A scoping review published in PAIN Reports on 1 August 2026 has drawn together 57 studies to explain how music reduces pain. The Drexel University-led analysis points to three converging mechanisms – emotional pleasure, a sense of control over music choice, and moving in time with the music – with clear implications for how clinicians might advise patients to use it.
Clinicians have long observed that music can take the edge off pain, from patients humming through a cannulation to those listening to a favourite album during chemotherapy. Systematic reviews cited in the paper put the effect size of music-based interventions (MBIs) on acute pain at 0.65-0.91 (standardised mean differences), comparable with opioids (SMD 0.60) but without the associated risks of dependence or adverse effects. Yet, as the authors note, MBIs are “often dismissed as ‘adjunctive’” precisely because their mechanism of action has remained unclear – a gap this review, led by Joke Bradt, PhD, of Drexel’s College of Nursing and Health Professions, sets out to close.
Clinical implications first
The practical message for clinicians is straightforward, although it runs counter to some standard practice. Rather than piping in generic relaxation music, patients should be encouraged to select music they personally enjoy. “It is important for people to select their own music that they enjoy – rather than music provided by the healthcare provider,” Bradt said, “and that they should actively engage by tapping, playing or moving along with it when using music for pain management.” Even singing along outperformed passive listening in one included study. For services already offering music medicine or music therapy as an adjunct to procedural or chronic pain care, this suggests refining protocols towards patient-selected, actively engaged listening rather than standardised playlists.
Three candidate mechanisms
Drawing on 663 screened records reduced to 57 eligible studies, the authors “identified convergent evidence for several candidate mechanisms, including positive emotional valence, cognitive agency, and sensorimotor synchronization.” Positive valence – how pleasant the music feels – consistently predicted pain reduction more reliably than whether music was categorised as happy or sad. Cognitive agency, meaning perceived control over what is played, tracked with lower pain intensity and greater tolerance in experimental studies, echoing clinical findings that pain-related self-efficacy mediated the benefit of music therapy in patients with advanced cancer. Sensorimotor synchronisation – tapping or drumming in time with a rhythm – amplified analgesic effects beyond passive listening alone, pointing to an embodied, motor-affective route into the pain system.
What is happening in the brain
Neuroimaging data, though heterogeneous in method, suggested music dampens pain signals at more than one stage. The authors write that “evidence from neuroimaging studies point to the impact of music on early stages of pain processing as well as on higher-order cognitive and affective interpretation of pain.” In people with fibromyalgia, self-selected music appeared to help normalise disrupted connectivity within the brain’s default mode network – the circuitry implicated in self-referential rumination that often accompanies chronic pain.
Gaps that limit the evidence
The review has its limits. Most included studies used experimentally induced pain in healthy volunteers rather than people with clinical pain, and the vast majority examined passive listening rather than active music-making, despite Bradt noting that in her own clinical work she favours singing and instrument-playing for chronic pain because she has “seen this to be much more effective… than merely listening to music.” Many studies were also underpowered or tested only partial statistical pathways, meaning true mediation – as opposed to simple correlation – was rarely established.
The authors conclude that MBIs “show clear potential for pain relief, yet mechanistic understanding remains constrained by inconsistent conceptualization and design,” and call for causal manipulation studies, alongside more research in people with chronic pain and in active music-making, before mechanistic claims can be more firmly established.
Reference:
Bradt, J., Hirsh, A., Jensen, M. P., et al. (2026). A scoping review of music-based pain treatment mechanism research. PAIN Reports, 11(2026), e1467. https://doi.org/10.1097/PR9.0000000000001467
