Dissertations & Theses (Open Access)

Date of Award

Summer 8-2022

Degree Name

Doctor of Philosophy in Nursing (PhD)


Constance Johnson, PhD

Second Advisor

Diane Santa Maria DrPH

Third Advisor

Hyochol Ahn, PhD

Fourth Advisor

Luca Pollonini, PhD


Background: Low back pain (LBP) is a complex, multifaceted, and widespread condition that impairs the quality of life of older adults aged 65 years or older. Although nonpharmacologic interventions informed by the biopsychosocial model are recommended as first-line therapy for LBP, pharmacologic therapies, including opioids, are commonly used as first-line interventions in practice. This could be attributed to a lack of understanding of the analgesic properties of most nonpharmacologic interventions. Nonetheless, some nonpharmacologic therapies, such as passive music listening, have been shown to modulate pain via pathways that target the neurophysiological mechanisms associated with pain.

Specific Aims: The specific aims were to determine: (1) the feasibility and acceptability of listening to one’s preferred music to relieve pain in older adults with LBP, aged 65 years or older, and (2) if music reduces pain and affects pain-related physiological markers such as cerebral hemodynamic response to experimental pain, as measured by function near-infrared spectroscopy (fNIRS), heart rate variability (HRV), and conditioned pain modulation (CPM).

Methods: This was a single-center, single-arm, open-label study. Twenty community-dwelling older adults (≥ 65 years) with LBP were recruited to use noise-isolating headphones to listen to their preferred style of music for 20 minutes twice daily for four days using the MUSIC CARE® app. Feasibility was measured by tracking enrollment, adherence, attrition rates, and acceptability (measured by the treatment acceptability and preference scale). Average daily clinical LBP scores as well as other pain-specific physiological markers; fNIRS, HRV, and CPM were collected at baseline and post-intervention. Repeated-measures ANOVA, a general linear model based on autoregressive iteratively reweighted least squares (AR-IWLS), and custom Python codes were used to evaluate clinical pain, fNIRS, and HRV data respectively. The Wilcoxon signed-rank test was run on the CPM data as it violated the test of normality.

Results: Feasibility measures of enrollment, adherence, and attrition rates were 95.25% 100.00%, and 0.00%, respectively. When compared to baseline measurements, acceptance rates were higher after the intervention. Pain scores on the numeric rating scale (NRS) for pain decreased marginally but non-significantly from baseline to post-intervention. The physiological measures (fNIRS, HRV, and CPM) revealed that treatment has the potential to reduce pain.

Conclusion: These findings suggest that listening to preferred music for 20 minutes twice a day for four days is a feasible and acceptable intervention for reducing pain in older adults with LBP, aged 65 years or older. Also, listening to preferred music at home resulted in marginal but nonsignificant reductions in clinical pain sensitivity (NRS). Furthermore, the effects of listening to preferred music on pain were evident in the selected pain-related physiological markers, implying that these markers may be investigated as pain assessors in future studies. Future large randomized and ethnically diverse studies should investigate the underlying mechanism of music-induced analgesia.


Music listening, conditioned pain modulation, functional near-infrared spectroscopy.

Included in

Nursing Commons



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.