The use of music in the treatment of chronic pain: a scoping review

ABSTRACT

Objective

Music is a promising strategy to address the physical, psychological, and social needs of people with chronic pain. To better understand its potential in the treatment of chronic pain, this study aims to assess the state of knowledge regarding the effects of music in the context of chronic pain treatment.

Methods

A scoping review was conducted in eight databases using music, chronic pain, and treatment concepts and associated keywords. Studies were included in the review if they reported some effects of any form of music on chronic pain or concomitant conditions.

Results

Sixty-three studies were identified. Results showed numerous benefits of music-based interventions on chronic pain and common concomitant difficulties including emotional regulation, anxiety and depression symptoms, and social issues. Though literature supports varied forms of music-based interventions, those that account for participants’ preferences and that encourage self-management and autonomy appeared to be the most effective.

Conclusions

Despite the benefits of music in the management of pain and concomitant difficulties, there remain few examples of applied music interventions in services designed for people who experience chronic pain. More research is needed to identify the musical modalities that would be the most adapted and effective to complement chronic pain services.

Plain Language Summary

What is this review about?

This study investigated the different ways musical activities have been used to treat pain and mental health conditions among people who experience chronic pain.

What were the results?

The review identified that music interventions, especially when patients are truly involved in musical activities in which they are interested, can significantly improve the experience of physical pain, facilitate the management of mental health and emotional difficulties, and to reduce the isolation, all issues that are often associated with chronic pain.

What do the results mean?

These results suggest that music-based interventions are promising in helping chronic pain patients to address their physical, emotional, psychological and social needs, at times inside healthcare services and in the individuals’ everyday lives.

1. Introduction

In Canada, epidemiological surveys suggest that between 20% and 30% of adults suffer from moderate or severe chronic pain [1–3]. Chronic pain, defined as pain that persists for more than three consecutive months [4], negatively impacts individuals in several dimensions of their lives. Chronic pain can lead to consequences, such as decreased quality of life, mental health issues (e.g., anxiety, depression, suicide), and social isolation [5–7].

To intervene and improve the quality of life of people who experience chronic pain, it is important to understand the mechanisms underlying the experience of chronic pain. From a neurophysiological perspective, chronic pain is associated with important alterations of the central nervous system. For example, they experience lower dopamine production levels [8], lower serotonin levels [9], and lower endorphin levels [10]. The main treatment offered to individuals with chronic pain is the prescription of opioid medications [11]. However, a growing body of research shows that long-term opioid use can lead to important negative consequences, including mental health issues, the development or worsening of a substance use disorder, and an elevated risk of overdose [12–18].

In addition, pharmacological treatments specifically target pain, but do not necessarily address the other needs of people who experience chronic pain, including mental health needs (e.g., anxiety, depression) and social support. Finally, long-term opioid use can lead to a state of increased sensitivity to pain, which is referred to as opioid-induced hyperalgesia [19]. Hence, over the long term, the prescription of opioids can actually worsen pain conditions, leading to a cycle of increased opioid use, increased physical and mental health risks, and increased pain experience [19].

For these reasons, it is important to develop alternative intervention strategies that will contribute to limit the systematic use of pharmacological methods in the treatment of chronic pain. Such alternative interventions could contribute to better control or reduce the quantity of opioids prescribed, and in turn limit the associated negative consequences. Complementary non-pharmacological intervention strategies could also maximize the effectiveness of the treatments offered through a global approach that accounts for the conditions often concomitant with chronic pain.

According to literature, music-based interventions appear as promising strategies to contribute to reduce pain intensity (i.e., magnitude of pain experienced [20]). Indeed, a number of studies led among clinical populations who experience chronic pain show that music, through its effect on the neural pathways responsible for the experience of pain, contributes to reduce subjective pain intensity, and to increase pain tolerance, so much so that it can sometimes help to decrease the amount of opioid medications needed to treat this condition [21–23]. A number of studies explored the neural mechanisms underlying the influences and effects of music on the experience of chronic pain. In a literature review, Arnold et al. (2024) highlighted the capacity of musical activities to modulate the activity of the neurotransmitters and receptors associated with endorphin, dopamine, oxytocin and serotonin. Because these neurotransmitters play a role in the experience of physical pain (e.g., endorphin), concomitant psychological and mental health symptoms (e.g., dopamine, serotonin), and social behaviors (e.g., oxytocin) it is suggested that musical activities may as well modulate the experience of chronic pain and improve patients’ physical, psychological and social conditions [24]. Coherently, beyond physical pain, several studies also demonstrated numerous benefits of music on the emotional, psychological and social difficulties often concomitant with chronic pain, particularly with regards to emotional regulation, management of symptoms associated with anxiety and mood disorders (e.g., depression), and social isolation [21,25–30].

Moreover, music-based interventions are generally highly accessible both within and outside healthcare settings, inexpensive and easily applicable in a variety of contexts, in addition to having little to no side effects [31,32]. Music-based interventions also have excellent acceptability rates from people suffering from chronic pain, which is reflected in a greater motivation to initiate and maintain their commitment in psychosocial interventions and follow-ups [33,34].

Despite that literature supports the use of music-based interventions in the treatment of chronic pain, this knowledge mostly emerged from experimental studies [33–35] and remains poorly applied in the services designed for people with chronic pain. Also, given the heterogeneity of the music-based interventions in the literature, there is a lack of comprehension about what kind of music interventions are most effective to promote the well-being of people with chronic pain. As a result, our comprehension about the optimal ways in which music-based interventions could be integrated in chronic pain services remains limited.

Finally, though research increasingly highlights the need to develop strength-based interventions in health contexts [35], few studies have considered the benefits of music as it is used autonomously by people with chronic pain in their natural environment rather than being administered by a professional in a controlled setting [30,33,34]. For example, different kinds of research reviews (e.g., systematic reviews, meta-analyses) about the effects of music therapy on chronic pain or on concomitant mental health issues experienced by people with chronic pain were published in the last few years [36,37]. However, these reviews are generally highly limited to research led in treatment settings and in a highly controlled environment. Yet, the way music is used outside those services, and the extent to which music-based self-management strategies are used and efficient in the daily lives of chronic pain patients, has been largely overlooked. Hence, little remains known about how music-based interventions can serve as an empowering force to act autonomously on chronic pain and concomitant conditions on a daily basis, outside treatment and healthcare settings.

Given these observations, there is a need to explore the impact of music not only in healthcare and in treatment settings, but also in patients’ natural environment. To develop knowledge about how music-based interventions can be applied in the context of chronic pain treatment, there is also a need to develop a better comprehension about the musical modalities that are the most effective in addressing chronic pain and concomitant conditions.

2. Objectives

The objective of this scoping review is to critically assess the state of knowledge regarding the ways music is used in the context of chronic pain treatment, inside and outside healthcare settings. This review also aims to document the effects of different music-based interventions on chronic pain, as well as on the psychological, emotional and social difficulties often associated with the experience of chronic pain. A better comprehension of the effects of various music-based interventions could facilitate the identification of optimal ways through which music-based interventions could contribute to the treatment of chronic pain.

3. Methodology

3.1. Design

To address the research objectives, a scoping review was conducted. A scoping review was deemed appropriate given the heterogeneity of the literature regarding the research designs that were used, the types of interventions that were developed and the heterogeneous outcomes measured when studying music and chronic pain. This flexible approach will allow to consider each type of research as well as their strengths and limitations within their own approaches, and to better understand how music interventions, beyond the common experimental research perspectives, have been applied concretely to the treatment of chronic pain inside and outside healthcare settings.

The review followed the Arksey and O’Malley’s (2007) methodology [38]. This method consists of five specific steps: 1) identify the research objective; 2) identify the studies relevant to address the research objective; 3) select research articles based on inclusion and exclusion criteria; 4) organize and classify research results; and 5) summarize, report, and discuss the results.

To conduct the scoping review, the following three key concepts were identified and developed by the research team: music, chronic pain, and treatment, as defined below. For each concept, the first author developed a series of keywords to be included in the search strategy. Then, the search strategy was validated by the second author (see Table 1).

Table 1.

Concepts and keywords.

Concepts	Keywords
Theme 1: Music	Music*, choir, music* instrument, lyric, composition, live music, music practice
Theme 2: Chronic pain	chronic pain, long-term pain, long term pain, persistent pain
Theme 3: Treatment	treatment, therapy, therapeutic, intervention, management, opioid agonist treatment, opioid agonist program, medication, support

3.2. Key concepts

3.2.1. Music

In this study, all types of musical activities were considered, including music listening, the practice of a musical instrument or singing, live music, music and lyric composition, regardless of individuals’ level of music education [39–41]. According to the literature, all of these musical activities have the potential to play a role in the promotion of individuals’ physical, psychological, emotional and social well-being [39–43].

3.2.2. Chronic pain

Chronic pain is defined as a physical discomfort that persists over a duration of at least three months [4]. Chronic pain is often associated with negative mental health and well-being outcomes, especially at the psychological (i.e., depression and anxiety), emotional, and social level [5,44–46].

3.2.3. Treatment

Treatment is conceptualized broadly in order to include music interventions that are applied in a variety of contexts and through diverse modalities. Accordingly, we considered people who suffer from chronic pain and who are undergoing various forms of treatment such as opioid treatment programs, and psychological therapeutic treatments [47,48]. In addition, we were interested in the different forms music interventions can take as complementary modalities to usual pain treatment (e.g., music therapy, music-based interventions, self-administered music interventions and strategies [29,49–51].

3.3. Search strategy

The review was conducted during winter 2024 in a total of eight databases from the scientific literature: Academic Search Complete, PsycInfo, PsycArticles, CINAHL, SocIndex, Medline, Music index, and Google Scholar. The search strategy was developed from the previously identified concepts and keywords. We also developed a set of eligibility criteria to identify research articles that are relevant to our study. To be included in our review, research articles had to be published in peer-reviewed journals and written in French or English, in coherence with the capacity of our research team to understand those languages. We included populations from all age ranges. Studies with diverse research designs (e.g., qualitative, quantitative, mixed) were also included, as long as they were explicitly led in populations who experienced chronic pain. Moreover, studies had to report some effects or influences of any form of music on chronic pain itself or on the concomitant conditions often associated with it, including at the psychological (e.g., depression and anxiety), emotional, and social levels. Finally, given the scarcity of studies on the topic of chronic pain and music-based interventions, we considered the studies published in any given year, and in any area of the world. The flowchart that demonstrates the selection of research articles is shown in Figure 1.

Figure 1.

Studies included and excluded from the scoping review.

3.4. Selection of research articles

Both authors were involved in the selection of research articles. Following the development of the search strategy, the first author was responsible for applying the strategy in the identified databases. She was also responsible to complete a first screening of the results based on the articles’ titles and abstracts. During this first round, she excluded articles that were duplicated, articles that were clearly out of topic (i.e., did not imply music and/or chronic pain), those that did not include our population of interest, and those that were not written in French or English. She also excluded research articles that were either theoretical, reflexive or methodological because they were not providing research results. In the second round, she read the remaining articles (n = 142) and excluded additional articles based on similar reasons. In the cases where the eligibility of the articles was ambiguous, she consulted the second author and they discussed to determine whether the article should be included or not in the analysis. The first author then presented the selected articles, their topics, population and results to the second author and to the larger research team so that they can validate their relevance for the current study.

3.5. Data charting

Once we completed the selection of relevant research articles, the first author read them entirely and developed reading notes and a summary for each of them. A descriptive overview of the literature that addressed the effect of music on chronic pain and concomitant conditions is provided in Table 2. More specifically, we identified the authors, years of publication, research objectives, designs and target populations, the variables studied and the main research outcomes, as shown in Supplementary Table S1. Moreover, for each study included and analyzed in our scoping review, we paid attention to the type of music intervention used (e.g., self-administered, administered by a professional in healthcare settings or by a music therapist), the modality of music use (e.g., music listening, practice of a musical instrument, live music), and the specific music parameters including whether the music was self-chosen or selected by other intervening persons (e.g., researchers, healthcare professionals).

Table 2.

Characteristics of the included studies.

Design
Quantitative	Qualitative	Mixed-methods	Literature reviews
n = 38	n = 5	n = 8	n = 12
Research settings
Research laboratory		Natural environment	Treatment/Therapy/Healthcare	Mixed settings	Online intervention
n = 9		n = 14	n = 25	n = 14	n = 1
Type of intervention
Self-care		Music therapy	Guided intervention	Mixed
n = 17		n = 18	n = 17	n = 11
Main outcomes studied
Effects of music on chronic pain		Effects of music on concomitant conditions	Effects of music on chronic pain and concomitant conditions
n = 25		n = 4	n = 34

Data were organized based on a content analysis of the results. Specifically, we categorized data based on the main reported effect of music, whether it was on pain itself and the use of opioid medications, or on concomitant conditions including psychological, emotional, and social dimensions of well-being.

4. Results

Based on our research strategy, we found 903 results. After the elimination of 63 duplicates, 840 articles were screened based on their titles and abstracts, from which 698 were excluded because they did not meet the eligibility criteria (i.e., 392 articles were out of scope, 40 pertained to conditions and populations other than chronic pain, 22 were written in languages other than English or French, 35 reported no research data, and 209 were duplicates). Based on a complete reading of the remaining 142 articles, 84 more were excluded for similar reasons. As a result, 58 research articles were included in this scoping review. We also included 5 more articles that were identified using a snowball technique through other articles’ reference lists, for a total of 63 articles included in our analysis (see the complete flowchart in Figure 1).

Among the eligible studies, 38 were quantitative, including 17 randomized controlled trials, 13 experimental research, 4 correlational studies, 1 longitudinal, 1 quasi-experimental and 2 case studies. The scoping review also includes 5 qualitative studies, 8 mixed-methods studies, and 12 literature and systematic reviews. To organize the results section, each study was classified based on its main research outcomes. Accordingly, 25 studies examined the effect of music on chronic pain, 4 explored the effect of music on difficulties concomitant with chronic pain (e.g., mental health), and 34 studies examined both the effects of music on chronic pain and concomitant difficulties. To deepen our analysis of each thematic, we further explored the effects or influences of music while considering the type of music intervention used and the context of music use. The description of each theme is followed by a critical analysis of the results’ implications and limitations in terms of applied knowledge and practices.

4.1. Effects of music on chronic pain

Among the 25 studies that examined the effects and influences of music on chronic pain, 20 used quantitative methods (i.e., mostly experimental, randomized controlled trials), 3 were literature reviews, and 2 were mixed studies. In these studies, the effect of music on pain was examined in different contexts, including healthcare settings, during therapeutic treatments, in individuals’ natural environment, and in experimental laboratory settings.

Nine studies explored the effect of music on pain specifically in the context of healthcare settings. The results of these studies suggest that different modalities of music intervention have heterogeneous effects in reducing the intensity of pain. Interventions based on music listening significantly contributed to reduce the level of pain intensity in some chronic pain patients [52–55]. However, this tendency did not hold for all chronic pain patients and the benefits of listening to music did not always last beyond therapeutic sessions [53,56]. Some studies also focused on active means of engaging in music therapy. For example, a study conducted in a therapeutic context aimed to evaluate the effect of music therapy sessions on chronic pain [57]. In this experimental research, music interventions mostly relied on individuals’ active involvement in music, through active music listening, lyrical analysis, practice of musical instruments, singing or music composition. This study showed that the intervention was largely accepted by patients, and that the music therapy exercises allowed to moderately reduce pain intensity, from the first intervention session. According to participants, this reduction in pain was explained by a better capacity to relax, to express their feelings relative to the experience of pain and to distract themselves from the pain [57]. Coherently, Bradt [29] reported that music therapy was highly accepted by patients as demonstrated by low attrition rates over an 8-week intervention [29]. Moreover, receiving daily music therapy, compared to other forms of weekly therapies (e.g., physical therapy and psychotherapy), was estimated to be among the most successful means to decrease pain intensity [58]. Music-based interventions were also particularly adapted to patients with lower education and lower quality of life, as they tend to benefit more from music therapy compared to other patients [59].

Regarding the use of music in everyday life and outside therapeutic and healthcare services, research has shown that music was one of the most common non-pharmacological method used by people who experience chronic pain to act autonomously on their pain experience [60–62]. In this context, some studies in which music interventions were developed by professionals but self-administered by chronic pain patients in their own living context showed that daily listening to self-selected music effectively contributed to reduce pain intensity [52,63]. In addition, some studies demonstrated that listening daily to self-selected music led chronic pain patients to experience a reduction in sensory, affective and perceived pain intensity [61,64–66]. For example, two of them involved listening to music selected by the researchers daily during a period ranging from 14 to 28 days [64,65]. In addition to decreasing the intensity of chronic pain, these studies suggested that this effect did not fade over repeated use. Rather pain intensity kept decreasing as participants continued to listen to music daily [64,65]. However, despite that music may reduce pain intensity, this does not necessarily translate into an improvement in functional capacity [64]. Another study supported that this effect can be observed after having listened to music for 20 min [67] and was most effective when it was self-selected and corresponding with individuals’ preferred music [67].

Other studies were conducted specifically in controlled research laboratory settings [67]. Among these studies, two consisted of actively listening to music, while the researchers were performing guided mental imagery or transmitting positive suggestions [68,69]. In coherence with previously discussed studies that included active forms of music therapy, guided music listening strategies also led to decreased pain intensity [68,69]. As for the other studies led in experimental settings, they were all focused on the effects of music listening on chronic pain. For example, Zhang et al. [70] conducted a study in which they analyzed the neurophysiological and physical effects of music listening on pain relief. In this study, they found that compared with a control group, the group who were exposed to music showed lower activation in response to a pain stimulus. Participants also reported that the music intervention helped to distract themselves from the pain and to relieve themselves [70].

However, in these studies, the environment, and especially the selection of the musical pieces was highly controlled and often selected by the researchers, which in itself may influence the effect of music on chronic pain. Indeed, the benefits of music listening seems to be limited to patient-selected music or at least to music they consider pleasant, given that studies where musical preferences were not considered showed either small effects of music on pain intensity, non-significant effects, or effects that do not last beyond intervention sessions [71–73]. Yet, studies that did consider individuals’ musical preferences and where patients could choose their own music suggested that it not only contributed to reduce pain intensity and increase pain tolerance, but it also promoted functional and motor capacities [21,74].

4.2. Effects of music on conditions concomitant with chronic pain

Four studies explored the effects of music specifically on the conditions that are frequently concomitant with chronic pain. Among them, two evaluated the effectiveness of music to reduce depression and anxiety symptoms in the context of music therapy, one sought to understand the importance of music in the person’s own living environment, and one observed the effect of non-pharmacological interventions on the amount of medications used to control the pain condition.

More specifically, Cheng [33] conducted a systematic literature review assessing the interventions meant to address depression among people who suffer from chronic pain. This review showed that music-based interventions, which sometimes include self-selected and researcher-selected music, are among the non-pharmacological treatments with the most beneficial effects on reducing depressive symptoms [33]. Namely, this review demonstrated that music therapy based on active music listening of patient-selected music efficiently contributed to promote the experience of positive moods. The practice of a musical instrument also allowed to promote relaxation and to reduce anxiety, as was the case when attending live music performed by a music therapist [75].

One study sought to understand the importance of music in the lives of people who experience chronic pain, from their own perspective and based on their daily habits [52]. In this qualitative study, participants reported that music helped them promote emotional regulation, limit the experience of negative emotions, and express negative emotions rather than repressing them. In other words, music helped to modulate and adapt one’s emotional states. Music also promoted individuals’ level of arousal, by helping them relax when needed, and by making them feel more motivated and energized when they needed to engage in physical activities. However, participants reported that music could sometimes have negative effects (e.g., irritation, negative moods, increased pain), especially when it is not self-selected [51]. Coherently, a majority of people with chronic pain report that music is important in their lives, and 50% of them listen to music daily [62]. The reasons underlying their involvement in music are mainly attributed to the benefits of music on their capacity to regulate emotions and to alleviate the burden of negative emotions [62].

Lastly, a randomized controlled trial compared the effects of two non-pharmacological interventions on the use of pain medications, one of which consisted of passively listening to researcher-selected music deemed to be relaxing. This study showed that music, compared to compassionate mind training, had no effect on medication use [76]. Nevertheless, another review suggested that music was an effective non-pharmacological and psychological intervention strategy to improve the quality of life of people with chronic pain [77].

4.3. Global perspectives about chronic pain and concomitant conditions

Thirty-four studies endorsed a broader perspective to consider at times the effects of music on chronic pain and on the conditions frequently associated with chronic pain, including global well-being and mental health.

In this perspective, nine studies were conducted in the context of music therapy. Four quantitative studies showed that listening to music helped to reduce pain intensity, anxiety and depressive symptoms, and psychosocial outcomes, so much so that some participants reduced their use of anxiolytic medications following music therapy sessions [25,78–80]. This was especially the case when patients had the opportunity to choose music that corresponded to their preferences [78]. Similarly, listening to relaxing music was also shown to reduce the intensity of negative emotions [78]. In addition, two studies used a mixed-methods design [81,82]. While the quantitative methods generally supported the efficacy of music for decreasing chronic pain intensity, qualitative methods allowed to gather knowledge about other emerging benefits of music on global well-being. Namely, those studies showed that the everyday use of music helped to reduce anxiety and depressive symptoms, to promote positive mood states, to improve feelings of self-efficacy and empowerment over the chronic pain condition, to improve participants’ capacities to take part in social events, to develop social relationships and to break isolation [81,82].

Regarding individuals’ active involvement in music, another quantitative study examined the effects of active music therapy techniques in a group of women who experience chronic pain and found that it contributed to reduce fatigue and pain perception, but most importantly, to improve relaxation, self-esteem and concentration [83]. Similarly, a qualitative study highlighted that the participation in a group singing intervention constituted a source of empowerment and an effective strategy to distract individuals from pain, to reduce pain intensity and the experience of negative emotions, all while improving physical functioning [84]. In comparison, an experimental study demonstrated that passively listening to pleasant music led to decreased pain and fatigue levels, but not more so than listening to other pleasant non-musical sounds [85].

In a literature review, Alley [36] also supported that actively engaging in the practice of a musical instrument, music composition and singing facilitated the expression of negative emotions and the communication around the experience of pain among youth with chronic pain. Music was also among the preferred and most accepted non-pharmacological strategies according to youth but also from the perspective of their surrounding [36]. Similarly, another literature review suggested that combining active involvement in music therapy and usual pain treatment contributed to reduce physical pain and psychological distress, so much so that it doubled the effect of pharmacological treatments alone [86].

Some studies examined the effects of guided music activities to promote the well-being of people living with chronic pain. In this context, research explored the effects of active involvement in music, either through active listening and guided techniques [27], or through their participation in a choir [87,88]. These studies revealed similar results as those presented above, where active participation in musical activities resulted in diminished pain intensity, improved mood, better functional and motor capacities, greater sense of power over the chronic pain condition, reduced medication use, development of new strengths and self-worth, and improved social relationships [27,87]. These results were supported by another study in which active and guided music listening led to benefits on mental health and pain improvement [89]. A literature review suggested similar results regarding formal music therapy approaches, and supported the benefits of music in reducing pain and promoting the experience of positive emotions [90]. Yet, the review also demonstrates that these benefits are sometimes small or inexistant [91].

One explanation for the heterogeneous effects of music on pain and well-being is the consideration of patients’ musical preferences. Interventions that consider patients’ preferences when selecting the musical pieces were shown to be more effective in achieving pain reduction compared to interventions where individuals’ preferences were not considered [92,93]. Another potential explanation for these heterogeneous results is the level of involvement of the patients in the intervention. For example, while active involvement in musical activities demonstrated multiple benefits on pain and well-being, passive music listening seems to show weaker and more heterogeneous results [94].

Outside intervention settings, eight studies explored individuals’ perspectives about their personal use of music as a self-management strategy and its effects in their everyday lives. According to these studies, music contributed to decrease pain intensity, anxiety, and depression, to promote emotional regulation, distraction, relaxation, and to improve concentration and cognitive abilities [37,60,95–101]. In addition, music could help patients to remind themselves of their self before pain, which was experienced as comforting and as a way to temporarily escape from their currently painful body [51].

Five more studies considered the effects of music on chronic pain and concomitant conditions as observed in the context of an experimental research setting. Among these, two literature reviews supported that music listening contributed to reduce pain intensity [30,32]. These reviews and the experimental research they discuss also support the beneficial effects of music on reducing depression and anxiety symptoms. These studies also contribute to clarify that music has its greatest effects on chronic pain and concomitant conditions when it is self-selected by the participants rather than by the researchers, and when it is familiar rather than unknown to the patients [30,32]. Indeed, most of the studies that found no benefits of music come from experimental research where music was selected by the researchers, without regards to participants’ musical preferences [30,32]. For example, [102,103] ran a randomized controlled trial using a music-based intervention where the music was selected by the researcher and found no or very little effect of music on chronic pain, mood, stress, depression and quality of life [102,103]. Nevertheless, passively listening to preferred music, compared with active musical activities, does not guarantee benefits on all dimensions of well-being [104].

5. Discussion

This scoping review aimed to assess the current state of knowledge regarding the use of music in the context of chronic pain treatment, as well as to document its effects on chronic pain and on the psychological, emotional, and social difficulties often associated with the experience of chronic pain. In that aim, we analyzed 63 studies that were published between 1993 and 2023. Literature provides important scientific support for the use of music as a non-pharmacological complementary treatment for chronic pain, at times inside healthcare and therapeutic services and in individuals’ daily lives. Research also demonstrates that pain needs to be considered as a biopsychosocial experience that requires multidimensional interventions to address at times physical, emotional, psychological, and social issues [87]. Our review demonstrates that music could be particularly beneficial not only in terms of pain management but also to facilitate the management of other issues often concomitant with chronic pain, including depression, anxiety, and social isolation. The review also highlights that music can be effective in therapeutic and healthcare contexts but can also be used efficiently on the long term to address daily needs autonomously and outside treatment services, in addition to having little side effects or access barriers. Yet, we observed that there exists few concrete examples of applied music interventions in services designed for people who suffer from chronic pain, hence limiting our knowledge about the modalities that are the most accepted, appreciated, adapted and effective for this specific population and in the different services designed for this population.

5.1. Limitations in previous research

While this scoping review allows us to better understand what is known about the use of music in the context of chronic pain experience and concomitant conditions, previous research encompass several limitations. First, we observed that music has been studied and was shown to be effective in a variety of contexts, including in music therapy treatment, experimental research settings, and in individuals’ everyday life. Yet, it either remains little applied in the context of chronic pain treatment, or received little attention from healthcare professionals in terms of supporting patients’ health-promoting strategies outside treatment services. In other words, our scoping review highlights music interventions that bring significant benefits regarding global well-being, yet they remain little applied as complementary methods to the treatment of chronic pain. As a result, research gives very little guidance about how music interventions could optimally translate into applied interventions to support people who experience chronic pain and who consult healthcare and community services.

Secondly, literature shows heterogeneous results regarding the effects of music on pain and concomitant conditions, which is mostly due to the use of heterogeneous musical parameters. On the first hand, most research explored the effect of passive music listening. While this is the most common way of engaging in music, other music modalities, such as attending live music, practicing a musical instrument, and active music listening, are known to have greater benefits for global well-being. Yet, very few research considered other potentially beneficial music modalities and how people with chronic pain could benefit from them. Hence, little remains known about how different modalities compare when it comes to chronic pain and concomitant conditions. Coherently, because most of the literature is centered on music listening, the current review does not allow us to understand the potential risks of musical practice for the development or worsening of chronic pain. For example, some studies highlighted the importance of not only looking at the potential benefits of music, but also to the potential risks of music for people with chronic pain. Namely, playing for many hours each week could have a negative impact on pain conditions [105]. It will be important to take this possibility into account in future research because interventions need to be adapted to maximize the benefits regarding the use of music in chronic pain treatment but also to keep the risks as minimal as possible [105,106].

In addition, little is known about how different modalities could be more or less adapted to the different services people with chronic pain consult or to the different environments they find themselves in. More studies are needed to determine the music-based interventions that would be optimal in supporting chronic pain treatment and that are best adapted to the different contexts this population may encounter.

The selection of musical pieces listened to in previous research is also heterogeneous. While research has demonstrated that self-selected musical pieces and music corresponding to individuals’ preferences tend to be the most effective regarding the promotion of global well-being, many studies failed to consider participants’ preferences (e.g., music genre, preferred modality of music use, be it music listening or practice). In addition, while research values strength-based approaches where individuals are encouraged to develop capacities, empowerment and autonomy, most studies include interventions that are strictly developed and guided by an intervening person or a researcher with little consideration of the individuals’ perspective, interests and autonomy. Hence, music interventions are rarely adapted to individuals’ specific needs, preferences and autonomy, which may explain some of the heterogeneous or null effects of music on chronic pain and concomitant conditions in the literature.

Finally, while many researchers aimed to develop music-based strategies as a complementary and non-pharmacological intervention in the context of chronic pain to reduce the reliance on opioid medications, the effect of music on medication reduction has been very little considered. That is, many studies suggest that music contributes to reduce pain intensity, but only few of them actually explored whether this translates into a better management of opioid medications.

5.2. Future perspective

The results of this scoping review suggest that music is an acceptable tool, appreciated by people who experience chronic pain and helpful to deal with concomitant physical, emotional, psychological and social issues, making it a promising non-pharmacological intervention strategy to promote the well-being of people with chronic pain over the long term. Additionally, anterior studies were led among different profiles of people who experience chronic pain, which suggests that music could be beneficial to numerous sub-populations whose chronic pain originate from diversified causes. However, while some music interventions performed in healthcare settings (e.g., music therapy) showed beneficial results, these often do not last long after the end of the treatment or therapeutic sessions. Rather, research shows that when individuals’ capacities and autonomy are taken into account, such as in music-based interventions where individuals are being taught to self-administer music interventions outside services, the benefits of the interventions tend to last beyond therapy sessions into individuals’ everyday lives. Hence, the ideal intervention could be a combination of a music intervention in treatment settings and a professional guidance to perform self-administered music interventions outside such services, so that individuals obtain greater benefits by developing more power and autonomy over their chronic pain condition. Yet, the manners in which such interventions could be applied, and whether they would be acceptable according to healthcare professionals and chronic pain sufferers, need to be further examined.

Another important element to consider is the way of using music as a treatment. Indeed, though research has mainly focused on music listening, different music modalities could bring different benefits on well-being [75]. Hence, future studies should also take greater account of individuals’ preferences not only regarding the musical selection itself, but also the musical modalities used, in order to gain optimal outcomes for their life conditions. A better consideration of these elements would help develop adapted interventions that are tailored to the needs and preferences of people with chronic pain, all while engaging them in an empowering process that promote control over one’s life conditions.

In order to develop and implement music-based strategies that will be effective and engaging from the perspective of people with chronic pain and intervening persons in the services designed for this population, it will be important in the future to understand which music-based interventions are the most acceptable and efficient from the perspective of these key stakeholders. It will also be important to examine how to apply these interventions in a more efficient manner in the different healthcare and community services designed for people with chronic pain. This could be achieved using rigorous feasibility, implementation and evaluation studies.

6. Conclusion

This study aims to document the effects of various music-based interventions on chronic pain and on the emotional, psychological and social issues often concomitant with the experience of chronic pain. Our scoping review suggests that the most effective music-based interventions are those that take into account the individuals’ musical preferences, and that offer a combination of interventions that are administered by healthcare professionals but that also encourage individuals’ autonomy and empowerment in developing capacities to use music in their everyday lives outside treatment services. Music-based interventions are promising non-pharmacological strategies but require further research to implement them more concretely in the services designed for people who experience chronic pain.

Funding Statement

This study is funded by the Institut Universitaire sur les Dépendances (IUD) and the Canadian Research Initiative in Substance Misuse (CRISM).

Article Highlights

• The negative consequences and the limitations associated with long-term opioid use highlight the need to develop innovative and non-pharmacological intervention strategies to support people who experience chronic pain.

• Music is a promising resource to promote physical, emotional, psychological and social well-being among people who experience chronic pain.

• The results of our scoping review suggest that music-based interventions that promote individuals’ autonomy and that account for musical preferences tend to be the most effective.

• The results also suggest that active involvement in music (i.e. lyrics analysis, practice of a musical instrument) tends to bring more benefits than passive music listening at the physical, psychological and social levels.

• Despite these encouraging results, we still find very few examples where this knowledge is applied in intervention and treatment settings designed for people with chronic pain.

• In future research, it will also be important to examine how to apply music-based interventions more efficiently in the services designed for people with chronic pain, using rigorous feasibility, implementation and evaluation studies.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Author contributions

Elise Cournoyer Lemaire: Conceptualization, methodology, formal analysis, investigation, writing – original draft, visualization, project administration, funding acquisition. Michel Perreault: Validation, writing – review & editing, supervision, funding acquisition

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17581869.2024.2435243