An analysis of 57 studies reveals why music can alleviate pain, highlighting personal choice, enjoyment, and active engagement as key factors. The findings were published in the journal PAIN Reports.
When in pain, people often turn to music, assuming it works by distracting them from the discomfort. However, distraction alone isn’t the answer. Unpleasant music can hold a listener’s attention just as effectively without reducing pain; conversely, in several experiments, music provided relief even when it stopped before the pain actually began.
A new review of 57 studies points to a different aspect: whether the person likes the music, chose it themselves, and is actively engaged with it. The common thread is not the sound itself, but the listener’s attitude toward it.
A key caveat of the review is that most of the studies involved healthy volunteers exposed to brief, experimentally induced pain, rather than people suffering from chronic, everyday pain.
“Our findings help explain why music can be an effective, low-risk method for pain relief and how we can maximize its impact,” says study lead Professor Joke Bradt of Drexel University.
If the goal were simply to capture attention, any engaging sound would suffice—but that isn’t the case. In one experiment, pleasant, relaxing music reduced pain sensations during electrical stimulation, whereas unpleasant music intensified them.
In another study, volunteers reported concentrating intensely on both pleasant and unpleasant music, as well as on the listening task itself. Yet, only the pleasant music and the listening task improved their pain outcomes. Timing also strengthens the argument: in several studies, music was played before the pain stimulus rather than during it, and participants still experienced less pain. While attention remains a factor, the idea that a song simply displaces negative feelings does not align with the data. Observing nature has also been linked to changes in pain-related brain activity, suggesting mechanisms beyond mere distraction.
In two experiments conducted by the same team, only one variable differed: the extent to which participants could choose the music. In the first experiment, 51 adults submerged their hands in ice water. Those given more choice endured the cold longer and rated the pain as less intense; the effect was strongest among those who reported liking the music they heard.
In the second study, 286 adults experiencing pain participated in an experiment that simultaneously varied both the choice and the complexity of the music. Having a choice reduced pain intensity, whereas complexity had no effect.
Similar results emerged from a clinical trial. Ninety-two adults with advanced cancer were randomly assigned to two groups: one received six sessions with a music therapist, while the other served as a control group, receiving the same level of attention but without a music therapist.
The positive outcome was driven by a sense of self-efficacy in managing pain—the feeling that one could take action against the pain. Of the 24 studies aiming to investigate how music works, this was the only one to undergo a full statistical analysis.
Fifty-nine adults either tapped along to the music, tapped in silence, listened without tapping, or sat still while a device applied pressure to them. Tapping along to the music proved more effective than any of the other conditions.
Singing yielded an even greater effect. In a study involving 40 people who submerged their hands in ice water, singing a chosen song proved more effective than either listening to music or sitting in silence. Listening alone yielded no better results than silence across all pain-related measures.
Moreover, 83% of participants in this group identified singing as the most effective distraction. However, distraction was not the factor that distinguished the “winners” from the “losers.”
“One study also showed that singing along is more effective than simply listening to music,” explains Bradt.
The imaging results show a clear distinction. Music reduced pain-induced activity in areas directly innervated by the spinal cord and thalamus—early stages in the pain-processing pathway. It also altered activity in the prefrontal cortex, a region that helps shape cognitive and emotional responses to pain.
Two studies examined individuals with fibromyalgia, a chronic pain condition. After listening to music of their choice, a specific set of brain regions …began to function more like that of people without the disorder. Chronic pain can fuel this kind of inward-looking, egocentric thinking, and this offers initial grounds to believe that music can alter this behavioral pattern.
“Neuroimaging studies have shown that music can influence both the early stages of pain processing in the brain and higher-level cognitive and emotional responses to pain,” says Bradt.
Other research on how music can benefit the brain points to these same areas, and music evokes physical sensations that people can relate to bodily feelings.
A research team searched five databases for studies up to February 2026, analyzed 663 records, and selected 57. These studies were conducted in 20 countries and involved between 12 and 200 participants each. None of the studies involved children.
Almost three-quarters of the studies used laboratory-based interventions with healthy volunteers, and 93% tested recorded music played for the listener. Four studies examined active music-making, and only one involved a qualified music therapist.
A more significant issue lies in what the studies measured and what they claimed. Moderation effects were typically assessed by dividing people into groups rather than through formal statistical testing for moderation.
“Researching the impact of music on pain might seem straightforward, but it is actually a very complex task due to the complexity of both music and pain,” says Bradt.
Pain manifests differently in a body that has suffered from it for years. Results obtained from a healthy volunteer holding ice may differ from those seen in a person with fibromyalgia or cancer-related pain. Past injuries influence how the brain handles subsequent ones, and a review has shown that few studies have examined whether this effect persists.
Bradt keeps returning to the second excerpt.
“In my clinical practice, I primarily use active music-making methods—such as singing, vocal improvisation, and playing instruments—because I believe they are far more effective for chronic pain than simply listening to music,” Bradt explains.
Studying this is more challenging than studying a playlist. You can ask a person in a scanner to lie still and listen to the same recording as everyone else. However, there is no way to apply standardized assessments to someone who is improvising. Until researchers solve this problem, one of the most compelling clinical hypotheses in the field will remain insufficiently tested.
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