Daily pain showed favorable trends but was not statistically tested
The music therapy group showed small numerical improvements in:
Average pain intensity
Maximum daily pain
Pain interference with desired activities
Effects of pain on sleep
Effects of pain on mood
However, the researchers did not conduct formal between-group statistical tests on the daily pain-diary outcomes. These changes should therefore be described as trends, not proven treatment effects.
ADDITIONAL REPORTED BENEFITS
Qualitative interviews identified two main themes.
Participants learned new self-management skills
Participants described learning to:
Use breathing to calm themselves
Refocus attention away from pain
Recognize pain and stress triggers
Manage emotional reactions
Use imagery and music intentionally
Create distance from stressful thoughts
Incorporate music into daily self-care
Approach pain with greater confidence and control
Some participants said they had listened to music before the study but had not previously used it as an intentional symptom-management strategy.
Participants felt better able to cope with pain
Participants reported that music therapy helped them:
Manage pain more effectively
Reduce stress and anxiety associated with pain
Remain calmer during painful episodes
Change how they thought about pain
Continue daily activities
Use strategies other than medication alone
Feel less overwhelmed by sickle cell symptoms
Some participants described using the exercises alongside pain medication rather than as a replacement for prescribed treatment.
Several said that using the strategies early helped them manage symptoms at home or made pain feel more tolerable. These were participants’ qualitative reports. The study did not establish a reduction in pain-medication use, and the researchers indicated that further analysis would be needed to compare these statements with pain-diary medication data.
The study found no significant between-group differences in emergency department visits, hospital admissions, or acute care clinic visits.
Participants also identified time as a challenge. Learning and regularly practicing the exercises required commitment, and some wanted more time to master the techniques.
CLINICAL IMPLICATIONS
This study suggests that individualized music therapy may be a feasible and acceptable supportive-care approach for adults living with sickle cell disease and chronic pain.
The intervention went beyond passive music listening. Participants worked with a board-certified music therapist to develop structured, personalized strategies involving breathing, relaxation, imagery, active music making, pain education, and cognitive reframing.
The improvement in self-efficacy is especially relevant because chronic sickle cell disease requires ongoing daily symptom management. Helping people feel more capable of managing pain, stress, sleep, and daily functioning may support broader quality-of-life goals.
The findings also suggest that personalized music exercises can be transferred from the clinical setting into daily life through mobile recordings and home practice.
Several limitations should be considered:
The study included only 24 participants.
Each group contained only 12 participants.
The trial was designed for feasibility, not to establish definitive efficacy.
No formal sample-size calculation was performed.
The control group was a waitlist rather than an active attention-control group.
Participants and the therapist could not be blinded.
Some participants had previous clinical relationships with the music therapist.
There were baseline differences between groups on some measures.
Multiple outcomes were tested without correction for multiple comparisons.
Daily pain trends were not formally compared statistically between groups.
The study was conducted at one institution with specialized personnel and technology.
Transportation, scheduling, smartphone access, and technical support affected participation.
Long-term durability was not evaluated.
Music therapy should therefore be viewed as a complementary supportive-care intervention rather than a replacement for hematology care, prescribed medications, or emergency treatment during a sickle cell crisis.
Larger randomized trials with active comparison groups and longer follow-up are needed.
RELEVANCE TO SICKLE CELL SUPPORT
Unlike the other studies in this series, this study directly involved adults living with sickle cell disease and chronic pain.
That makes it especially important to the Sickle Cell Support series.
The study provides preliminary evidence that structured, personalized music therapy may support:
Greater confidence in managing sickle cell symptoms
Reduced pain interference
Improved sleep disturbance
Better sickle cell–related social functioning
New self-management skills
Improved ability to cope with pain
It also demonstrates that participants were willing to attend the sessions, use personalized exercises at home, and incorporate music-based strategies into daily symptom management.
However, this study evaluated music therapy, not vibroacoustic therapy. Participants did not receive low-frequency vibration through a table, chair, mat, or transducer system.
The study, therefore, does not prove that VAT would produce the same outcomes. Its relevance to VAT is indirect: it shows that music-based, nonpharmacological supportive care can be acceptable and potentially beneficial for adults with sickle cell disease.
VAT research involving people with sickle cell disease is still needed to determine whether adding physically felt sound vibration offers similar, additional, or different benefits.
WHY IT MATTERS
This study matters because it moves beyond applying evidence from other chronic-pain populations to sickle cell disease.
The participants themselves were adults living with sickle cell disease and chronic pain.
The program also addressed more than pain intensity. It focused on the broader realities of living with sickle cell disease:
How pain interferes with daily life
How symptoms affect sleep
How people respond emotionally to recurring pain
Whether they feel capable of managing their condition
How illness affects social functioning
Whether supportive strategies can be used independently at home
The study’s mixed-methods design adds depth. The numerical findings showed preliminary improvements in several quality-of-life outcomes, while the interviews explained how participants used music to change their breathing, attention, stress responses, pain coping, and self-care.
This distinction is important: a supportive intervention does not have to eliminate pain to be meaningful. Helping a person feel less overwhelmed by pain, remain engaged in daily life, sleep better, and develop greater confidence in symptom management may still represent an important benefit.
The findings are not definitive, but they provide a strong foundation for larger music-therapy trials and support further investigation of sound-based approaches in sickle cell care.
PUBLICATION & RESEARCH ACCESS
Study: Effects of Music Therapy on Quality of Life in Adults with Sickle Cell Disease (MUSIQOLS): A Mixed Methods Feasibility Study
Authors: Samuel N. Rodgers-Melnick, Lucas Lin, Kristina Gam, Evanilda Souza de Santana Carvalho, Coretta Jenerette, Douglas Y. Rowland, Jane A. Little, Jeffery A. Dusek, Nitya Bakshi, and Lakshmanan Krishnamurti
Journal: Journal of Pain Research
Year: 2022
Volume: 15
Pages: 71–91
Published: January 11, 2022
Study Classification: Mixed-methods randomized feasibility study
Clinical Trial Registration: NCT03556657
DOI: 10.2147/JPR.S337390
Primary Study Site: University Hospitals Cleveland Medical Center
Funding: Kulas Foundation; additional author support from the National Heart, Lung, and Blood Institute
Research Access: Open-access full-text article
Important Classification Note: This study examined music therapy delivered by a board-certified music therapist. It did not evaluate vibroacoustic therapy or vibroacoustic stimulation.