Drexel University review pinpoints how music eases pain through emotion, control and rhythm

Music can measurably dull pain in a clinical or laboratory setting, but researchers have long struggled to explain why it works, a gap a new scoping review set out to close, according to the review published in PAIN Reports.

The review was led by Joke Bradt, Ph.D., a professor in Drexel University’s College of Nursing and Health Professions. The umbrella term "music-based intervention” (MBI) covers everything from a patient cueing up a favorite playlist before a procedure to a structured session led by a credentialed music therapist.

She and her team combed through 663 records across five databases for studies published through February 2026, narrowing the pool to 57 that tested a mechanism, moderator or predictor of music’s effect on pain. Earlier meta-analyses have already put MBIs’ effect on acute pain in roughly the same range as opioids, with a more modest but still real benefit for chronic pain. Despite that track record, the authors wrote that music is still frequently dismissed as a secondary, "adjunctive" therapy, largely because so little is known about the mechanism driving the benefit. "Insights into their mechanisms of action could help increase clinical credibility and uptake and guide more precise application of MBIs into patient care," they wrote in the paper.

What the review found

The evidence base skews heavily toward one format: 93% of the studies tested prerecorded music, with only a handful examining active music making, such as singing or drumming, and none included children. Across that evidence, three explanations for music’s pain-relieving power kept surfacing. How pleasant a listener found the music, what researchers call positive emotional valence, tracked consistently with lower pain ratings across a range of pain models, and enjoyment mattered more than a piece’s emotional label; liking the music predicted relief better than whether it was happy or sad. A sense of control over the music selection, termed cognitive agency in the review, also lined up with less pain and greater tolerance in laboratory settings. That echoes a separate clinical finding: music therapy’s benefit for pain in advanced cancer patients was explained in part by patients’ growing confidence in managing their own pain, not by the music alone. The third mechanism was physical: participants who tapped or drummed along to a beat reported greater relief than those who only listened, a pattern the authors linked to music’s ability to recruit the motor system alongside emotional and cognitive circuits.

Brain imaging backed up the behavioral findings at two points along the pain pathway. Some studies picked up changes as early as the spinal cord and brainstem, where raw pain signals first register, while others found shifts in the prefrontal cortex, where the brain assigns meaning and emotional weight to that signal. In two studies of people with fibromyalgia, self-selected music altered connectivity in brain regions tied to self-focused thought, which the authors suggested could be one way music interrupts the rumination that often compounds chronic pain.

What it means for payers and providers

The review lands as payers and health systems lean further into non-drug pain management. Therapeutic music programs already have backing from organizations such as the Veterans Health Administration, the Alzheimer’s Association and the Cleveland Clinic, and a 2026 industry roundtable hosted by HLTH found payers and providers increasingly weighing coverage as value-based contracts reward lower-cost, lower-risk alternatives to pharmacologic pain treatment.

Going forward, the authors want studies built to test cause and effect directly, using tools such as pharmacological blockers or brain stimulation to confirm which pathways drive the relief, along with more research in people living with chronic pain rather than the healthy volunteers who made up most of the current evidence base.

“By clarifying distinctions between mediation, moderation and prediction, and by promoting methodologically sound approaches, this review provides a conceptual foundation for future mechanistic research in music and pain,” Bradt and her team conclude in the study. “A clearer understanding of these processes will support more targeted and effective applications of MBIs in pain management.”