Pain perception while listening to thrash heavy metal vs relaxing music at a heavy metal festival - the CoPainHell study - a factorial randomized non-blinded crossover trial

Objectives - Music festivals are often a source of joy, but also a risk of injury. While previous studies suggest music can relieve pain, its effect has not been tested in festival settings, nor has the effect of high-energy vs soothing music been compared. We hypothesized that guests at a heavy metal music festival would experience less pain when listening to thrash heavy metal compared to relaxing music, with the effect being influenced by music preference and increased with higher alcohol intake. Methods - This factorial randomized non-blinded crossover trial assessed pain during a 5°C cold pressor test (CPT) at a heavy metal festival. Participants were randomized to listen to either Slayer's "Raining Blood"or Enya's "Orinoco Flow"during their first CPT, and the opposite song during the second CPT. The primary outcome was pain during the CPT, assessed as area under the curve (AUC). Music fondness and breath alcohol concentration (BrAC) were measured before each CPT. Results - Forty-five adults, aged 19-58 years, were included, and completed both CPTs. Significantly more pain was reported while listening to Enya (AUC 1,155 [IQR 588-1,507]) vs Slayer (AUC 975 [IQR 682-1,492]) (p = 0.048). Higher BrAC was associated with decreased pain (p = 0.042). Participants with higher fondness of Enya experienced significantly more pain than those who liked the song less (p = 0.021). Fondness of Slayer had no effect on pain perception (p = 0.7). Conclusion - Listening to thrash heavy metal, specifically "Raining Blood"by Slayer during painful stimuli results in lower pain intensity than listening to relaxing music in the form of "Orinoco Flow"by Enya. The findings' impact on pain in a clinical setting should be explored.