Can music therapy make MS spasticity injections less painful?
Patients in France being recruited for clinical trial
- Music therapy is being trialed to reduce pain and stress from botulinum toxin injections for spasticity.
- Patients with spasticity often find botulinum toxin injections painful, leading to anxiety.
- The trial uses music to induce relaxation, measuring heart rate variability.
A clinical trial testing whether music therapy can make botulinum toxin injections for spasticity more tolerable for people with multiple sclerosis (MS) and other neurological conditions is enrolling participants at Clermont-Ferrand University Hospital in France.Â
The study’s protocol was published in PLOS One, in a paper titled, “Musical intervention to reduce stress during botulinum toxin injection for spasticity: Protocol for a randomized controlled trial (MUSIBOT).”
Botulinum toxin formulations, such as Botox (onabotulinumtoxinA) and Dysport (abobotulinumtoxinA), are used to treat spasticity in people with MS and other neurological conditions. Spasticity in MS occurs because nerve cells are sending too many signals telling muscles to contract, and botulinum toxin can help dampen these signals to relieve spasticity.
While the treatment has been proven to help ease spasticity, the injections themselves are often reported to be painful. This can lead to a vicious cycle where patients are expecting the injection to be painful, so they tense up, and the fact that they are tense makes the injection even more uncomfortable. In the long run, this can compromise adherence to treatment and overall quality of life.
The clinical trial, dubbed MUSIBOT (NCT06920524), aims to determine whether music therapy can help make the process less stressful. “To our knowledge, no studies have specifically investigated the effect of music therapy on stress related to botulinum toxin injections,” the researchers wrote.
Music designed for gradual relaxation
The trial is expected to enroll about 80 adults with spasticity due to MS or other neurological issues such as stroke or head injury. The study is open to patients who are eligible for treatment with botulinum toxin therapies and have a history of pain or anxiety.
Patients who are taking medications that can affect heart rate, such as blood pressure medications, are not eligible. The study is also not open to patients who are pregnant or breastfeeding.
All participants will first undergo an injection session of botulinum toxin following standard procedures, without music therapy, but while wearing a monitor to track heart rate.
Three to four months later, they will undergo a second injection session, following the usual schedule for botulinum injections, while also wearing a heart rate monitor. Half of the patients in this session will receive music therapy, while the other half will not. The control group will be offered music therapy in the following injection session.
The music therapy used in the study is delivered through headphones and is “structured in several stages designed to gradually guide the patient into relaxation,” the researchers said.
The music sequence lasts 20-60 minutes and follows a so-called U-shaped pattern: it starts fast and energetic, then slows down and becomes more relaxing, and then speeds up again.
“Music intervention offers several advantages: it is non-invasive, non-pharmacological, low-cost, and easily accessible and portable,” the researchers wrote. “By helping to isolate the patient from the clinical environment, it enables the individual to focus on the musical experience and become distracted from the unpleasant stimuli of a stressful medical setting.”
The study’s main goal is to see if music therapy reduces heart rate variability (HRV), which can be used as a proxy for stress, since the heart beats faster when a person feels stressed.
“Although stress is an abstract concept, it can be quantified through HRV,” the scientists wrote.
Researchers will also collect patient-reported assessments about anxiety and pain, as well as overall satisfaction ratings from both patients and clinicians.
The trial is expected to run through late 2027.
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