A scoping review of music-based pain treatment mechanism research.

Research supports the efficacy of music-based interventions (MBIs) for pain management, but understanding of their underlying mechanisms is lagging. This scoping review aims to map existing mechanism-focused MBI research, identify knowledge gaps, and highlight the strengths and weaknesses of this body of research. Studies were eligible if they tested a mechanism, moderator, or predictor of the effects of MBIs on clinical or experimental pain and were published in English in a peer-reviewed journal. Following the Joanna Briggs Institute scoping review methodology, we searched MEDLINE, Embase, PsycINFO, PubMed, and Scopus from inception through February 2026. Two reviewers completed screening and data extraction, with discrepancies resolved by a third reviewer. From 663 records screened, 57 studies were included. Most studies employed experimental pain models with healthy volunteers. All but 4 studies examined the mechanisms of music audio recordings; the remaining studies examined active music-making. We identified convergent evidence for several candidate mechanisms, including positive emotional valence, cognitive agency, and sensorimotor synchronization. Evidence from neuroimaging studies point to the impact of music on early stages of pain processing as well as on higher-order cognitive and affective interpretation of pain. Finally, preliminary evidence suggests that music may restore default mode network connectivity involved in self-referential thoughts. Across studies, several methodological limitations constrained inferences. Future research should (1) employ rigorous designs that distinguish between competing mechanistic models and, when feasible, incorporate causal manipulations to test hypothesized mechanisms and (2) examine whether music influences pain processing differently in populations with vs without clinical pain.