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NCCIH Clinical Digest

for health professionals

Music and Health: What the Science Says

April 2022

Clinical Guidelines, Scientific Literature, Info for Patients: 
Music and Health

African American man playing guitar for his mother

Pain

There is some evidence that music-based interventions may help to relieve pain associated with specific health conditions.

What Does the Research Show?


  • A 2016 meta-analysis of 97 randomized controlled trials involving a total of 9,184 participants examined music-based interventions for acute or chronic pain associated with a variety of health problems and medical procedures. The overall evidence suggested that music-based interventions may have beneficial effects on both pain intensity and emotional distress from pain and may lead to decreased use of pain-relieving medicines. 
  • A 2017 systematic review and meta-analysis of 14 randomized trials (1,178 participants) examined music-based interventions for various types of chronic pain and found that the interventions reduced self-reported chronic pain and associated depressive symptoms, with a greater effect when the music was chosen by the participant rather than the researcher. The study participants had a variety of conditions that can cause chronic pain, including cancer, fibromyalgia, multiple sclerosis, or osteoarthritis, and most of the interventions involved listening to recorded music.  Overall, the data suggested that as an adjuvant therapy, music reduces self-reported pain and common comorbidities associated with chronic pain.
  • In recent studies, music-based interventions were helpful for pain associated with childbirth, platinum-based chemotherapy, shock wave lithotripsy, oocyte retrieval for in vitro fertilization, treatment of nose fractures, and sickle cell disease. However, music didn’t seem to be helpful for pain associated with loop electrosurgical excision, and the results of studies on pain during cystoscopy and pain during colonoscopy were inconsistent.

Anxiety

Music-based interventions have been evaluated for their effects on anxiety in a variety of disease conditions and health care settings. Most studies have had promising results.

What Does the Research Show?


  • A 2013 Cochrane systematic review of 26 studies involving a total of 2,051 participants found that listening to recorded music significantly reduced anxiety in people who were waiting to have surgery. However, there was potential for bias in most of the studies because the investigators who performed the studies knew which participants had listened to music. 
  • A 2016 Cochrane systematic review of 17 studies involving a total of 1,381 participants evaluated the effect of music-based interventions on anxiety in adults with cancer. The findings from the review suggested that music-based interventions may have a large anxiety-reducing effect as well as beneficial effects on pain, fatigue, and quality of life in people with cancer. However, there was a high risk of bias in the studies. 
  • A 2015 systematic review and meta-analysis of 5 studies (290 participants) in people who were receiving incenter maintenance hemodialysis suggested that listening to music reduced anxiety. However, the studies included in the review have limitations because of their small size and high risk of bias.

 

Autism Spectrum Disorder (ASD)

It’s uncertain whether music-based interventions are helpful for people with ASD.

What Does the Research Show?


  • A 2021 systematic review of 22 studies (850 participants) on music therapy for children with ASD was unable to reach any definite conclusions on whether adding music therapy to their care was beneficial, although some studies had promising results. For example, some studies of educational music therapy (involving techniques such as musical games) showed possible benefits on the children’s speech, and some studies of improvisational music therapy (in which children produce music) showed possible benefits on social functioning.
  • A 2017 randomized controlled trial of improvisational music therapy for children with ASD (which was included in the review described above) was a multinational trial involving 364 children from 9 countries. It is the largest study completed so far, and its design was especially rigorous. In this study, the severity of symptoms related to difficulties in social communication did not differ between children who received improvisational music therapy along with standard care and those who received standard care alone. 

Chronic Obstructive Pulmonary Disorder (COPD)

There is some limited evidence that music-based interventions may be helpful for shortness of breath, anxiety, and sleep quality in adults with COPD.

What Does the Research Show?


  • A 2021 systematic review of 12 studies (812 participants) showed that music-based interventions (i.e., listening to music or a combination of listening and singing) were helpful for shortness of breath, anxiety, and sleep quality in adults with COPD but were not helpful for depression. Because the studies were brief (several days to 12 months) and because researchers measured effects in different ways in different studies, there is some uncertainty about the conclusions.

Cognitive Impairment and Dementia

Much research is being done on the potential benefits of music-based interventions for people with cognitive impairment or various types of dementia, such as Alzheimer’s disease. Limited evidence suggests that music-based interventions may improve emotional well-being, behavioral challenges, and quality of life in people with these conditions. Whether the interventions have benefits for cognitive functioning is unclear; effects might depend on the population studied or the type of intervention used.

What Does the Research Show?


  • A 2018 Cochrane systematic review evaluated 22 studies (1,097 participants) of music-based interventions for people with dementia who were living in institutions. Some of the interventions were receptive (listening to music), some were active (singing, playing instruments, moving to music, etc.), and some were a combination of the two. The evidence from these studies indicated that music-based interventions probably reduce depressive symptoms and improve overall behavioral problems, but effects differ for different behavior problems. They may also improve emotional well-being and quality of life and reduce anxiety. However, the interventions may have little or no effect on agitation, aggression, or cognitive function. 
  • A 2021 systematic review and meta-analysis analyzed 21 studies involving 1,472 participants with either mild cognitive impairment or mild or moderate dementia for potential effect sizes and intervention activities. Nine of the studies (495 participants) were included in a quantitative analysis of effects on cognitive functioning This analysis indicated that the music-based interventions had a small beneficial effect on cognitive functioning for older adults with probable mild cognitive impairment or dementia. There was also some evidence for beneficial effects on mood and quality of life.

Depression

There is some evidence that adding music-based interventions to usual treatment may improve depressive symptoms when compared with usual treatment alone. There is also some evidence that music-based interventions may help decrease anxiety levels and improve functioning in people with depression.

What Does the Research Show?


  • A 2017 Cochrane systematic review looked at 9 studies (421 participants) of music-based interventions in adults or adolescents with depression. There was moderate-quality evidence that adding music-based interventions to usual treatment saw improvement based on clinician‐rated and patient‐reported measures of depression when compared with usual treatment alone. Music-based interventions also helped decrease anxiety levels and improve functioning of people with depression (for example, their ability to maintain involvement in work, activities, and relationships).

Multiple Sclerosis (MS)

Findings from several studies suggest that music-based interventions may be beneficial for coordination, balance, some aspects of gait and walking, emotional status, and pain in people with MS.

What Does the Research Show?


  • A 2021 systematic review of music-based interventions for people with multiple sclerosis (10 trials, 429 participants) found consistent evidence overall that the music-based therapies were better than conventional care or no intervention for fatigue level, fatigability, coordination, balance, some aspects of gait and walking, emotional status, and pain, but no effect was observed for mental fatigability or memory. The music-based therapy came from one of four different modalities: (1) Rhythmic auditory; (2) Playing musical instruments; (3) Dance strategy; and (4) Neurological music therapy.  

Parkinson's Disease (PD)

There is some limited evidence that rhythmic auditory stimulation may significantly improve gait speed and stride length in people with PD. There is some evidence that music-based movement therapy may improve motor function, balance, freezing of gait, walking speed, and mental health. In addition, a few studies have found some evidence that singing may have a beneficial effect on speech in people with PD.

What Does the Research Show?


  • Rhythmic auditory stimulation. A 2021 systematic review and meta-analysis of 5 studies (209 total participants) showed significant improvements in gait speed and stride length in people with PD who participated in rhythmic auditory stimulation. However, the quality of evidence was low, and the number of studies and participants was small.
  • Music-based movement therapy. A 2021 systematic review and meta-analysis of 17 studies (598 participants) of music-based movement therapy showed evidence of improvements in motor function, balance, freezing of gait, walking speed, and mental health but not gait cadence, stride length, or quality of life in people with PD.
  • Singing. The potential benefits of singing for people with PD have been studied primarily in terms of effects on speech. In a 2016 systematic review of 7 studies (102 participants), 5 studies found some evidence of a beneficial effect on speech.

Sleep Problems

Results of studies have been mixed as to whether music-based interventions can be helpful for sleep problems.

What Does the Research Show?


  • A 2021 systematic review of 16 studies involving 812 older adults with sleep problems found mixed results; some studies suggested that the music interventions were helpful, while others did not.
  • 2015 Cochrane systematic review of 6 studies involving a total of 314 participants with insomnia found that music-based interventions may be effective for improving subjective sleep quality in adults with insomnia.

Stress

Music-based interventions, particularly music therapy, may be helpful for improving physical and psychological markers associated with stress, according to two related reviews.

What Does the Research Show?


  • A 2020 systematic review and two meta-analyses of 104 studies (9,617 participants), analyzed the effects of a variety of music-based interventions on measures associated with stress, including both physiological measures (heart rate, blood pressure, and levels of stress-related hormones) and psychological measures (anxiety, nervousness, restlessness, and feelings of worry). The music-based interventions had a small-to-medium sized beneficial effect on the physiological measures and a medium-to-large beneficial effect on the psychological measures. 
  • A 2022 systematic review and meta-analysis of 47 studies (2,747 participants) of music therapy (excluding other music-based interventions) found an overall medium-to-large beneficial effect on stress-related outcomes. The effects were greater than those seen in the larger review. The investigators who performed the review suggested that the opportunity for music therapists to tailor interventions to the needs of individual patients might account for the difference.

Stroke

There is evidence that music-based interventions may be helpful in the rehabilitation of people who have had a stroke.

What Does the Research Show?


  • A 2019 systematic review of 27 studies (730 participants) found positive effects on physical status (upper-limb activity, various aspects of walking, balance), cognition (paying attention, communication), and mood in people who had a stroke. In particular, rhythmic auditory stimulation had beneficial effects on gait and balance, and receptive music therapy was helpful for mood and some aspects of cognitive function (i.e., verbal memory, focused attention).

Safety

  • In general, research studies of music-based interventions do not show any negative effects. However, listening to music at too high a volume can contribute to noise-induced hearing loss. You can find out about this type of hearing loss on the National Institute on Deafness and Other Communication Disorders website
  • Because music can be associated with strong memories or emotional reactions, some people may be distressed by exposure to specific pieces or types of music. 
  • Music-based interventions that involve exercise or other types of movement could lead to injury if appropriate safety precautions are not taken.

References

NCCIH Clinical Digest is a service of the National Center for Complementary and Integrative Health, NIH, DHHS. NCCIH Clinical Digest, a monthly e-newsletter, offers evidence-based information on complementary health approaches, including scientific literature searches, summaries of NCCIH-funded research, fact sheets for patients, and more.

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