Lower Anxiety after Listening to Self-Selected Music Contributes to Lower Pain Severity among Patients with Acute Back Pain in the Emergency Department

Acute exacerbation of back pain is one of the most common reasons that patients present to the emergency department (ED). Few nonpharmacologic analgesic options exist that can be flexibly deployed in the ED. Music is a non-opioid alternative adjunctive therapy that has shown some promise in reducing pain, as well as modulating anxiety. However, the use of music in clinical settings has not been widely studied. This pilot study evaluated the impact of a brief patient-selected music intervention versus noise cancellation on pain severity and anxiety in patients presenting to the ED with back pain. Patients (N=40) were randomized to one of two interventions: 1) self-selected music or 2) noise cancellation headphones. Immediately before and after the intervention patients rated their current pain severity and anxiety using a numeric rating scale (0-10). Analyses of covariance were used to examine whether post-intervention pain and anxiety differed between the groups, while controlling for baseline characteristics. A mediation analysis was conducted to explore the role of post-intervention anxiety as a mediator of the group difference (music vs. noise cancellation) in post-intervention pain. After the intervention, patients in the music group reported significantly lower anxiety and pain compared to patients in the noise cancellation group. A mediation analysis showed that patients who listened to self-selected music reported lower post-intervention anxiety compared to those in the noise cancellation group, which contributed to why they reported lower post-intervention pain. Our findings suggest that music may be a beneficial tool for modulating psychological distress and pain.