Jeffery A. Dusek

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.

This paper describes three research networks funded by the U.S. National Center for Complementary and Integrative Health (NCCIH) and the National Endowment for the Arts (NEA). The networks seek to advance the mechanistic understanding of music-based interventions (MBIs) for pain management. The networks address critical gaps hindering MBI research, including inconsistent terminology, lack of mechanistic understanding, and insufficient objective measures. The Music4Pain Network focuses on the development of a taxonomy, a mechanistic framework, and research priorities; the ENSEMBLE Network promotes cross-disciplinary collaboration, collation of real-world data from clinical settings, and biomarker identification; and the Audio Analgesia Network emphasizes computational methods and innovative technologies to advance mechanistic research in MBIs. Together, these networks form the Music and Health Consortium, conducting collaborative research through specialized working groups, pilot funding opportunities, and training programs to improve the rigor and mechanistic understanding of MBIs for pain management.

Background: Cost sharing, or the extent to which patients contribute to health care spending, has been linked to various outcomes. The relationship between cost sharing and acupuncture utilization is unclear. Objectives: To measure the association between cost sharing (eg, copays, share of spending paid out of pocket, and consumer-driven health plans marked by high deductibles) and the use of in-network acupuncturists. Methods: Our team used commercial insurance claims. The study sample included 105 501 individuals who visited an in-network acupuncturist between 2012 and 2021. Results: In plans with less out-of-pocket spending overall, more members used an in-network acupuncturist. Plans with $0 copays and consumer-driven health plans had less acupuncture utilization compared to plans with higher copays and non-consumer driven health plans. Conclusion: Cost sharing had an inconsistent impact on acupuncture utilization. Our findings suggest that access to in-network acupuncturists is more important than cost sharing when it comes to increasing acupuncture utilization.

Background: Several clinical trials support the efficacy of Whole Systems Traditional Chinese Medicine (WS-TCM) modalities, including acupuncture, for improving outcomes among women undergoing in vitro fertilization (IVF), but few studies have described its real-world integration within an academic medical setting or its immediate effects on pain, stress, and anxiety. Objective: To characterize the clinical delivery of WS-TCM and assess its effects on patient-reported outcomes (PROs) among patients receiving WS-TCM while undergoing IVF. Methods: A retrospective review of patients who received ≥1 WS-TCM treatment associated with ≥1 embryo transfer at a single center was conducted. A linear mixed model adjusting for the random effect of patients seen over multiple treatments was used to calculate PRO changes among those with pre-treatment PROs ≥1 on a 0-10 numeric rating scale. Results: 1896 WS-TCM treatments were provided during 202 embryo transfers among 146 patients. Patients (mean age 35.76 ± 4.37) were predominantly white (79.5%), and 26.7% had a documented mental health diagnosis. Of the 202 embryo transfers, 64.9% included pre-transfer treatment, 88.6% included day-of-transfer treatment, and 32.2% included post-transfer treatment. Patients reporting pre-treatment PROs ≥1 reported clinically significant mean [95% CI] reductions in pain (−1.38 [−1.70, −1.07]), stress (−2.11 [−2.47, −1.74]), and anxiety (−2.22 [−2.63, −1.81]) within a single treatment. Conclusions: This study supports the integration of WS-TCM within IVF and its benefits for reducing acute pain, stress, and anxiety. WS-TCM may improve patient experiences and be a useful treatment for psychosocial concerns that often accompany IVF.

Background: The integrative medicine (IM) clinic is an innovative care model that may increase access to guideline-concordant nonpharmacologic treatment use in healthcare delivery systems for prevalent conditions such as low back pain (LBP). Objective: To describe the use and effectiveness of IM services for LBP in IM clinics. Research Design: Prospective cohort study. Subjects: Adult patients with LBP enrolled at seventeen IM clinics. Measures: Patterns of IM service use were assessed over 12 months. Changes in clinical outcomes were assessed between index visit and 12-month follow-up using linear mixed-effects models. Primary (pain interference, physical function) and secondary (pain intensity, anxiety, depression, fatigue, sleep disturbance, social participation) outcomes were obtained from the PROMIS-29 instrument. Results: We identified 660 participants with LBP (mean age = 51.6 years, 75% female). Over the 12-month study period, common IM services were IM consults (56%), acupuncture (44%), chiropractic care (24%), physical therapy (19%), and massage (17%). Over two-thirds (70%) of participants received at least one guideline-concordant nonpharmacologic treatment. Participants with follow-up outcome data (n = 443, 67%) reported a modest reduction in pain interference with life activities in the short- and long-term (2-month mean difference [MD] = −1.47, 95%CI = −2.98, −0.64; 12-month MD = −1.98, 95%CI = −3.12, −0.88). By contrast, improvements in physical function were not statistically or clinically significant (2-month MD = 0.37, 95%CI = −0.28, 1.01; 12-month MD = 0.69, 95%CI = −0.31, 1.69). At 12 months, small improvements were observed on all secondary outcomes (pain intensity, anxiety, depression, and social participation) except fatigue and sleep disturbance. Conclusions: Most patients with LBP receiving care at IM clinics received at least one guideline-recommended nonpharmacologic treatment. However, improvements on clinical outcomes were relatively small. Additional multi-site studies are needed to explore the optimal implementation approach.