When Music Hurts: An Assessment of Performance-related Pain in Musicians
—Musculoskeletal complaints are highly prevalent among musicians, and according to this study, professional musicians are at greater risk than music students.
Investigators recently assessed and compared the lifetime prevalence of performance-related pain in professional musicians and in music students, and reported their findings in Pain Medicine.1 The investigators were based at the University of Porto in Portugal, as well as at the Institute of Music Physiology and Musician鈥檚 Medicine in Hannover, Germany.
Musicians often suffer from performance-related pain, impacting their ability to play and affecting their overall well-being. The lifetime prevalence of musculoskeletal complaints among professional musicians has been estimated to be between 62% and 93%.2 However, existing studies lack tailored comprehensive pain assessment tools and focus primarily on orchestra professionals.
While some studies have been based on non-validated tools or tools not specific to musicians,2,3 the Musculoskeletal Pain Intensity and Interference Questionnaire (MPIIQM) typically used in other studies has limited applicability beyond orchestral settings.4,5 The recently validated Performance-Related Pain Among Musicians Questionnaire (PPAM) offers a broader scope, accommodating various musician backgrounds.1,6
The PPAM is a specialized questionnaire created to appraise performance-related pain in musicians. It includes 33 core items divided into 3 categories: pain intensity, pain interference in general activities, and pain interference in performance, all rated on a numeric scale from 0 (no interference or pain) to 10 (maximum interference or pain). Additional modules cover a range of elements from pain prevalence and duration to symptom management and intervention efficacy.6
Comparing professional and student musicians
This multicenter cross-sectional study enrolled 585 Portuguese musicians; 294 were music students, and 291 were professional musicians. Each participant took the PPAM questionnaire, the Modified Fatigue Impact Scale (MFIS), the 10-item Kessler Psychologic Distress Scale (K10), version 2 of the Medical Outcomes Study Short Form 36-Item Health Survey (SF-36v2), and the short form of the International Physical Activity Questionnaire (IPAQ-SF). The primary outcome was performance-related pain as quantified by the PPAM. Secondary outcomes were fatigue, anxiety/depression, health-related quality of life, and physical activity levels as characterized by MFIS, K10, SF-36v2, and IPAQ-SF.1
Among the musicians surveyed, the lifetime prevalence of performance-related pain was 55.0% (n=322), with a notable discrepancy between professionals and students (57.5% vs 42.5%, P<.001). The duration of pain was also significantly longer for professional musicians compared with students (6.0 months [1.0-24.0] vs 2.0 [1.0-13.5], P<.001). Overall, 33% of musicians with performance-related pain never sought healthcare.1
The neck, lower back, and shoulders were the most affected sites (29.1%, 15.4%, and 12.8% respectively), with no significant differences between the professional musicians and music students.1 鈥淭he predominance of neck, lower back, and shoulders as the most common pain locations corroborate previous studies and can be explained by the biomechanical requirements of the instruments most frequently played,鈥� wrote the authors.
Although no statistically significant difference existed with interference in performance between professional musicians and students, students were more likely to report elevated levels of fatigue based on MFIS (30.0 [17.0-42.0] vs 23.0 [14.3-37.0], P=.008) and distress based on K10 (26.0 [20.0-30.0] vs 18.0 [13.0-22.0], P<.001). Additionally, they had lower overall physical and mental health SF-36 scores (P=.008 and P<.001, respectively).1
The number of hours played per week was higher in professional musicians compared to music students (25.0 [20.0-30] vs 11.0 [6.0-20.0], P<.001) as was the number of years of playing (29.0 [22.0-40.0] vs 9.0[5.0-12.5], P<.001). This may have contributed to outcome differences between the two groups.1
Limitations
The authors noted that this study is limited due to the heterogeneity of both the professional and music student groups, as it pertained to skill level and duration of practice. Additionally, violinists may have been over-represented in this sample, accounting for 10.6% of the musicians surveyed. Similarly, the most common genre was classical music (74%). The authors acknowledge a larger study sample would be needed to minimize these concerns.1
This study underscores the significant prevalence of performance-related pain in musicians. 鈥淒espite the amount of evidence about the high prevalence of performance-related pain among musicians, few studies characterize pain intensity and interference, as well as other symptoms usually associated (e.g.: fatigue, anxiety, depression and distress) and their impact in quality of life,鈥� wrote the authors.1
They emphasize the critical need for increased awareness and preventive measures to address performance-related pain in musicians, starting from a young age. They note that by implementing targeted interventions and support programs, healthcare providers can mitigate the negative impact of pain on musicians' performance capability and overall quality of life.1
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