Impact of sociodemographic, clinical, and intervention characteristics on pain intensity within a single music therapy session

Several studies support the efficacy of music therapy (MT) for reducing pain, but few have examined which interventions are most effective or which patients are more likely to respond. This study investigated which sociodemographic, clinical, and intervention characteristics are associated with clinically significant reductions in pain intensity (0-10 numeric rating scale reduction ≥2 units) within a single MT session. We conducted a retrospective review of 2039 MT sessions provided across a large health system among 1203 adult patients reporting pre-session pain ≥4/10, a complete post-session pain score, and a complete pre-session stress score. We employed a multivariable logistic mixed effects model to evaluate binary pain reduction response (≥2 units vs. < 2 units) where patients were considered nested within therapists. The model included a fixed covariate for MT intervention type: receptive only, recreative (i.e., singing or active instrument play), compositional/creative (e.g., songwriting), or music-assisted relaxation and imagery (MARI). Covariates in the model associated with higher adjusted odds ratios (aOR [95% CI]) included (1) recreative (1.37 [1.00, 1.86]) and MARI (1.48 [1.01, 2.17]) MT interventions as compared to receptive; (2) 15-minute increases in session length (1.40 [1.22, 1.61]); (3) 1-unit increases in pre-session pain (1.19 [1.11, 1.28]), (4) 5-unit increases in Elixhauser comorbidity count (1.29 [1.05, 1.60); and (5) a documented MT session goal of pain management (3.58, [2.64, 4.86]). MT interventions involving singing, active instrument play, and relaxation/imagery may be more effective for reducing pain intensity than interventions only involving live or recorded music among patients with high pre-session pain. PERSPECTIVE: This study examined factors associated with meaningful reductions in pain (0-10 numeric rating scale reduction ≥2 units) within a single music therapy session. Among hospitalized patients, interventions involving singing, active instrument play, and relaxation/imagery may be more effective for reducing pain than interventions only involving live or recorded music.