fonte : ELENA DUSI PER LA REPUBBLICA - 

 

Non solo pillole e cerotti. Nei kit degli ospedali andrebbe inclusa anche una cuffia per la musica. Tanto grande – e per molti versi misterioso – è il potere della melodia nel curare sia la mente che il corpo, che il professore di Harvard Claudius Conrad ha proposto un suo uso regolare nei reparti di ospedale.

In un editoriale sulla rivista scientifica The Lancet, il medico (e pianista) americano ripercorre la storia dell´abbraccio fra medicina e musica dai tempi di Esculapio (non a caso figlio di Apollo) fino agli studi più recenti, che stanno descrivendo nei dettagli la risposta degli ormoni all´ascolto di brani celebri di musica classica.

 

La riflessione di Conrad si concentra sui due luoghi più duri di un ospedale: la sala operatoria e il reparto di rianimazione. «Ascoltando brani lenti di Mozart, alcuni pazienti molto gravi ricoverati in rianimazione hanno reagito con un calo degli ormoni che indicano il grado di stress» scrive il ricercatore nella sua pubblicazione. Epinefrina e Interleuchina-6 (i due ormoni misurati) sono diminuiti in alcuni pazienti anche del 20 per cento. «Abbiamo poi osservato un aumento dell´ormone della crescita nel sangue», che secondo Conrad è uno degli indici della guarigione in corso.

 

Prima degli interventi chirurgici, l´ascolto della musica facilita la sedazione. Subito dopo, riduce la quantità di farmaci necessari a sopportare il dolore. Qualche anno fa un medico italiano, Luciano Bernardi, dimostrò al San Matteo di Pavia che l´ascolto di qualunque brano di musica – inclusa rap e techno – fa momentaneamente accelerare il ritmo del cuore, ma dopo l´ultima nota produce uno stato di relax in cui i battiti rallentano, la pressione sanguigna diminuisce, il respiro si fa meno frequente e più profondo.

 

«Nessuno ha mai capito a cosa serva la musica dal punto di vista biologico» prosegue Conrad. «Eppure già Esculapio la raccomandava come terapia». Ma se i benefici delle melodie sono noti da tempo e la musica ci accompagna da 40mila anni (a tanto tempo fa risale il primo flauto ritrovato dagli archeologi in Germania), la strada che le note seguono all´interno dell´organismo per apportargli benessere e migliorare l´umore sono ancora al centro della ricerca scientifica. «Solo oggi – prosegue il medico musicista – cominciamo a capire qualcosa degli effetti sul sistema ormonale e immunitario». Quei dentisti ricordati da Lancet che il secolo scorso alzavano al massimo il volume per cercare di distrarre i loro pazienti agivano in nome del più puro empirismo. Ma oggi vedono confermate dalla scienza le loro intuizioni, con una riduzione del bisogno di analgesici nei pazienti con dolore cronico che ascoltano regolarmente i loro brani preferiti.

 

Usata per cercare di alleviare depressione, Alzheimer, autismo e disturbi del linguaggio, la musica viene sperimentata ora anche nella riabilitazione dopo un ictus. A luglio una pubblicazione sulla rivista Cochrane Systematic Review ha dimostrato che gli esercizi accompagnati da brani di musica molto ritmici venivano eseguiti meglio dai pazienti: con passi più lunghi, movimenti più ampi delle braccia e del bacino. Ascoltare un brano senza ballare, si è dimostrato, è una tentazione a cui gambe e braccia sanno resistere solo a prezzo di uno sforzo di autocontrollo. E allora, invita Conrad, è ora che il nostro istinto musicale inizi a essere sfruttato anche nella terapia.

 

ecco un estratto  dal Lancet  di dicembre 2010

 

Perspectives
1980 www.thelancet.com Vol 376 December 11, 2010
The art of medicine
Music for healing: from magic to medicine
Music has had an illustrious position in the course of
human history: not only as an art, but also as a medium
for healing. Only recently has there been growing interest
by the research community in trying to understand how
music aff ects patients and physicians. Within the past
few years, human and animal studies have examined
the psychological and physiological eff ects of music.
Yet a fundamental question underlying the role of music
in health is also to ask why music developed in the first
place and why it produces an emotional reaction and
attenuation of the human stress response in the listener
despite serving no essential biological need.
The discovery of simple fl ute-like instruments disinterred
with Cro-Magnun and Neanderthal remains suggests that
music has existed since prehistoric times. Scholars, such as
Robert Dunbar, believe that ancient musical rituals—drums
beating, voices chanting, bodies swaying—may have been
the earliest form of religion and served to invoke a sense
of deindividuation. However, while hypotheses abound
about how and why music evolved and remained part of
the human fabric, few have experimental or descriptive
evidence to corroborate them. The oldest example of the
contextual use of music for healing may be the depiction
of harp-playing priests and musicians in frescos from
4000 BCE. During this era, a Codex haburami (hallelujah to
the healer), was performed as sonorous reimbursement
for medicinal services rendered. In 2000 BCE, the
cuneiform writings of Assyrians depict the use of music to
circumvent the path of evil spirits. In later centuries, the
fi rst specifi c application of music as therapy developed in
ancient Greece, with Aesculapius recommending the use
of music to conquer passion. Perhaps not until the 6th
and 5th centuries BCE, did an interest develop in trying to
understand the eff ects of music on human beings.
At that time, the Pythagoreans were the first to
elucidate the mathematical relations of tones. They were
fascinated by concepts that would help to define the
infinite: to understand space, they developed astronomy;
to understand numbers, they introduced mathematics;
and to understand music, they created harmony theory.
Severinus Boethius (480–526 CE), who has been credited
with discovering the relation between the weight
of a hammer hitting an ambos and the pitch of the
resulting sound, also detailed how the Pythagoreans
examined the relation between various rhythms and
their resulting alterations of human aff ect in his work, De
institutione musica.
An important fi gure with great interest in how music
aff ects man was the philosopher Plato. He believed that
the study of music could resolve the inherent dichotomy
of the soul, claiming in The Republic: “Music is most
sovereign because rhythm and harmony find their way to
the inmost soul and take strongest hold upon it, imparting
grace, if one is rightly trained.” He also extrapolated from
the Pythagorean grouping of various musical qualities to
defi ne the modal system, which has been so influential
in the development of western music. The modal system
detailed unique qualities and generative properties
of diff erent musical progressions. Phrygian mode, for
example, should be used to create an atmosphere of peace
and acquiescence. Aristotle was also deeply engaged in
understanding the eff ects of music, but deviated from the
Platonic approach of using music to refi ne the aesthetic,
and instead focused on the cathartic properties. He
believed that music allows one to overcome “feelings such
as pity and fear, or enthusiasm”, and that mystic music
allows one to “heal and purify the soul”. Although they
held disparate beliefs on how music aff ected man—Plato
perceived music as a force to slowly build up the individual
psyche, whereas Aristotle hailed music’s force to destroy
this illusion—both philosophers believed in the ability of
music to heal  ( ........)
An early documented case of a physician in the
20th century using music in the context of surgery
occurred in 1914, when Evan O’Neil Kane published his
report in JAMA on the use of the phonograph within the
operating room. The next year, W P Burdick published a
more detailed account of the experiment in the American
Yearbook of Anesthesia and Analgesia. He recalled: “Dr Kane,
upon witnessing the benefi c eff ect of the phonograph
in the recovery wards, moved it into the operating
room itself, and found that patients almost universally
tolerated anesthetic induction better and also benefi tted
from reduced anxiety before undergoing the ‘horrors
of surgery’.” Four decades later, the eff ect of auditory
analgesia was shown by the observation of a decreased
need for pharmacological analgesia in patients undergoing
painful dental procedures if they are exposed to both loud
auditory stimulus as well as background music. Thus, if a
patient was subjected to a very loud sound, the crescendo
of which is under his or her control, the attention to the
auditory stimuli would diminish the response invoked
from the pain pathway once the dental procedure began.
Extrapolations from this study led to further research
that suggested music intervention during procedures
resulted in reductions in haemodynamic variability,
postoperative pain, the amount of sedative and analgesic
medication needed, and even an overall improvement
in the postoperative recovery period. Recent studies are
now looking into how these positive eff ects of music
might be mediated. For example, in our own research we
have investigated the benefi ts of music on patients in
intensive care units. One mechanism of music-induced
stress relaxation might be the restoration of the disrupted
homoeostasis in these patients through a modulation
of the hypothalamic pituitary adrenal axis. Indeed, we
found a signifi cant decrease in dehydroepiandrosterone,
epinephrine, and interleukin-6 concentrations, and other
components of the stress response in a group of critically
ill patients exposed to Mozart’s music, compared with
healthy volunteers. We also found that growth hormone
plasma concentrations increased signifi cantly in these
patients. Such fi ndings, together with the work of others,
are beginning to illustrate the immunomodulatory eff ects
of music. Aside from clinical randomised controlled trials
such as ours on music-induced stress relaxation, bench
research has provided possible insights about this eff ect,
especially with regard to the role of sex-specifi c hormones
and dopamine synthesis. Female sex hormones seem
to promote an exaggerated stress response that is
amenable to music anxiolysis, when compared with male
sex hormones. The same hormones might also increase
the sensitivity of women to music mediated anxiolysis.
Although the underlying mechanisms governing this
response warrant further research, such observations
indicate that there may be sex-specifi c responses to
severe illness and to music. Other studies indicate that
exposure to music might lead to an increase in calcium/
calmodulin-dependent dopamine synthesis in the brain,
and that the subsequent increase in dopamine reduces
blood pressure via dopamine 2 receptors. This mechanism
may also be implicated in understanding the stressreducing
eff ects of music in the hypermetabolic response
to severe injury.
The evolution of music as therapy began as a key
element of healing in a magical or ritual context. Today,
music is viewed as an adjunct to overcome some of
the anonymity and deindividuation of the clinical
environment, as well as a valuable tool to positively
infl uence patients’ stress response. However, research
remains in its incipient stages and much work remains to
be done. Not only do the beneficial physiological effects
of music need to be considered, but also the potential
adverse eff ects associated with its use, including
potential distraction of physicians in the operating
room, the negative arousal effects of vocal music, and
the incompatibilities of varying personal preferences.
Furthermore, not all music is created equal, with classical
and dichaotic music having very diff erent eff ects. Music
may well be a potentially powerful tool for improving
clinical outcomes with little known risk when applied
appropriately and judiciously. Whether music in medicine
will grow to be widely accepted as an adjunctive therapy
will depend on a better understanding of its role through
clinical and scientific experimentation.
Claudius Conrad
Harvard Medical School and Harvard Stem Cell Institute,
Massachusetts General Hospital, Department of Surgery, Boston,
MA 02114, USA
cconrad1@partners.org