Neurobiological mechanisms underlying the beneficial effects of music interventions in perioperative care

Frequent complications in perioperative care include pain, anxiety, stress, sleep disturbance, and delirium, which are collectively known in clinical research as the "Big-5". These complications reflect pathological or compensatory changes in brain activity. Given that listening to music can have many effects on various brain regions, it has the potential to alleviate each of these complications. Different neuroanatomical pathways, including reward circuits, are engaged during music listening. To leverage the potential of music as medicine, it is timely to integrate knowledge about the neurobiological underpinnings of music listening with that on the impact of music on the "Big-5". In this narrative review, we first present the current evidence on the effects of music listening on pain, anxiety, stress, sleep disturbance, and delirium; next, we elucidate the neurobiological pathways involved in music exposure in healthy subjects; and finally, we explore how manipulating these pathways may alleviate each of the "Big-5" symptoms. Integrating these three interactions raises, at least from a theoretical perspective, the possibility of alleviating each of the perioperative complications or a combination thereof by applying music treatment on a personal, yet neuroscientific, basis. Hence, we propose to exploit recent advances in our understanding of neurobiological mechanisms, facilitating perioperative care by designing music treatment as personalized medicine.