The pain was particularly intense when she swam the breaststroke. “My legs would bend back and my kneecaps would bang against the cartilage,” Alicia Mullis says. “That’s not supposed to happen. The cap should fit in a nice little groove, but my kneecaps are a little off center.”

For years Mullis endured chronic pain, some days even struggling to walk. But it was never bad enough to make her to stop swimming. As her high school athletic career went on, Mullis did specific exercises to strengthen the knee tendons so that the caps would be more centered. While she was an undergrad at UNC, over several months the pain became more manageable—nothing an ice pack couldn’t handle. Looking back, though, she can’t give all the credit to modern sports medicine. She conducted her own research and wrote undergraduate thesis on chronic pain. Now Mullis thinks something else helped her cope with her faulty knees—playing music.

Musical evolution

Mullis has played the piano since she was seven and the clarinet since she was eleven. Her music teacher once told her she was good enough study to either instrument in college.

“I considered majoring in music,” Mullis says. “But it’s such a competitive field, and I felt I had other options.” She settled on psychology and biology—with a minor in Arabic—and then joined the lab of psychologist Mark Hollins.

At first Mullis didn’t think playing music had anything to do with relieving her own chronic pain. She just wanted to do research that would have real-life implications for others. But during a course on evolutionary psychology, a few short textbook passages piqued her interest in music’s evolutionary role. “It’s a phenomenon that evolutionary psychologists can’t explain,” she says. Why did humans start playing musical instruments?

Mullis thought that maybe music had functioned as a kind of pain modulator for humans living tens of thousands of years ago. That is, playing music somehow helped the brain cope with pain.

Mullis devised a project to test her hypothesis. She recruited forty-one UNC students and used a standard survey to sort participants by whether they had chronic pain and whether they played music. She gave each participant two cognitive tests: a letter-counting task and a number-prediction task. Researchers in the past had used similar methods to show that chronic pain sufferers struggle with cognitive tasks. And clinical observations showed the same thing, Mullis says. Fibromyalgia patients, for instance, often say they feel like they’re in a fog; their brains don’t function as well as other people’s brains.

Click to read photo caption. Donn Young

After Mullis crunched her data, she found that people who have chronic pain and play music at least once a week did substantially better on cognitive tasks than people who have chronic pain but don’t play music. Her results also showed that people without chronic pain who play music didn’t do any better on the cognitive tasks than people without chronic pain who don’t play music. The findings suggest that music had a protective effect against chronic pain.

The number-prediction task, which involves making decisions, was such a good predictor of musicians maintaining cognitive skills that Mullis hopes the test can be turned into a diagnostic tool. “It’s really hard sometimes to differentiate between acute and chronic pain,” Mullis says. “Those patients need to be treated differently; a new tool would be enormously helpful to the field.”

Your brain on music

Mullis says that music as a pain alleviator doesn’t work like a pill or an icepack. When her knee would flare up after swimming laps, she wouldn’t towel off and start playing the clarinet to sooth her ailing knee. Instead, the theory goes, playing music for years helped Mullis’s brain cope with pain better than had she not played at all. Playing music helped train her brain to not focus on the pain.

Think of it like this: whenever a person experiences the same pain stimulus over and over, neurons in the brain fire in consistent ways day after day for months or even years. That much is fact. What that does to cognition is unclear, but Mullis says that those consistent neural responses may train the brain to process specific pain stimuli at the expense of other impulses. The result would be loss of cognitive ability, which is what those tried-and-true cognition tests have predicted. “Think about it like a neural rut,” she says. “Interactions between the brain and body become more linear.” Brain activity becomes simplified and focused. That’s called decomplexification, and it can lead to all kinds of problems—lower pain thresholds, sensitivity to light and touch, emotional sensitivity. Patients say they can’t help but focus on the pain.

Music, she says, might serve as a kind of countermeasure—a recomplexifier. “Brain imaging studies have shown that when people play music, their brains just light up,” Mullis says. Many parts of the brain are involved, because playing music is about complex patterns interacting. That’s the way the brain was meant to function. That’s how our brains do function, until chronic pain takes hold. Music may help the ruts from getting too deep, Mullis says, which helps people avoid the worst that chronic pain has to offer—such as a diminished capacity to make decisions or even depression. And that could explain why chronic pain never got the best of her.

“I don’t know if my data say as much about recomplexification as about music being effective for people with chronic pain,” Mullis says. “But it’s an interesting idea that’s worth looking into.”

Mullis might do just that in graduate school. But first she wants to publish her thesis and work for at least a year before choosing a doctoral program. She says, “I want to make sure I choose the right one.”

Alicia Mullis graduated in May 2011 with a bachelor of science degree in psychology and biology, and a minor in Arabic, from the College of Arts and Sciences. Mullis received the Dunlevie Honors Undergraduate Research Award to help fund her project. She was one of four students whose posters were voted the best at UNC’s annual Undergraduate Research Symposium in April 2011. The other undergraduates with top posters were Alice Pilo, Matt Waters, and Alison Howard.