Can Listening to Music Decrease Pain?

By Grant Frost · Physiotherapist • Last clinically reviewed: 20 May 2026

Imagine a treatment that could reduce your pain without medication, without side effects, and without invasive procedures. What if that treatment was as simple as listening to music, singing along, or playing an instrument?

A large new study published in The Journal of Pain (Rodgers-Melnick et al., 2025) analysed 2,039 music therapy sessions across 1,203 hospitalised adults reporting moderate-to-severe pain (≥4/10). The researchers examined which factors - from the type of music intervention to patient demographics to session length - predicted clinically meaningful pain reduction (a drop of ≥2 points on the 0-10 pain scale).

As a physiotherapist, I find these results so interesting. So much so, they may have implications for how we think about pain management, not just in hospitals but for anyone living with acute or persistent pain. Music therapy may not just be a pleasant distraction. It's now an evidence-based, non-pharmacological intervention that may meaningfully reduce pain intensity, particularly when patients actively engage with the music.

How music calms the nervous system and reduces pain

Before diving into the study findings, it is worth understanding why music might help with pain. The mechanism is not just psychological - it is neurobiological.

When you are in pain, your sympathetic nervous system (the "fight or flight" response) is often on high alert. Your heart rate can increase, your breathing may become more shallow, your muscles more tense, and your brain can ultimately amplify your pain experience. Ultimately, this is a normal, protective response, but thanks to the modern world and all it's stressors, things can easily get out of hand.

Music therapy works, in part, by doing the opposite. It activates the parasympathetic nervous system - the "rest and digest" branch - which:

• Slows heart rate and breathing
• Lowers blood pressure
• Reduces cortisol (the stress hormone)
• Decreases muscle tension
• Modulates the descending pain pathways in the brain

Studies like this highlight that music-based interventions can modulate the descending pain pathway - the brain's own system for turning down the volume on pain. Engaging with music, especially actively (singing, playing an instrument), also enhances cognitive processes like refocused attention, motivation, self-efficacy, meaning, and enjoyment - all of which contribute to the analgesic response.

Study design: 2,039 sessions, 1,203 patients

This was a retrospective review of electronic health record data from 10 medical centres within a large non-profit health system in Ohio. The study included 2,039 music therapy sessions delivered to 1,203 adult patients (mean age 58 years, 66% female, 67% non-Hispanic White, 33% non-Hispanic Black/African American).

All patients reported moderate-to-severe pre-session pain (≥4/10 on the 0-10 Numeric Rating Scale). Music therapy sessions were delivered by board-certified music therapists and documented using a structured EHR template.

The researchers classified music therapy interventions into four categories:

• Receptive only: Patient listens to live or recorded music without active participation
• Recreative: Patient engages in singing or active instrument play
• MARI (Music-Assisted Relaxation and Imagery): Guided relaxation, breathing exercises, or imagery paired with music
• Compositional/creative: Songwriting, song dedication, or music-assisted life review

The primary outcome was clinically significant pain reduction (≥2-point drop on the 0-10 pain scale), which has been validated as a meaningful threshold in prior music therapy and acupuncture research.

Active music making beats passive listening

One of the most important findings is that not all music interventions are equally effective. Compared to receptive interventions (simply listening to music), the study found:

• Recreative interventions (singing, instrument play): 37% higher odds of meaningful pain reduction
• MARI (relaxation and imagery): 48% higher odds of meaningful pain reduction
• Compositional/creative (songwriting): 51% higher odds, though this did not reach statistical significance

Why are active interventions more effective? The researchers point to several mechanisms:

Sensorimotor synchronisation: Playing an instrument or singing involves coordinating movement with sound, which engages multiple brain regions and may enhance analgesic response.

Cognitive engagement: Active music making enhances refocused attention, motivation, self-efficacy, meaning, and enjoyment - all cognitive processes that contribute to pain reduction.

MARI's unique role: Guided relaxation and imagery may specifically modulate the sensory-descriptive dimension of pain. By inviting patients to imagine peaceful places, take deeper diaphragmatic breaths, or release tension, music therapists help shift the nervous system from threat to safety.

Longer sessions work better

Dose matters. Each 15-minute increase in session length was associated with a 40% increase in the odds of meaningful pain reduction.

Sessions that resulted in meaningful pain reduction were, on average, 3.3 minutes longer (37.6 vs 34.4 minutes). This suggests that the time music therapists have to engage patients, build rapport, and implement active interventions has a meaningful effect on analgesic response.

For clinicians and patients, this means that longer, more immersive music therapy sessions are likely to be more effective than brief interventions. Rushing through a 15-20 minute session may not allow enough time for the nervous system to shift from sympathetic to parasympathetic dominance.

The power of intention: pain management goal

Sessions with a documented pain management goal were 3.6 times more likely to achieve meaningful pain reduction compared to sessions without such a goal.

This finding may seem obvious, but it has important clinical implications. When the music therapist (and presumably the patient) enters the session with the explicit intention of addressing pain, the intervention is more focused and effective. This aligns with the broader principle in chronic pain management that setting clear, specific goals improves outcomes.

It also highlights the importance of communication between healthcare providers. When physicians, nurses, or other clinicians refer a patient for music therapy, specifying "pain management" as the goal (rather than a more general goal like "coping" or "mood modification") may lead to better outcomes.

Who responds best to music therapy?

The study also identified several patient characteristics associated with better or worse pain responses:

More likely to respond:

• Higher pre-session pain: Each 1-point increase on the 0-10 pain scale increased odds of meaningful reduction by 19%. This makes mathematical sense - those with higher pain have more room to improve.
• More comorbidities: Each 5-unit increase in Elixhauser comorbidity count increased odds by 29%. Patients with more health conditions may have more complex pain that is more responsive to multimodal interventions.

Less likely to respond:

• Men: Male patients were 25% less likely to report meaningful pain reduction than female patients. This may relate to differences in pain reporting, engagement with non-pharmacological modalities, or other factors.
• Medicaid insurance: Patients with Medicaid were 40% less likely to respond than those with private insurance. This likely reflects the impact of social drivers of health and chronic stress on pain processing.
• Sickle cell disease (SCD): Patients with SCD were 58% less likely to report pain reduction. The authors note that the Numeric Rating Scale may not adequately capture the unique pain experience of SCD patients, who may fear that reporting lower pain scores could lead to delayed medication or early discharge.

Higher Social Vulnerability Index (neighbourhood disadvantage) was also associated with lower odds of response. This finding is consistent with known associations between chronic stress, adverse neighbourhood conditions, and altered pain processing.

From my clinical experience: music as a tool for pain modulation

As a physiotherapist, I see patients every day whose nervous systems are stuck in high alert. They are in pain, they are stressed, they are anxious. Their sympathetic nervous system is running the show, and their parasympathetic "rest and digest" system cannot get a word in edgewise.

This study confirms what I have observed clinically: active engagement with music can help shift that balance. When patients sing, play an instrument, or engage in guided imagery with music, something shifts. Their breathing deepens. Their shoulders drop. Their face relaxes. And often, their pain intensity drops with it.

Of course, I am not a music therapist. I cannot prescribe music therapy. But I can recommend that my patients incorporate music into their pain management toolkit. Here is what I suggest:

Be active, not passive. Listening to relaxing music is good, but engaging actively is better. Sing along. Tap your foot. Play a simple instrument. The sensorimotor engagement enhances the analgesic effect.

Make it a ritual. Set aside 20-30 minutes each day for intentional music engagement. Use it before or after therapy, before bed, or during flare-ups. Consistency matters.

Combine with relaxation techniques. The MARI approach - pairing music with guided relaxation, deep breathing, or imagery - was particularly effective in this study. Find music that helps you feel safe and calm, then pair it with slow, deep breathing.

Address your stress. If you are living in a high-stress environment (financial strain, neighbourhood disadvantage, caregiving responsibilities), music therapy alone may not be enough. But it can be a valuable tool within a broader stress management plan.

Be realistic about expectations. Music therapy is not a cure for chronic pain. But it is an evidence-based, non-pharmacological tool that can meaningfully reduce pain intensity, with no side effects and no risk of addiction.

Strengths and limitations

Strengths:

• Large sample size (2,039 sessions, 1,203 patients) across 10 medical centres
• High Black/African American representation (33%), addressing a gap in prior research
• Real-world effectiveness data (not a controlled trial, but reflective of actual clinical practice)
• Controlled for important covariates including opioid exposure and social drivers of health
• Immediate pre- and post-session measurement of pain intensity

Limitations:

• Retrospective design - associations do not prove causation
• Single-item Numeric Rating Scale - does not capture the multidimensional nature of pain
• Single-session effects only - does not examine longitudinal changes over hospital admission
• Broad intervention categorisation - may not capture nuanced aspects of therapy (e.g., specific instruments, tempos, or songwriting techniques)
• Limited generalisability - sample may not represent all US inpatients (e.g., high prevalence of mental health/substance use disorders at 64.8%)
• EHR data limitations - demographic data extracted as entered by healthcare providers may not fully reflect patient identities

Conclusions: music as medicine

This study provides strong evidence that music therapy is an effective non-pharmacological intervention for acute pain in hospitalised adults. Active interventions (singing, instrument play, relaxation/imagery) are more effective than passive listening. Longer sessions work better. And sessions with an explicit pain management goal are dramatically more likely to succeed.

The findings also highlight important disparities in pain response. Male patients, Medicaid beneficiaries, and those with sickle cell disease were less likely to report meaningful pain reduction. This may reflect differences in pain reporting, engagement, or the unique burden of chronic stress and social disadvantage on pain processing.

For patients living with persistent pain, music therapy offers a safe, accessible, and enjoyable tool for pain management. While it does not replace other evidence-based treatments (physiotherapy, exercise, medication when appropriate), it can be a valuable addition to the toolkit.

As the authors conclude: "Given the continued importance of inpatient pain management, the need to minimise opioid exposure, and the directives from accrediting bodies to promote and provide nonpharmacologic pain treatments, many health systems are now making an intentional shift from relying on opioids toward providing evidence-based nonpharmacologic modalities." Music therapy should be part of that shift.

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