Musical pain relief at Welsh National Opera

The term ‘social prescribing’ is becoming ever more integrated with medical care, especially for chronic conditions, and Welsh National Opera’s Wellness with WNO: Managing Persistent Pain Programme is a clear demonstration of the benefits of a holistic approach for patients. In an evaluation report published by Milestone Tweed in March 2025, figures show that there was a 67 per cent improvement in pain for participants and for at least one in 10, pain reduced significantly.

Funded by Welsh Government and in partnership with NHS Wales, the WNO Wellness programme, which focuses on singing and breathwork, was originally devised in 2021 as a response to a need for varied approaches to tackle symptoms of Long Covid. NHS professionals were given demonstrations to explain the programme and Owen Hughes, NHS Wales’ national clinical lead for persistent pain saw a potential overlap in its benefits for pain management and asked the WNO team (vocal specialists Zoë Milton-Brown, Jenny Pearson and Kate Woolveridge MBE) to develop something which could be expanded to help patients suffering from other long term chronic conditions such as arthritis and fibromyalgia. They developed the Managing Persistent Pain programme, which has been running as a pilot scheme since March 2024.

Home comforts: Sessions are held on Zoom to mitigate travel costs and other accessibility (Image courtesy of WNO)

Sessions are held weekly over Zoom, which means that travel and accessibility are not an issue for any of the participants. With a maximum of 12 participants in a group, it remains small enough to feel sociable, and the group facilitators always begin with a check-in. ‘Before a new six-week programme, I will have a one-to-one meeting with each participant which I find incredibly important, so that people can share how they are feeling physically and emotionally,’ says Zoe Milton-Brown. For patients feeling isolated by their conditions, the social aspect of the group is incredibly important for mental health and wellbeing.

Andrew Mills was referred to the programme by the Long Covid clinic because of pain in his left hip, and he has certainly noticed decreased pain having been part of the programme for the past nine months. ‘Although I feel exhausted after a fifty-minute session, I’m left feeling so positive,’ he says. His takeaways from the sessions are ‘positivity, awareness and breath’ which he says are highlighted through the ‘feeling our breath’ exercises at the beginning of each workshop. The emotional support of being part of a group also helps with the depression and anxiety issues which are an unfortunately inevitable consequence of having a chronic condition, giving up a job and becoming physically isolated from people due to where he lives.

The cast of WNO's Gianni Schicchi ©Craig Fuller

The sessions are structured with the physical benefits of breathwork and singing at their root. ‘Our aim is to work on expanding the lower diaphragmatic breath, which we do with our breathwork exercises at the beginning of the sessions,’ explains Zoe Milton-Brown. ‘Then the humming and singing parts of the sessions actually cause strands of the vagus nerve to vibrate (as do any activities involving singing).’ The nerves run over the throat and vocal chords and activate the parasympathetic nervous system – the ‘rest and digest’ response which is the antidote to the ‘fight and flight’ of the sympathetic nervous system.

The vocal exercises of the workshops are not designed to turn people into opera singers but are aiming to build flexibility and stamina. Throughout the six-week programme, techniques and challenges increase in difficulty, but they are gentle and tailored to the cohort. The sessions finish with singing some simple songs – often folk songs, and sometimes even a little piece of opera. Participants are muted for the workshops which, according to Andrew Mills is ‘great, because with Long Covid the smell and vocal chords are affected, so pitching notes can be difficult. I wouldn’t turn up to a live session!’. There is absolutely no requirement for anyone to have musical knowledge, but it is obviously a bonus for people like Mills for whom music is a part of their life. ‘The sessions are extraordinarily fun,’ he tells me. ‘I’ve always loved classical music and music through the ages, and this has connected with me.’

The nature of the funding being Welsh-specific has meant that there is no current roll-out of the programme to other areas, despite Zoe Milton-Brown having been approached by external organisation, including some from America. Originally, the NHS funding available meant that there were just a short number of sessions offered, but extra funding for the WNO has meant that there are now fortnightly and weekly sessions offered, keeping some continuity for participants. There is a clear cost benefit for this kind of support: sessions are estimated to cost of £12 per person per hour, compared to £34.30 for an NHS Band 7 Physiotherapist from Chronic Pain Services.

‘High engagement rates, cost efficiency, and transformative outcomes on the individual’s long term health highlight its potential as a valuable intervention’, says Emma Flatley, director of WNO Programmes and Engagement. It is clear that the sessions form an integral part of the week for participants, and some have used them as inspiration to join choirs when their health has improved enough to allow it. The combination of the physical effects of the work, the social interaction and the endorphin release that any music-making brings is transformative. ‘I was really quite anxious approaching the end of the six-week programme,’ explains Andrew Mills, ‘but the fortnightly and weekly sessions now have been brilliant – little top-ups. They’ve been the brightest thing in my diary’.

Nicky Spence stars in WNO's production of Peter Grimes ©Dafydd Owen