Joke Bradt has spent her career watching patients tap their toes, hum along, and even sing their way through some of the hardest moments of their lives — and she wanted to know why it works. Now the Drexel University professor and her team have mapped the evidence, and the answer is surprisingly simple: the music that helps most is the music you choose yourself, and the more you move with it, the better it gets.
Pain is one of medicine's trickiest puzzles, and for decades, doctors have known that music can ease it — for people living with cancer, arthritis, and many other conditions. But exactly how music does this has remained a mystery. Bradt's new review, published in the journal PAIN Reports, sifted through more than 600 scientific records, narrowing the field down to 57 studies, to find what really drives music's pain-relieving power.
Three clear mechanisms emerged from the evidence. First, there is the "positive emotional valence" — the warm, uplifting feeling a good song gives you. Second is a sense of control, or agency — the power that comes from picking your own playlist instead of having a doctor choose one for you. And third is synchronizing your body with the beat, whether that means tapping your fingers, drumming on a table, or swaying in your chair.
The practical takeaway, Bradt explains, is that people should choose music they genuinely enjoy and actively engage with it — not just press play and sit still. "One study also showed that singing along is more effective than just listening to music," she said. Brain imaging studies back this up, showing that music influences both the very early stages of pain processing in the brain and the higher-level emotional response to pain.
Bradt, who leads the Music4Pain Research Network funded by the National Center for Complementary and Integrative Health, sees active music-making as the future. In her own clinical work, she relies on singing, vocal improvisation, and playing instruments because they help chronic pain patients far more than passive listening. She admits this kind of research is harder — you can't easily ask someone to sit still inside a brain scanner while belting out a song — but she believes it's essential.
The review also underlined a gap: very little mechanistic research has focused on people living with chronic pain, whose pain processing differs from healthy adults. Bradt wants to know whether findings from healthier groups can be applied to them. "Researching how music affects pain may sound simple, but it is actually very challenging because of the complexity of music and the complexity of pain," she said.
By understanding these mechanisms, clinicians and researchers can build more targeted, personalized music-based interventions for people in acute or chronic pain. Musicians call the moment a song clicks with a listener "the feeling of being moved." Thanks to this research, that feeling now has science to back it up.