Accepted Manuscript

Music is an effective intervention for the management of pain: An umbrella review

Juan Sebastian Martin-Saavedra, Laura Daniela Vergara-Mendez, Claudia Talero-

Gutiérrez

PII: S1744-3881(18)30141-5
DOI: 10.1016/j.ctcp.2018.06.003
Reference: CTCP 879

To appear in: Complementary Therapies in Clinical Practice

Received Date: 20 March 2018

Revised Date: 30 May 2018
Accepted Date: 5 June 2018

Please cite this article as: Martin-Saavedra JS, Vergara-Mendez LD, Talero-Gutiérrez C, Music is an
effective intervention for the management of pain: An umbrella review, Complementary Therapies in
Clinical Practice (2018), doi: 10.1016/j.ctcp.2018.06.003.

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 ACCEPTED MANUSCRIPT

TITLE: Music is an effective intervention for the management of pain: An umbrella review
SHOR TITLE: Music for the management of pain

AUTHORS:
Juan Sebastian Martin-Saavedra, M.D. (Corresponding author).

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• Email: juans.martin@urosario.edu.co
• Affiliations: Research assistant of the Clinical Research Group. Escuela de Medicina y

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Ciencias de la Salud. Universidad del Rosario, Bogotá D.C., Colombia.
• Address: Carrera 24 # 63c-69
• Contact: + 57 1 297 0200 ext 3426

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Laura Daniela Vergara-Mendez, M.D.
• Email: laura.vergara@urosario.edu.co

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• Affiliations: Pediatrics Resident Escuela de Medicina y Ciencias de la Salud. Neuroscience
Research Group NeURos. Universidad del Rosario, Bogotá D.C., Colombia.
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Claudia Talero-Gutiérrez, M.D.
• Email: claudia.talero@urosario.edu.co
•
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Affiliations: Main professor and Coordinator of the Neuroscience Unit, Nueroscience

Resarch Group NeURos. Escuela de Medicina y Ciencias de la Salud. Neuroscience
Research Group NeURos. Universidad del Rosario, Bogotá D.C., Colombia.
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TITLE: Music is an effective intervention for the management of pain: An umbrella review
SHORT TITLE: Music for the management of pain

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ABSTRACT
Aim: This study aims to analyze and describe the effects of music listening in the management of pain in
adult patients, as reported in systematic reviews and meta-analysis.
Methods: A search of articles published between 2004 and 2017 was conducted on Pubmed,
ScienceDirect, Scopus, SCIELO, SpringerLink, Global Health Library, Cochrane, EMBASE and
LILACS. Search, quality assessment, and data extraction was done independently by two researchers.

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Results: Most of reviews found a significant effect of music on pain. All analyses had a high
heterogeneity, and only acute pain and music delivered under general anesthesia had moderate
heterogeneity. No differences were found when music was chosen by the patient. Music type and its

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characteristics are scantly described and in terms that lack validity.
Conclusions: More focused trials and reviews, objective language for music, and trials with music chosen

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by its characteristics are required.
KEYWORDS
Music; Music Therapy; Pain; Pain Relief; Music characteristics; Review.

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1. INTRODUCTION

The International Association for the Study of Pain (IASP) defines pain as an unpleasant sensory and
emotional experience associated to an actual or potential tissue damage (1). Pain is one of the main
symptoms and burdens in clinical practice (2), and the complexity of its management has motivated the
study of complementary therapies (defined as “health care approaches with a history of use or origins
outside of mainstream medicine”) (3).

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The American Music Therapy Association has defined music therapy as the use of music by a certified
professional (defined as an individual who has completed an approved music therapy program) for the
accomplishment of specific therapeutic goals (4, 5). Music therapy can be active (the patient participates

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through singing or playing an instrument during the intervention) or passive (the patient only listens to
music) (4-6). Music listening involves different areas related to pain modulation like periaqueductal gray
matter, spinal networks, primary somatosensorial cortex, cingulate cortex, and others (7-12). Additionally,

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music modifies brain activity during pain stimulation (13), supporting its analgesic effect. As a result,
listening to music has been proposed as a complementary therapy for pain (14).
The present study’s objective is to summarize the evidence on the effects of music listening as a

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complementary therapy in the management of pain of adult patients, according to what has been reported
in systematic reviews and meta-analyses in the last twelve years. Particularly, this paper aims to analyze
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the effect of music on different kinds of pain, the description and reporting of the music listening
intervention, and if any conclusions on the type of music or music characteristics have been reached.
2. METHODS
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2.1 Study design

The main search protocol was done with the following pre-defined search criteria: controlled trials,
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systematic literature review or meta-analysis, published from 2004 to July 2017 in Spanish, English,
French, Italian and German. Two studies were conducted, a systematic review and meta-analysis of
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randomized clinical trials, and this umbrella review. Umbrella reviews (also known as overview of
reviews) are a recently developed method to summarize, and analyze systematic reviews. This type of
review is based on a planed and structured comprehensive search, similar to traditional systematic
reviews, but it searches systematic reviews instead of clinical research (e.g. Clinical Trials). Currently, no
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widely used guidelines exist to carry out this type of review. However, we followed the recommendations
of the PRISMA statement for search strategy design, and made use of the AMSTAR tool for quality
assessment. Another related issue is that it is a summary of summaries, so specific information may not be
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described (15). As the main search protocol was designed with the PRISMA guidelines, the methodology
was adapted for Umbrella Reviews.
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2.2 Search strategy

The search was constructed based on the 2010 PRISMA statement (16). The MeSH terms music, pain and
music therapy; and the non-MeSH terms pain relief, music-supported therapy, instrumental music, slow
music, rapid music, music mode, pleasant music, unpleasant music, music tempo, music tonality, pitch
range music, and musical structural features were used. The search was performed on Pubmed, Scopus,
SCIELO, SpringerLink, Global Health Library, Cochrane (through OVID), EMBASE, and for a broader
search ScienceDirect and LILACS were also searched as they include gray literature. The search was
refined by means of each search engine’s filters, if this functionality was unavailable, they were included

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as additional search terms, as follows: (“music” AND “pain”) AND (“systematic review” OR “meta-
analysis” OR “clinical trial”) AND adults.
2.3 Duplicate search and study selection
JSMS and LDVM undertook continued surveillance of literature and results from the search were
imported to EndNote™ and duplicates were eliminated. JSMS and LDVM checked titles and abstracts to
eliminate all studies that weren’t clinical trials, systematic reviews or meta-analysis. Abstracts were then

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reviewed, and studies were eliminated according to inclusion and exclusion criteria (see figure 1).
Systematic reviews, Cochrane reviews or meta-analyses of music interventions used for pain relief were
included in this review. Studies that did not evaluate music’s effect on pain, that only included studies

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combining music with other therapies (e.g. Music and guided imagery), or that only included studies not
evaluating pain with a quantitative tool, were excluded.

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2.4 Quality assessment
JSMS and CTG assessed quality for all included articles independently using the Systematic Reviews and

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Meta-analysis Notes for completion checklist (SIGN tool) (based on the AMSTAR checklist (17)). A third
author resolved discrepancies. The assessment was done as follows: if a ‘yes’ was marked, a point was
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given, if ‘no’ or ‘can’t say’ were marked no points were given. When ‘does not apply’ was marked, no
points were given but the item was removed from the possible max score. If the final score was 80-100%
quality was marked as 3 (high quality or very low risk of bias), 65-80% as 2 (acceptable quality or low
risk of bias), 50-65% as 1 (low quality or high risk of bias), and ≤ 50% as 0 (unacceptable quality or very
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high risk of bias) (see table 1).

2.5 Data collection

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The following data was extracted by JSMS and CTG from each article: 1. Authors; 2. Title; 3. Year; 4.
Quality; 5. Type of pain, acute defined as any pain that lasted less than 3 months or chronic, defined as
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any pain of at least 3 months in duration; 6. Cause of pain, defined as procedural (diagnostic or surgical
procedures), oncological, labor, neuropathic, or other (e.g. experimental pain); 7. Summary measurements
(only for meta-analysis); 8. Intervention characteristics (delivery type, duration, timing, and music
selection); 9. Music type (how music is described and if music characteristics like tempo, harmony,
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instrumentation or other were used); 10. General conclusions regarding the effect on pain, analgesic use or
sedative use by music, and how music type or characteristics affected this effect.

2.6 Data analysis

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Only descriptive synthesis of results was done. No quantitative analysis was performed, and results of this
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type are presented as published by the original authors.

3. RESULTS

The full text of 128 articles was analyzed, of which 109 clinical trials were excluded (see supporting
information on TableS1), so a total of 19 reviews were evaluated. Six were excluded for the following
reasons: one included studies that only evaluated music in combination with other interventions (18), four
did not include music listening studies (19-22), and one was published before 2004 (23). A final sample of
13 reviews (6, 24-35) was included for quality assessment and analysis (see figure 1).
Figure 1. PRISMA (36) flow diagram

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3.1 Quality assessment

A total of five studies (26, 31-34) (38.46%) were of unacceptable quality, one (35) (7.69%) was of
acceptable quality, and seven (6, 24, 25, 27-29) (53.85%) were of high quality. Risk of selection bias was
identified in nine (69.23%) reviews that did not list excluded studies (26-29, 31-35) and in five (38.46%)
as selection of studies was not done by two people (25, 26, 31-33). Publication bias was identified in eight
(61.54%) that did not search for gray literature (6, 26, 27, 31-35), and in six in which this bias was not

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evaluated (25, 26, 31-34). Attrition bias exists in four articles (30.77%) as two researchers did not perform
concurrent data extraction (26, 31-33). Risk for false result was identified in six studies (46.15%) due to
not considering article quality in the analysis (26, 28, 31, 32, 34, 35), and in four (30.77%) that did not
evaluated quality at all (26, 31, 32, 34). Risk for other biases were present in six reviews (46.15%) where

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authors did not declare conflicts of interest (24, 26, 31-34) (see table 1).
Table 1. Quality assessment

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3.2 Study characteristics
The included reviews searched studies from 1898 (27) to January 2016 (30). All studies searched and
included randomized clinical trials (RCT) (6, 24-35), and some included other controlled trials (31, 34),

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quasi-experimental (31, 32), and repeated measures studies (31). Six reviews included only research on
adult population (24, 26, 27, 32-34), five included both adult and pediatric population (6, 25, 28-30), and
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two did not specify population characteristics (31, 35). Excluding the studies that did not specify
population, the number of included studies of music listening in adults ranged from 8 to 73. Three reviews
did not specify the number of allocated individuals per group, therefore the number of participants
exposed to music listening could not be determined (32, 34, 35). The total number of individuals that were
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exposed to music listening ranged from 357 to 3095 (see table 2).
Music listening was compared with treatment as usual (6, 24-33, 35), silence (34), music combined with
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other interventions (31-33, 35), active music therapy (29, 30) and other non-pharmacological interventions
(6, 25-27, 31, 33-35). All studies evaluated pain intensity or relief (6, 24-35) and some evaluated sedative
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or analgesic use (24, 25, 27, 28, 31-33, 35) (see table 2).
Table 2. Characteristics of included studies
3.3 Effect on pain relief
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Six of the reviews performed a meta-analysis (24, 25, 27-30) and all of them had a high quality
assessment. The rest (n=7) only did qualitative summary of results, and of those only one was of high
quality (6), one was of acceptable quality (35), and the other five were of unacceptable quality (26, 31-34)
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(see table 1).

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Five of the six meta-analyses found that music had a significant effect on pain reduction compared to
controls (25, 27-30). Except for one study (28), all meta-analyses reported heterogeneity (25, 27, 29, 30)
the smallest being in oncologic pain (I2= 65.07%) (29), and the highest in acute postoperative pain
(I2=92%) (27) (see table 3). Two reviews reported a meta-regression (25, 27), and one a sensitivity
analysis (29) but heterogeneity remained high. A sub-group analysis by Cepeda et al. found a significant
effect of music on acute pain reduction (MD -0.56, CI 95% [-0.82, -0.29]) with an acceptable
heterogeneity (I2= 34.9%) (25) (see table 3).
One meta-analysis evaluated different types of pain together, finding a small but significant effect (MD -
0.4, CI 95% [-0.7, -0.2]) (25). The only meta-analysis that did not find a significant effect evaluated pain

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during colonoscopy (-0.46, CI 95% [-0.98, 0.07]) (24), contrary to this, Wang et al. found a significant
effect on pain secondary to endoscopic procedures including Colonoscopy (WMD -1.53, CI 95% [-2.53, -
0.53]) (28). Tsai et al. and Bradt et al. evaluated oncologic pain, finding a significant effect (SMD -0.91,
CI 95% [-1.46, -0.36] and SMD -0.656, CI 95% [-1.016, -0.295] respectively) (29, 30). Only one meta-
analysis focused on postoperative pain, finding a significant effect (SMD -0.77, CI 95% [-0.99, -0.56])
(27) (see table 3).

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Of the reviews describing qualitative synthesis only, two did not find that music had a significant effect on
pain on most of their included studies (6, 31). Two reviews evaluated acute and chronic pain; one included
14 studies and in 9 of them (64.29%) found a significant effect (26) and the other one included 4, finding a
significant effect in 3 (75%) (34). Nilsson et al. evaluated post-surgical pain finding a significant effect of

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music in 13 of 22 studies (59%) (33), similarly another review found a significant effect in 15 of 18
studies (83.3%) (32) (see Table 3).

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One review reported that music groups used significantly less morphine than controls (MD -0.48, CI 95%
[-0.85, -0.12], I2= 55.9%) (25), and another that they used lower doses of analgesics (SMD -0.37, CI 95%
[-0.54, -0.2], I2= 75%) (27). No differences in meperidine (WMD -5.27 CI 95% [-13.96, 3.41], I2= 81.3%)
or midazolam use (WMD -0.55; CI (95%) [-1.21, 0.10]; I2= 89.1%) (24), and no differences in analgesic

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(WMD -8.44, CI 95% [-19.23, 2.34]) or sedative use (WMD -0.53 CI 95% [-1.39, 0.33]) in colonoscopy
procedures were identified (28). Among reviews reaching qualitative synthesis only, results were
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contradictory (31, 33).
Table 3. Study results
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3.4 Characteristics of the intervention

Among the described results, four types of delivery mechanisms were identified (see table 3), headphones
(6, 26-28, 30-33), speakers (27, 28, 30, 33, 35), music pillow (27), live music (26, 30, 32, 34), and three
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reviews did not specify any (24, 25, 29). One review exclusively searched studies using live music
preferred by the patient (34). The duration of the music intervention was described in six reviews (26, 27,
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29, 30, 33, 35), ranging from 5 minutes to 4 hours (27, 30, 33). In three reviews, the music intervention
was described as matching that of the procedure being carried out (27, 30, 33). Eleven reviews specified
who selected the music (6, 24, 26, 27, 29-35). Regarding the timing of the music intervention on
procedural acute pain, music was delivered exclusively before, during, or after the procedure, or as a
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combination of these (6, 27, 28, 32, 35).

Sub-group analyses found no significant differences when music was picked by patient or researcher (25,
27, 30). Hole et al. did sub-group analyses finding that the effect on pain was greater when music was
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delivered before (SMD -1.28, CI 95% [-2.03, -0.54], I2=94%) than during (SMD -0.89, CI 95% [-1.2, -
0.57]), I2=92%), or after surgery (SMD -0.71, CI 95% [-1.03, -0.39], I2= 87%). Additionally, music had a
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greater effect on postoperative pain of patients that were conscious throughout the procedure (SMD -1.05,
CI 95% [-1.45, -0.64], I2=94%), with a smaller, but significant effect, when subjects were under general
anesthesia (SMD -0.49, CI 95% [-0.74, -0.25], I2=25%) (27). No other sub-group analyses or conclusions
regarding the characteristics of the intervention were reported.
3.5 Music type and music characteristics
Most of the reviews described the music used in their included studies using musical genre, song name,
artist, or personal descriptions like “relaxing”, “soothing” or “easy listening” (24, 26-28, 30-33, 35). Three
reviews failed to describe, in any form, the type of music used (6, 25, 34). Only six of the reviews
included studies that described at least one music characteristic, but the number of patient groups exposed
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to music described in terms of music characteristics was very small per review (see table 3) (26, 27, 30,
32, 33, 35). The only music characteristics described were a tempo of 60-80 bpm (26, 27, 30, 33) or under
120 bpm (35), music without lyrics or instrumental (26, 27, 32, 33), and music with a sustained melody
(26). No analyses or conclusions were done regarding music type or music characteristics.
4. DISCUSSION

The majority of the included reviews in this study concluded that music has a significant effect on pain

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intensity (25-30, 32-34), even when unacceptable quality reviews are excluded the majority are meta-
analyses and support the analgesic effect (25, 27-30). Despite that the effect of music on pain was
relatively small in some studies (see table 3), no adverse events were reported. Therefore results from

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these reviews are strong enough to consider music a clinically significant complementary therapy to be
used for the management of pain (6, 24-35).

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This study has some limitations, the most important being that it is an umbrella review, or review of
systematic reviews, which is a relatively new methodological approach for the analysis of summarized
evidence. Nonetheless, systematic reviews and meta-analyses have steadily increased in number (37) and
strategies to analyze these types of studies are required (15). As mentioned before, umbrella reviews lack

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clear guidelines. However, to address this, established guidelines (PRISMA, AMSTAR) were used to
carry out portions of this review (15). Finally, only articles published in the last twelve years were
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searched.
Pain is a complex clinical condition, and music is also a complex form of intervention, so the research of
both things can be highly complex. In such complexity, the high heterogeneity reported by the meta-
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analyses is expected and mandates a detailed analysis (24, 25, 27, 29). When heterogeneity is high, results
must be analyzed with caution as some variables might be affecting the statistical effect of one or more
studies (38). These variables can be related to clinical environment, population, intervention, or
measurement methods (37-39). It is important to highlight that all studies reported heterogeneity using I2,
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this statistical approach is useful as it includes the proportion or number of studies in its calculation,
avoiding the sample size limitation of other formulae (40).
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Conceptual homogeneity is expected when adequate, focused and specific research question and inclusion
criteria are used (37, 39). All meta-analysis use adequate and well formulated questions, but there are
some differences on how focused their questions were. Cepeda et al. searched for all types of pain, in
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children and adults, of both sexes and didn’t specify clinical context (25). Hole et al. addressed their
research question to acute postoperative pain in adults (27) without specifying the type of surgery. Bradt et
al. and Tsai et al. focused on cancer pain in both children and adults (29, 30), but one included pain
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secondary to procedures (except biopsies) (30). The other two evaluated pain related to endoscopic
procedures (24, 28), one did not specify type of endoscopic procedure or population (28), and Bechtold et
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al. focused on adult patients undergoing colonoscopy (24). In consequence, it should be expected a
smaller heterogeneity in the study by Bechtold et al. and higher in Cepeda’s, but both were equally
heterogeneous (I2= 84.7% and 84.9% respectively).
Heterogeneity can be addressed by means of a meta-regression, and sub-group or sensitivity analyses (37,
39). However, meta-regressions failed to identify a factor that could explain observed heterogeneity (25,
27), suggesting that the cause was a non-described variable. Cepeda et al. found that listening to music
had a significant effect on acute pain (I2=34.9%) (25), and Hole et al. a significant effect on postoperative
pain when music was delivered under general anesthesia (I2= 25%) (27). These sub-group results show

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moderate heterogeneity (38) and constitute the only significant reduction from the high heterogeneity
observed in all other analyses, suggesting that the grouping variable of acute pain might be of interest.
Results from this review show that the duration of music and timing of music is highly variable among
RCT’s (see table 3). Only one review performed a sub-group analysis on the timing of music delivery
finding a greater effect on pain when music was delivered before surgery than during, and the smallest
effect when delivered after, all three analyses with high heterogeneity (27). Sub-group analysis for music

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selection found no differences when the patient or the investigator chose music, and the heterogeneity
remained high (25, 27, 30). A meta-regression included the duration of the intervention as a covariate,
failing to identify the source of heterogeneity (27). In most of the RCT’s music was delivered by
headphones (see table 3), so it is highly unlikely that this is the reason for the observed heterogeneity.

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These findings prove that music as an intervention is highly variable and complex, therefore replicability
would be difficult. It is important to highlight that no differences on music selection were identified in this

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review. In consequence, music selected by the researcher can be as effective as the one selected by the
patient. For the sake of research, music selected by researcher will allow the use of highly controlled
interventions so specific conclusions related to the intervention can be reached. Nonetheless, selecting
music might be extremely difficult due to music’s complexity and variety.

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Music listening is considered a passive music intervention, and depending on the selection process can be
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considered a music therapy or music medicine intervention. If a certified music therapist is involved in the
process of selecting the song or songs, the intervention should be considered music therapy, if no music
therapist was involved, it is music medicine (4-6). It is hard to define what a certified music therapist is,
what level of formation they should have, or more importantly, if the formation is appropriate enough for
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music selection for a specific goal on a complex condition like pain. The complexity is larger for music
medicine, where no music therapist is involved.
Robb et al. published in 2011 reporting standards for music interventions (41). One of the main points in
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this paper is the appropriate description of the music intervention (Item 4B), but it does not provide an
objective language for this. It suggests that proper reference to the music sheet or recording used is the
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most adequate option, nonetheless those without music knowledge won’t be able to replicate, describe or
understand the intervention. Proper analysis of music description and reporting was an appropriate step on
music based interventions research, especially for music listening interventions.
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As shown in Table 3, music type was described mostly in terms of genre or other subjective characteristics
(e.g. “relaxing music”), and it was unusual for two studies to use the same type of music. Describing
music in in these terms lack validity and universal interpretation (42). This supports the need of a more
objective approach to describe music.
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Music theory is a discipline dedicated to the study of music and its components. According to it, music is
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defined as the organized combination of sound, which can be described in terms of musical organization
(harmony or melody), metrical organization (rhythm and its components), and sound related properties
(volume and pitch) (43, 44). For example, all melodies and harmonies are constructed under a scale or
mode that can be classified as major or minor (43, 45), and all rhythms have a defined tempo/pulse (46).
In consequence, two songs of the same genre can have very different melody and tempo, and two songs of
different genres can have similar melodies and tempo. Concepts used by music theorists are objective and
allow replication; therefore it is an appropriate language to be incorporated in the conduction and
reporting of music related research.

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Many authors have suggested that these characteristics are crucial for accomplishing specific therapeutic
goals (4, 14) and have highlighted the need for controlled musical interventions (4, 9, 47). This is
supported by the finding that neuronal networks activated by three pieces of Guquin music were different
on male subjects (10). Different cortical areas have been related to pain modulation (19), and music seems
to activate these structures (7, 11-13), supporting music’s pain modulatory effect.
These results show that music characteristics (like tempo, harmony and others) are not used in the

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selection of musical interventions for pain, nor are they described by authors of clinical trials. Although
reporting standards for music interventions exist (41), none of the reviews acknowledged their existence,
nor did they incorporate them into the quality assessment process. Therefore, no analyses or conclusions
can be reached regarding music characteristics. Complexity of both, music and pain, explains the results

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from this review, and proves that the research of music listening has come a long way, but there is still
much to do in the future.

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5. CONCLUSIONS

The low risk of bias in the included meta-analyses, the fact that the effect of music on pain was significant
despite multiple analyses, and that no secondary effects were described, evidence from these reviews

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support its use as complementary therapy for acute (surgical and procedural) and cancer pain relief. Due to
high heterogeneity it is unclear the specific pathologies or clinical context where it should be used.
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Researchers are not describing music objectively; neither are they taking into account music
characteristics like musical mode, tempo, consonance, and others when choosing the musical intervention.
This review proves that the research of music listening interventions has come a long way, but
replicability of interventions is still lacking. Problems with replicability may be secondary to how
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researchers are reporting and describing music, which may improve by incorporating the language and
concepts of music theory.
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ACKNOWLEDGEMENTS: The authors thank Dr. Ivan Felipe Pradilla Andrade for his support in
proofreading of the manuscript.
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Research Funding: No funding was received for this paper.

Conflict of Interest: No conflict of interest exist.
Data Statement: Data is presented through the text’s tables, figures and supplemental data, but if more
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information is required please contact the corresponding author.

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13. Dobek CE, Beynon ME, Bosma RL, Stroman PW. Music modulation of pain perception and pain-

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14. Huang S-T, Marion. Listening to music as a noninvasive pain intervention. Journal of

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Communication Research. 2013;5(3):105-30.
15. Aromataris E, Fernandez R, Godfrey CM, Holly C, Khalil H, Tungpunkom P. Summarizing
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17. Hamel C, Andersson N, Boers M, Wells George A, Grimshaw Jeremy M, Shea Beverley J, et al.
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reviews. BMC Medical Research Methodology, Vol 7, Iss 1, p 10 (2007). 2007(1):10.

18. Bardia A, Barton D, Prokop L, Bauer B, Moynihan T. Efficacy of complementary and alternative
medicine therapies in relieving cancer pain: A systematic review. JOURNAL OF CLINICAL ONCOLOGY.
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2006;24(34):5457-64.
19. Apkarian AV, Bushnell MC, Treede R-D, Zubieta J-K. Human brain mechanisms of pain perception
and regulation in health and disease. European Journal of Pain. 2005;9:463-84.
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20. Huntley AL, Coon JT, Ernst E. AJOG Reviews: Complementary and alternative medicine for labor
pain: A systematic review. American Journal of Obstetrics and Gynecology. 2004;191:36-44.
21. Smith CA, Collins CT, Cyna AM, Crowther CA. Complementary and alternative therapies for pain
management in labour. Cochrane database of systematic reviews (Online). 2006(4):CD003521.
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22. Matthew S, Antonio D, Assal H. The Pleasures of Sad Music: A Systematic Review. Frontiers in
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23. Pan CX, Morrison RS, Ness J, Leipzig RM, Fugh-Berman A. Complementary and alternative
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24. Bechtold ML, Puli SR, Bartalos CR, Marshall JB, Roy PK, Othman MO. Effect of Music on Patients
Undergoing Colonoscopy: A Meta-Analysis of Randomized Controlled Trials. DIGESTIVE DISEASES AND
SCIENCES. 2009;54(1):19-24.
25. Cepeda MS, Carr DB, Lau J, Alvarez H. Music for pain relief. Cochrane database of systematic
reviews (Online). 2006(2):CD004843.
26. Cole LC, LoBiondo-Wood G. Music as an Adjuvant Therapy in Control of Pain and Symptoms in
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27. Hole J, Ball E, Hirsch M, Meads C. Music as an aid for postoperative recovery in adults: a
systematic review and meta-analysis. LANCET. 2015;386(10004):1659-71.
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NURSING. 2014;37(6):E35-E50.
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31. Dunn K. Music and the reduction of post-operative pain. Nursing Standard. 2004;18(36):33-9.

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32. Engwall M, Duppils GS. Original Article: Music as a Nursing Intervention for Postoperative Pain: A
Systematic Review. Journal of PeriAnesthesia Nursing. 2009;24:370-83.
33. Nilsson U. The Anxiety- and Pain-Reducing Effects of Music Interventions: A Systematic Review.

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AORN Journal. 2008;87:780,2,5,97-,2,94,807.
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The Arts in Psychotherapy. 2016;49:1-7.
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Meaning of a Summary Estimate in a Meta-analysis. ANNALS OF INTERNAL MEDICINE. 2017;167(4):275-
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41. Robb SL, Carpenter JS, Burns DS. Reporting Guidelines for Music-based Interventions. JOURNAL
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Benemérita Universidad Autónoma de Puebla; 2011.

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2001. p. 36.
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2015;101(3):319-26.

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Figure 1. PRISMA (36) flow diagram

Identification

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Records identified through
database searching
(n = 6070)

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Records after duplicates removed
(n = 3815)
Screening

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Records screened or abstract for not being
(n = 3815) systematic reviews or
trials
(n = 3687)
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Full-text articles assessed Full-text articles excluded,

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for eligibility with reasons

Eligibility

(n = 128) (n = 115)
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109 clinical trials or other

1 included studies that

mixed music and other
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form of therapy

4 didn’t include music

listening studies
Included

Studies included in 1 published on 2000

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qualitative synthesis
(n = 13)

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Table 1. Quality assessment using RSL-SIGN

Authors Year 1 2 3 4 5 6 7 8 9 10 11 12 Score Max FINAL

Yinger et al. 2015 11 12 3

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Wang et al. 2014 10 12 3
Bechtold et al. 2009 11 12 3
Tsai et al. 2014 11 12 3

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Dunn K. 2004 3 11 0
Hole et al. 2015 10 12 3

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Engwall et al. 2009 3 11 0
Cole et al. 2014 3 11 0
Cepeda et al. 2006 10 12 3

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Silverman et al. 2016 5 11 0

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Subothini et al. 2015 7 10 2
Bradt et al. 2016 12 12 3
Nilsson U. 2008 5 11 0

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No/Can't say
Does not apply

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Yes

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Table 2. Characteristics of included studies

Review Dates Population Includ Total Intervention Comparison Type of Studies Outcomes Limitations
searched ed participa
studies nts
Bechtold 1966 - 2006 Adults 8 357 Music Usual care Randomized controlled Pain intensity, sedative Pain measurement tool not

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2009 undergoing listening trials use, midazolam mean specified; High heterogeneity
Colonoscopy doses, meperidine mean
doses
Cepeda 1966 - Oct Patients with 43a 1533a Music Usual care, other Randomized controlled Pain intensity, pain Too many outcomes and

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2006 2004 acute, chronic, listening pharmacological or trials relief, analgesic use clinical settings evaluated
neuropathic, non pharmacological together; High heterogeneity
cancer, or interventions

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experimental
pain
Cole 2014 2005-Mar Adults on an in- 14 574 Music Usual care, patient Randomized controlled Pain intensity Outcomes not previously
2011 patient setting listening; teaching, relaxation, trials established; Results presented

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Music resting as summary of studies
therapy

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Dunn K 1999-2004 Patients on 10b 904b Music Usual care, music + Randomized controlled Pain intensity, analgesic Population and comparison not
2004 post-operative listening other, resting, trials, controlled trials, use pre-defined; No clear inclusion
pain relaxation, noise quasi-experimental, criteria; Search limited only to

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control repeated measures the US and UK; Studies only
summarized
Hole 2015 1898- Oct Adults 73 3095 Music Usual care, other non Randomized controlled Pain intensity, analgesic High heterogeneity; Forrest

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1, 2013 undergoing listening pharmacological trials use plot for specific analysis not
surgery except interventions shown
CNS

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Nilsson 1955 – Jan Adults 42 1609 Music Usual care, other non Randomized controlled Pain intensity, analgesic Only articles in English were
2008 2007 undergoing listening pharmacological trials use, sedative use included; No specific
surgical interventions, music + qualitative analysis done
procedure other, white noise
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Subothini Until Apr Patients with 5b 329b c Music Usual care, pink noise, Randomized controlled Pain intensity, analgesic Only articles in English and in
2015 17, 2015 Osteoartritis or listening; music + vibratory trials use peer reviewed; Studies only
Fibromyalgia Music stimuli, vibratory summarized; Intervention
therapy stimuli allocation not specified
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Silverman 2000-2014 Medical in and 8 370c Patient Pink noise, silence Randomized controlled Pain intensity Only articles in English; Pain
2016 outpatients preferred trials, pre-posttest measurement tool not specified
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live music clinical trials

Tsai 2014 2002 – Dec Cancer patients 16a 593a Music Usual care, active Randomized controlled Pain intensity, pain Funnel plot not shown; Small
2012 listening; music involvement trials distress number of studies included for
Music pain meta-analysis.
therapy
Bradt 2016 1950 – Jan Cancer patients 32a 1928a Music Usual care, 60 cycle Randomized controlled Pain intensity Meta-analysis included studies
2016 not undergoing listening; hum listening, music trials that evaluated active music
biopsy or Music therapy, noise control, therapy
aspiration. therapy guided imagery,
resting

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Engwall 1998 – Adult patients 18 1604ⱡ Music Usual care, jaw Randomized controlled Pain intensity, pain Only articles in English were
2009 2007 on listening relaxation, music + trials, quasi-experimental distress, analgesic use included; Nine of the included
postoperative other intervention, studies were done by 2 authors;
pain headphones with no Three studies were secondary
music, resting, guided analysis of another one
imagery

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Yinger 1975 – Adults or 36a 1662a Music Usual care, guided Randomized controlled Pain intensity Only articles in English were
2015 2014 children (3 year listening imagery, headphones trials included
or older) with no music,
undergoing relaxing suggestion,

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medical massage, audio book
procedures
Wang 2014 Until Jul Patients 19a 993a Music Usual care Randomized controlled Pain intensity, analgesic No forest plots shown; No

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2013 undergoing listening trials use heterogeneity evaluation
endoscopic
procedures
a. Search included studies with pediatric population or didn't specified age in their results so number of studies and patients were adjusted to only adults
b. Population characteristics weren't specified so it is not known if pediatric population was included

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c. Number of subjects allocated to music intervention wasn't specified for any study so the total of the sample per study was used

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Table 3. Study results

Review Type of Music type Music delivery Music Quantitative results (meta-analysis only) General conclusions
pain election
(cause)
Bechtold Acute pain Relaxing Enya (n=1); Not specified Duration not specified. Selected by Pain reduction: SMD (random) = -0.46; CI (95%) No significant differences for pain scores,

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2009 (procedural) (n=2); Turkish classical (n=1). patient (n= [-0.98, 0.07]; I2=84.7% midazolam or meperidine dose changes were
Timing was prior or 2); Selected Midazolam doses: WMD (random) = -0.55; CI found.
during procedure (not by (95%) [-1.21, 0.10]; I2= 89.1%
specified) researcher Meperidine doses: WMD (random) = -5.27; CI All meta-analysis had very high heterogeneity (>

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(n=2) (95%) [-13.96, 3.41]; I2= 81.3% 80%) .

Characteristics of music like tempo, harmony, or

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other weren’t described or used for analysis.

Characteristics of intervention delivery weren’t

specified or used for analysis.

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No conclusions on music type or music election
were reached.

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Cepeda Acute Not specified Not specified Patient Pain reduction all studies: MD-0.4 (0-10), CI Music favors pain and morphine reduction.
2006 (procedural, selected (95%) [-0.7, -0.2)], I2= 84.9%
experimenta (n=18) Pain reduction in adults: MD (random) -0.01, Heterogeneity was very high in all meta-analysis
l, labor) Investigator CI (95%) [-0.09, 0.07], I2= 85.3% except for acute pain, with the effect favoring

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pain, and selected Acute pain: MD (random) music in almost all cases.
chronic (n=12) -0.56, CI (95%) [-0.82, -0.29], I2= 34.9%
(oncologic) Procedural pain: MD (random) 0.1, CI (95%) Meta-regression didn’t identified cause for high
[0.02, 0.19), I2=86.4%

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pain. heterogeneity.
Selected by patient: MD (random) 0.2, CI (95%)
[0.05, 0.35], I2= 82.3% Music type and delivery weren’t specified neither

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Selected by investigator: MD (random) -0.08, used for analysis.
CI (95%) [-0.17, -0.01], I2=88%
Overall risk of having 50% of pain relief: RR Music characteristics (e.g. tempo, harmony, or
(fixed) 1.7 favoring music, CI (95%) [1.21, 2.37], other) weren’t described or used for analysis.
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I2= 0.0% Morphine requirements:
MD (random) -0.48, CI (95%) [-0.85, -0.12], No difference was identified between music
I2= 55.9% selected by investigator or patient.
Cole 2014 Acute Not specified (n=6); Varied patient Delivery type: Not Only qualitative analysis was done. A significant reduction of pain was found on 9
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(labor, selected (n=1); Low pitched, slow Via headphones (n= specified studies of 14.
procedural, tempo of 60-80 bpm with no lyrics 6); Speakers (n=2 ); (n=2)
burned of three types (n=1); Slow, soft Not specified (n=4); Selected by Music characteristics where described in some of
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patients), music with no lyrics (n=1); Slow of Live music (n=1) patient the included studies but analysis of this wasn’t
neuropathic, 60-80 bpm and soft music (n=1); Duration: (n=5) performed.
chronic Slow of 60-80 bpm and soft of 50- 30m (n=6) Selected by
(oncologic) 60 dB music (n=1); Slow of 60-80 45m (n=2) researcher Music delivery characteristics where also specified
pain. bpm, no lyrics nor percussion, with 15m (n=1) (n=6) but weren’t used for analysis.
sustains melody (n=1); Live music 60m(n=1)
(n=1) 20m(n=2); Not No conclusions on music type, music
specified (n=1) characteristics, or delivery of music were reached.

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Dunn K Acute Not specified (n=9); Soothing and
2004 (procedural) stimulating music (n=1); Soothing
pain music (n=1)
Hole 2015 Acute Not described (n=28); Classical
(procedural) (n=7); Sedative (n=3); Relaxing
pain (n=10); Soothing (n=2); Turkish
classical (n=2); Easy listening
(n=1); Watermark by Enya (n=1);
Dream flight 2 (n=1); Slow and
rhythmic (n=1); Slow and soft
(n=1); Soft piano (n=1); Musicure
(n=3); Instrumental (n=3); Soft
instrumental (n=1); Baroque (n=1);
Pan flute music (n=1); 60-80 bpm
tempo (n=1); Soft music (n=1);
Chinese classical (n=1); Spanish
Guitar (n=1); Easy listening (n=1);
Prescriptive (n=1)
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Nilsson Acute pain Not specified (n=10); Classical,
2008 (procedural) environmental, new age,
country/western, easy listening
(n=1); Soothing music (n=1); New
age (n=5); Classical, jazz,
country/western, new age, easy
ACCEPTED MANUSCRIPT
Delivery type: Selected by Only qualitative analysis was done. Qualitative description of results with very poor
Via headphones (n=2) patient information.
Not specified (n=9) (n=2)
Duration not specified In the findings section mentions 11 studies were
Selected by included but only 10 described in the table of
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investigator results
(n=9)
Half of the studies found that music reduced pain
and analgesic need postoperatively
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Delivery type: Selected by Overall pain reduction: SMD -0.77, CI(95%) [- Subgroup analysis showed that type of control
Headphones, music patient 0.99, -0.56), I2= 90% didn’t affect music effect
pillow or speaker (not (n=42) Back calculation to VAS 100 mm showed an
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specified) average reduction of 23 mm by music Univariate meta-regression for all variables didn’t
Duration: Selected by Pain measured before 4 h: SMD -0.79, CI(95%) show significant differences.
Duration of procedure investigator [-1.06, -0.52], I2= 90%
(n=41); Duration (n=31) Pain measured 4h after surgery: SMD -0.76, No significant difference was found when patients
procedure + 60m CI(95%) [-1.19, -0.33], I2= 90% selected the music against when the investigator
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(n=1); Until patient Music elected by patient: SMD -0.86, CI(5%) [- did.
requested (n=1); Until 1.14, -0.57], I2=90%
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discharge (n=1); Music elected by researcher: SMD -0.70, High heterogeneity (I2= 75-92%) in main analysis
Before-during-after CI(95%) [-1.01, -0.39], I2=88% even after meta-regression.
ambulation (n=1); 2m Music delivered preoperatively: SMD -1.28,
and whenever the CI(95%) [-2.03, -0.54], I2=94% Acceptable heterogeneity was found in the effect of
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patient choose (n=1); Music delivered intraoperatively: SMD -0.89, music on pain under general anesthesia, and on
20m (n=4); 30m CI(95%) [-1.2, -0.57], I2=92% analgesia use when music was given after the
(n=13); 40m (n=1); Music delivered postoperatively: SMD -0.71, procedure. Both cases music had a significant
45m (n=1); 60m CI(95%) [-1.03, -0.39], I2= 87% effect on both outcomes. The smallest
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(n=2); 10m (n=1); 4h Music delivered when conscious: SMD -1.05, heterogeneity was found in the effect of music pre-
(n=1) Not specified CI(95%) [-1.45, -0.64], I2=94% operatively on analgesia use.
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(n=4) Music delivered under general anesthesia: SMD -
Timing: 0.49, CI(95%) [-0.74, -0.25], I2=25% Subgroup analysis showed that music used
During procedure Overall analgesic use: SMD -0.37, CI(95%) [- preoperatively, and with the patient conscious has a
(n=33); After 0.54, -0.2], I2= 75% greater effect.
procedure (n=23); Analgesic use when music was given before
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Before procedure procedure: SMD -0.43, CI(95%) [-0.67, -0.20], Characteristics of music like tempo, harmony, or
(n=1); Before, during I2= 4% other weren’t used for analysis.
and after (n=2); Before Analgesic use when music was given during
and during (n=9); procedure: SMD -0.41, CI(95%) [-0.70, -0.12], Other characteristics of music delivery like, the use
Before and after (n=3) I2= 84% of headphones, or time of intervention weren’t
Analgesic use when music was given after analyzed.
procedure: SMD -0.27, CI(95%) [-0.45, -0.09],
I2= 40% No conclusions on music type, music
characteristics, or delivery of music were reached.
Delivery type: Selected by Only qualitative analysis was done. From 22 studies, 13 (59%) music had a significant
Headphones (n=39) patients effect on pain reduction.
Speaker (n=1) (n=29)
Not specified (n=2) Only 15 of the included studies evaluated analgesic
Selected by use finding that 7 (47%) reported a significant
Duration: investigator decrease.
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listening, other (n=1); Classical Not specified (n=4); (n=23)

with nature sounds (n=1); Slow, 30m (n=9); Duration
quiet and instrumental (n=1); of procedure (n=7); Characteristics of music like tempo (only one
Synthesizer, harp, piano, orchestral Duration of procedure included study specified music of 60-80 bpm
or slow jazz (n=4); Pan flute (n=1); + two other (n=1); tempo), harmony, or other weren’t described or
Classical (n=1); Piano (n=2); 10m (n=1); 40m used for analysis.

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Eastern, western, easy listening, (n=2); 20m (n=6);
Chinese pop (n=1); Pop, jazz, 60m (n=5); 15m Author describes soothing as a tempo of 60-80
classical, new age (n=1); Classical, (n=2); 15m pre- bpm, therefore only one study had this
gagaku, noh, enka (n=1); Lullaby procedure + duration characteristic.

and relaxing (n=1); Classical,
popular, contemporary, Chinese
(n=1); Soft classical (n=1); Easy
listening, classical, or jazz (n=1);
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of procedure (n=1); 4h
(n=1); 117m (n=1); 2h None of the musical interventions were developed
n=1); for the treatment, therefore it can’t be concluded if
a specific designed music could have a better

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Mozart and ocean music (n=1); effect.
Slow rhythmic Chinese or Western
(n=1); Relaxing music (n=1); Conclusions on how music dosage characteristics
Chinse or Western (n=1); Relaxing, (e.g. volume, duration, other) affects the music

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slow rhythm and sedative (n=1); effect are required.
Country/western, instrumental, new

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age (n=1).
Subothini Chronic non Mozart’s Classical (n=1) Delivery: Selected by Only qualitative analysis was done. Small number of studies, insufficient to reach
2015 oncologic Not specified (n=4) researcher conclusions on these diseases.
pain and Bach’s Classical (n=1) Speaker (n=1) (n=3); by

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acute pain Duration: 20m (n=1); patient No conclusions on music type, characteristics, or
(procedural) Not specified (n=1) 60m (n=1); Not (n=1); delivery were reached.
specified (n=3) Not
Pleasant and <120 bpm (n=1) Timing: specified

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Before and during (n=1)
Salsa and classical (n=1) procedure (n=1)

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Silverman Acute pain Not specified (n=8) Delivery: Selected by Only qualitative analysis was done. Only four studies evaluated pain and 3 of them
2016 (procedural) Live music (n=8) patient found a significant effect.
and chronic (n=8)
oncologic Duration not specified Other characteristics of music like harmony, tempo
pain or other weren’t described or used for analysis.
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Timing not specified
Other characteristics of the intervention like
delivery and duration weren’t used for analysis.
Tsai 2014 Chronic Not specified (n=16) Delivery: Selected by Overall pain reduction: The overall effect favored music significantly for
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oncologic Not specified (n=16); patient SMD -0.656, CI(95%) [-1.016, -0.295], I2= pain reduction after meta-analysis, it included a
pain (n=12); 65.07% study on children and one with music therapy.
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Duration: Not Selected by

specified (n=6); researcher Heterogeneity was high and didn’t change with
30m(n=3); 15m (n=2); (n=4) sensitivity analysis.
45m (n=2); 20m
(n=2); 60m (n=1) Characteristics of music like harmony, tempo or
other weren’t described or used for analysis.

No conclusions on music type, delivery or election

were done.

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Bradt Chronic Relaxing music from classical, jazz, Delivery: Selected by Overall pain reduction: Overall effect on pain reduction included all forms
2016 oncologic folk, rock, country and western, Headphones (n=14); patient SMD -0.91, CI(95%) [-1.46, -0.36], I2=88%. of music intervention and populations, despite this
pain and easy listening, or new age (n=1); Live music (n=6); Not (n=16) a significant effect but a very high heterogeneity
acute pain Classical, easy listening, specified (n=8); Pain reduction on patient selected music: was found.
(procedural) inspirational or new age (n=1); Not Speaker (n=2) Selected by SMD -1.06, CI (95% [-1.93, -0.2], I2=91%
specified (n=9); New age, nature, researcher Three of the excluded studies from meta-analysis

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film soundtracks, Celtic melodies, Duration: (n=13) Pain reduction on researcher selected music (only found that music reduced significantly pain
or classical music (n=1); Live 45m (n=5); 4h (n=1); 2): intensity.
saxophone music (n=1); Chinese 15m (n=2); Not SMD -0.56, CI (95%) [-1.34, 0.15], I2=75%
classical music (n=1); Slow-paced, 30m(n=11); 60m specified When a subgroup analysis of music selection was

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melodic music at low volume with (n=2); 20m (n=2); 5m (n=1) done, a bigger effect with no significant difference
consistent tempo and dynamics of (n=2); duration of was found when music was selected by the patient
60-80 bpm average chosen from procedure (n=3); Not on pain.
mandarin, mandarin pop, taiwanese, specified (n=3);

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western or classical music(n=1); One study that described music as slow (60-80
Relaxing music from classical, bpm) and with controlled low volume (not
harp, general instrumental, nature specified) didn’t evaluate its effect on pain.
sounds, country, gospel or jazz

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(n=1); Live guitar music (n=3); One study described music as tempo 60-80 bpm,
New age (n=1); Sedative (60- without lyrics and controlled volume and pitch that

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80bpm) without lyrics, with evaluated pain. This study found an effect favoring
sustained melodies, controlled music.
volumes and pitch between
Taiwanese or Buddhist music Most studies didn’t described other characteristics

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(n=1); Chinese classical (n=1); of music like harmony, tempo or other weren’t
CM5-element music (n=1); described or used for analysis.
Vietnamese or children’s music
(n=1); Live music (no instrument Other characteristics of the intervention like

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specified) (n=2); Vivaldi’s Four delivery weren’t used for analysis.
Seasons (classical) (n=1); Rock and

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roll, big band, country, classical, No conclusions on music type, delivery strategy or
easy listening, Spanish or religious characteristics of music were done.
music (n=1); Sacred, Chinese
classical, western classical, or yoga
music (n=1); Chinese relaxation
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music, classical folk music, or
religious music (n=1).
Engwall Acute pain Piano, harp, synthesizer, orchestral, Delivery: Selected by Only qualitative analysis was done From all studies only three studies showed no
2009 (procedural) or slow jazz without lyrics (n=5); Live (n=1); the patient significant differences between music and control
C

Soft classical (n=1); Relaxing and Headphones (n=16); (n=10) groups on pain, the rest found a significant effect of
calming accompanied by sound Not specified (n=1) music on postoperative pain.
AC

waves (n=1); Soft instrumental or Selected by

new age synthesizer (n=2); Peaceful
pan flute music (n=1); Piano music
(n=1); Classical, jazz, light rock,
country, rock and roll, easy
listening, gospel, country, and rock
and roll (n=1); Western classical
music, gagaku, noh songs or enka
(n=1); Easy listening, classical, and
Timing: the Half studies found a significant difference on
Postoperative (n=13); investigator analgesic use.
Intra and postoperative (n=9)
(n=3); Several studies reported manipulating the
Intraoperative (n=1); environment (for better control) and giving
Not specified (n=1) instructions on music use.
Duration not specified.

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jazz (n=1); Synthesizer, harp, piano, Characteristics of music like tempo, harmony, or
orchestra, slow jazz, or flute (n=1); other weren’t described or used for analysis.
Chinese and western music (n=1);
Mozart and ocean music (n=1); Characteristics of intervention delivery weren’t
Slow and soft melodies played on a used for analysis.
harp (n=1)

PT
Analysis on election of music wasn’t done

No definite conclusions on music type, music

characteristics, or delivery of music were reached.

RI
Yinger Acute pain Not specified Duration not specified Selected by Only qualitative analysis was done. Only 25 studies analyzed the effect of music
2015 (procedural) Delivery: patient listening on pain perception on adults, finding that
Not specified (n=39); (n=23) only 11 (38%) favored music.

SC
Headphones (n=3) Selected by
Timing: researcher Characteristics of music like tempo, harmony, or
Before, during and (n=18) other weren’t described or used for analysis.
after procedure (n=6); Not
During procedure specified Characteristics of the intervention like delivery and

U
(n=17); Before and (n=1) duration weren’t specified or used for analysis.
during procedure

AN
(N=15); After Analysis on election of music wasn’t done.
procedure (n=2);
During and after No conclusions on music type, characteristics, or
procedure (n=2) delivery strategies was reached.

M
Wang Acute pain Not specified (n=10); Indian classic Timing: Not Overall pain reduction: The overall effect on endoscopic procedural pain
2014 (procedural) (n=1); sedative music (n= 2); During procedure specified WMD -1.53, CI(95%) [-2.53, -0.53] reduction favored the music group.
Turkish classical (n=1); Easy (n=15); Before
listening (n=1); Classical (n=2); procedure (n=2); Reduction of pain on Colposcopy procedures: Sub-group analysis found that the effect didn’t

D
Relaxation music (n=2); Slow Before and During WMD -3.30, CI(95%) [-13.49, 6.89] favored music on Colposcopy procedures.
rhythm (n=1); New wave (n=1) procedure (n=4)

TE
Analgesic use in Colonoscopy: No significant effect on analgesic or sedative use
Duration not specified WMD -8.44, CI(95%) [-19.23, 2.34] was identified.

Delivery: Headphones Sedative use: Heterogeneity wasn’t reported.

(not specified); WMD -0.53 CI (95%) [-1.39, 0.33]
EP
Speaker (not specified) Characteristics of music like tempo, harmony, or
other weren’t described or used for analysis.

Characteristics of intervention delivery weren’t

C

specified or used for analysis.

AC

Authors recognized that music tempo, harmony and

rhythm could have an impact on the effects on pain
despite no analysis on this was done.

No certain conclusion on music type, music

characteristics, delivery of music or music election
were reached.
n= Number of intervention groups that were exposed; m= minutes; h=hours; WMD= weighted mean differences; SMD= standardized mean difference; MD= mean difference; CI= confidence
interval.

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HIGHLIGHTS:
• Until now, no authors have analyzed the specific aspects behind music
listening as an intervention.
• There is no knowledge on the ideal ways to use this strategy, and despite the
existence of guidelines, this study proves it.
• This review offers analyses on what is needed for advancing on music for pain
relief.

PT
RI
U SC
AN
M
D
TE
C EP
AC