Music Interventions for Reducing Pain and anxiety in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis

Music Interventions for Reducing Pain and anxiety in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Music Interventions for Reducing Pain and anxiety in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis Hu Gao, Fajuan Tang, Shanshan Wu, Zhuan Zou, Xihong Li, Bin Chen This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6764110/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background This meta-analysis synthesizes the existing evidence regarding the efficacy of music interventions in reducing pain and anxiety among children undergoing emergency departments (EDs) procedures. Methods A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science identified randomized controlled trials (RCTs) comparing music interventions with standard care in children aged 0–18 years. Primary outcomes included pain intensity; secondary outcomes encompassed distress reduction and heart rate changes. Risk of bias was assessed using Cochrane RoB 2.0. Results SixRCTs (490 participants) were included. Music interventions significantly reduced pain intensity (standardized mean difference [SMD] = −1.62, 95% CI: −3.00 to −0.24, p < 0.001) and anxiety (SMD = −0.67, 95% CI: −1.03to −0.30, p ＝0.549) compared to standard care. Conclusion Music interventions effectively alleviate procedural pain and anxiety in pediatric EDs. Clinicians should consider integrating music therapy into routine care, particularly interactive formats, to improve patient outcomes and satisfaction. Registration PROSPERO no: CRD420251008279. Music therapy Pediatric emergency Pain Anxiety Meta-analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Background Pediatric pain management in emergency departments (EDs) remains a critical challenge due to underrecognition and undertreatment [ 1 , 2 ]. Approximately 30–50% of children in EDs experience moderate-to-severe pain, yet fewer than 20% receive adequate analgesia [ 3 ]. While pharmacological interventions like opioids and non-steroidal anti-inflammatory drugs are effective, they carry risks of side effects, addiction, and delayed administration [ 4 ]. These limitations have spurred interest in non-pharmacological interventions, with music therapy emerging as a promising adjunctive strategy [ 5 ]. Music-based interventions have been widely studied for pediatric pain management across settings, including procedural sedation [ 6 ], postoperative recovery [ 7 ], and cancer care [ 8 ]. Music’s analgesic effects are hypothesized to occur through multiple pathways: distraction from pain stimuli [ 9 ], modulation of stress hormones like cortisol [ 10 ], and activation of endogenous opioid systems [ 11 ]. Previous meta-analyses have found that music significantly reduces the pain intensity of adult patients [ 12 – 14 ], but pediatric-specific evidence remains fragmented. In EDs, music interventions face unique challenges. Children often present with acute, unpredictable pain requiring immediate intervention, and ED environments are inherently stressful due to noise, unfamiliar equipment, and time pressures [ 15 ]. Despite these challenges, several randomized controlled trials (RCTs) have demonstrated benefits of music in reducing pain during ED procedures like intravenous cannulation [ 16 ] and wound care [ 17 ]. However, existing studies vary widely in methodology, population demographics, and outcome measures, leading to inconsistent results. Some RCTs report no significant effects [ 18 ], while others highlight moderating factors like music preference [ 19 ], duration of exposure [ 20 ], and provider training [ 21 ]. This heterogeneity complicates evidence synthesis and clinical translation. To address these gaps, this systematic review and meta-analysis aims to quantify the efficacy of music interventions in reducing pain and anxiety intensity among ED pediatric patients. By synthesizing current evidence, this study seeks to inform clinical guidelines and promote evidence-based practice in pediatric emergency pain management. Methods This investigation strictly adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [ 22 ]. Furthermore, this systematic review and meta-analysis is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number (CRD 420251008279). Sources and search Strategy A comprehensive literature search will be conducted in electronic databases including PubMed, EMBASE, Cochrane Library, and Web of Science from inception to the present. The search strategy will incorporate medical subject headings (MeSH) and key terms related to "music," "pediatric," "pain," "anxiety," "emergency department," and "randomized controlled trials." The search will be limited to articles published in English. Additionally, we will hand-search relevant conference proceedings and reference lists of included studies to identify any additional eligible trials. Study Selection Criteria The present systematic review and meta-analysis aims to evaluate the efficacy of music intervention in alleviating pain and anxiety among pediatric patients in the EDs. We will include RCTs that compare music interventions with standard care or other non-music interventions in children aged 0–18 years undergoing painful procedures in the ED. Studies will be excluded if they involve patients with cognitive or developmental impairments that could affect their ability to perceive or respond to music. Data Collection Two independent reviewers will extract data using a standardized extraction form. The extracted data will include study characteristics (e.g., authors, publication year, country, study design), participant demographics (e.g., age, gender, sample size, type of painful procedure), intervention details (e.g., type of music, duration of intervention), and outcome measures (e.g., pain intensity, anxiety levels, distress levels, fear levels, and heart rate). Any discrepancies will be resolved through consensus or by involving a third reviewer. Risk of Bias Assessment The risk of bias in the included studies will be assessed using the Cochrane Risk of Bias Tool [ 23 ] to examine potential biases present in the included RCTs. The assessment domains encompass various aspects such as "randomization procedure" "allocation concealment," "blinding of participants and personnel," "incomplete outcome data," "selection of reported results," and "other biases." Each study will be rated as having a low, high, or unclear risk of bias for each domain. Discrepancies were resolved through discussion or consultation with a third reviewer. Data Synthesis and Analysis The primary outcome of interest is pain and anxiety intensity, which will be measured using standardized pain scales (e.g., Wong-Baker FACES Pain Rating Scale, Visual analog scale, Children’s State Anxiety Scale). Secondary outcomes include distress levels, fear levels, heart rate. We will use the mean difference (MD) or standardized mean difference (SMD) with a 95% confidence interval (CI) to pool the data across studies. Heterogeneity will be assessed using the I² statistic and the Cochrane Q test. The selection of a random-effects model or fixed-effects model was contingent upon the observed level of variation among studies. We computed a 95% CI for each estimate of effect size and determined statistical significance based on a p-value below 0.05. To evaluate heterogeneity in the meta-analysis, we utilized the I 2 statistic and considered it as low if I 2 < 50%[ 24 ]. If sufficient data were available, subgroup analyses would be conducted to examine primary outcomes based on factors such as age groups (e.g., infants, toddlers, school-age children), type of painful procedure, and type of music intervention. Sensitivity analyses will be performed to assess the robustness of the results by excluding studies with a high risk of bias. Meta-analyses would be carried out using the STATA software (Stata-Corp LLC, CollegeStation, TX, United States). Results Search Results and Study Characteristics Figure 1 presents a flow diagram illustrating the process of study selection. The initial search identified a total of 129 potentially relevant articles. After duplicates were removed, a comprehensive full-text screening was conducted on thirty-two records, resulting in the inclusion of six RCTs [ 25 – 30 ] for the final quantitative and qualitative analysis. The characteristics of the studies included in our analysis are summarized in Table 1 . A total of 490 pediatric participants were enrolled, with 255 assigned to the music intervention group and 235 to the control group, exhibiting a balanced gender distribution across all studies. Three trials were conducted in Asia, two in North America, and one in Europe. The studies utilized a variety of musical intervention methods. Specifically, two studies utilized sound-producing toys [ 25 , 29 ], two studies used nursery rhymes [ 26 , 30 ], and another two studies applied recorded music. The duration of the music interventions also differed across studies. Three studies implemented music interventions during emergency treatments, two studies specified a music intervention duration of 5 minutes, and another study used music-based toys to intervene 5–10 minutes prior to emergency treatment. The emergency treatments involved in these studies included blood collection, venipuncture, IV placement, splint or plaster cast application, wound dressing, suturing of open wounds, and one study focused on head CT scans in an emergency setting. Table 1 Characteristics of the included studies Author (year) Country Age (years) (mean ± SD) Sample Size Procedure Intervention Comparator Music duration Outcomes (measures) Alfatavi et al. (2022) Iran T: 4.48 ± 1.01 C: 4.34 ± 0.92 T:40/23M/17F C:40/21M/19F Blood sampling Doll music Routine care 5 mins Pain: WBFRS Fear: WBFRS Daihimfar et al. (2024) Iran T: 4.28 ± 1.23 C: 4.50 ± 1.12 T:60/29M/31F C:60/30M/30F Venipuncture Instrumental children’s song Routine care 5 mins Pain: VAS Hartling et al. (2013) Canada T: 5.33 ± 2.87 C: 6.50 ± 3.71 T:20/10M/10F C:19/16M/3F IV placement Recorded music Standard care During procedure Distress: OSBD-R Pain: FPS-R Heijden et al. (2019) Netherlands T: 7.5 ± 3.78 C: 7.7 ± 3.48 T:75/48M/27F C:54/40M/14F Venipuncture; IV placement; Splint or plaster cast; Wound dressing; Suture of open wound Recorded music Standard care During procedure Pain: AHTPS Distress: OSBD-R Karaca et al. (2022) Turkey 4–6 T:30/16M/14F C:30/13M/17F IV insertion Music-moving toys Standard care 5–10 mins Anxiety: CSA Fear: CSF Park et al. (2015) USA T: 1.37 ± 0.13 C: 0.87 ± 0.14 T:30/16M/14F C:32/40M/14F Head Computed tomographic scan Nursery songs Usual care During procedure Anxiety: VAS Abbreviations: T, experimental group; C, control group; M, male; F: female; AHTPS: Alder Hey Triage Pain Scale; CSA: Children’s State Anxiety Scale; CFS: Children’s Fear Scale; WBFRS, Wong/Baker Faces Rating Scale; NIPS: Neonatal Infant Pain Scale; FPS-R: Faces Pain Scale–Revised; VAS, Visual analog scale; OSBD-R: OBSDR, Observational Scale of Behavioral DistressRevised. Quality appraisal The risk of bias in the included studies is depicted in Figs. 2 and 3 . The critical appraisal results for the included RCTs were low to moderate. Due to the nature of music interventions, the quality criteria of RCTs for blinding participants, providers, and outcome assessors were poorly scored. Outcome Primary Outcomes Pooled analysis demonstrated a statistically significant reduction in pain intensity among children receiving music interventions compared to standard care (SMD = − 1.62, 95% CI: −3.00 to − 0.24, p < 0.001) (Fig. 4 ). High heterogeneity was observed ( I ² = 89%, p < 0.01), prompting the use of a random-effects model. Similarly, music interventions significantly alleviated procedural anxiety (SMD = − 0.67, 95% CI: −1.03 to − 0.30, p = 0.002) (Fig. 5 ).. Heterogeneity was moderate ( I ² = 45%, p = 0.12), and a fixed-effects model was applied. Secondary Outcomes No statistically significant differences were observed between the music intervention and control groups for distress levels (SMD = − 0.12, 95% CI: −0.43 to 0.20, p = 0.514) (Fig. 6 ).or fear scores (SMD = − 9.23, 95% CI: −22.91 to 4.46, p < 0.01) (Fig. 7 ). Heterogeneity was low for distress ( I ² = 0.0%) but moderate for fear ( I ² = 98.7%). Heart rate changes, a proxy for physiological stress, also showed no significant intergroup difference (SMD = − 1.2 bpm, 95% CI: −0.42 to 0.19, p = 0.917) (Fig. 8 ). Heterogeneity was low ( I ² = 0.0%). Discussion This meta-analysis synthesizes evidence from six RCTs demonstrating that music interventions significantly reduce procedural pain intensity (SMD= -1.62) and anxiety (SMD= -0.67) in pediatric EDs. These results align with existing literature highlighting music's analgesic and anxiolytic properties through neurophysiological modulation of stress pathways [ 31 – 33 ]. Clinically, music therapy should be integrated as a standard adjunct to pharmacological analgesia, particularly in high-distress procedures such as chemotherapy infusions [ 34 ] and wound dressing changes [ 35 ]. For example, Havva [ 36 ] reported that music intervention can be used in nursing practices for cancer patients during chemotherapy, while van der Heijden et al. [ 17 ] documented significant pain reduction during burn wound care with live music therapy. These findings underscore music’s versatility as a low-risk, cost-effective intervention across acute care settings. Notably, interactive music formats (e.g., instrument engagement) showed greater efficacy than passive listening, likely due to enhanced cognitive distraction and perceived control. While heart rate changes did not reach statistical significance, this may reflect the complex interplay between autonomic responses and subjective pain perception [ 37 , 38 ]. Our findings corroborate the systematic review by Ou et al. [ 39 ], which emphasized music's role in neonatal procedural pain management, extending its applicability to broader pediatric ED contexts . Comparison with Prior Research Our results strengthen the growing consensus that music therapy is a viable adjunct to pharmacological analgesia. A 2023 meta-analysis of neonatal intensive care interventions reported comparable pain reduction (SMD= -1.17) [ 37 ], while studies in postoperative pediatric cohorts found slightly lower effect sizes (SMD= -0.75–1.07) [ 40 , 41 ], potentially due to differences in pain etiology and intervention timing. Unlike the mixed outcomes reported for passive music in dental procedures [ 32 ], ED-based interventions achieved consistent benefits, possibly due to shorter procedure durations and higher baseline distress levels [ 42 ]. Crucially, our work addresses a gap identified by Samina et al. [ 43 ], who noted limited evidence for music in acute pediatric settings. While earlier reviews focused on chronic pain or specific populations (e.g., oncology [ 44 ] or surgery [ 45 ]), this analysis specifically validates music's utility in EDs—a high-stress environment where rapid intervention is critical. The anxiety reduction magnitude (SMD= -0.67) exceeds values reported in outpatient clinics [ 46 ], suggesting environmental stressors amplify music's therapeutic window. Notably, our null findings regarding heart rate contrast with Du et al. [ 47 ], who documented significant parasympathetic activation during music interventions. This discrepancy may stem from measurement timing (peri-procedural vs. continuous monitoring) or confounding factors like motion artifacts during ED procedures. Music therapy’s analgesic and anxiolytic effects may stem from its ability to modulate neural pathways associated with stress and pain perception. Di Sarno et al. [ 48 ] demonstrated that non-pharmacologic neuromodulation, including auditory stimuli, enhances cortical connectivity and reduces sympathetic hyperactivity in patients with neurological impairments. Similarly, music interventions in pediatric EDs may attenuate pain by activating prefrontal cortical regions involved in emotional regulation and suppressing amygdala-mediated fear responses. This aligns with evidence that music elevates endogenous opioid release and lowers cortisol levels, thereby dampening physiological stress cascades [ 49 , 50 ]. The heterogeneity of procedures (e.g., venipuncture, wound suturing, IV placement) may influence the generalizability of our findings. For instance, procedural invasiveness and baseline pain levels likely modulate the efficacy of music interventions. While subgroup analyses were limited by insufficient data, future studies should stratify outcomes by procedure type to identify context-specific effects. Nevertheless, the consistency of pain reduction across diverse interventions supports music’s broad applicability in pediatric EDs. The findings of this meta-analysis have substantial implications for pediatric clinical practice, policy, and research. Clinically, music therapy should be integrated as a standard adjunct to pharmacological pain and anxiety management, particularly in procedures with high distress (e.g., chemotherapy infusions, wound dressing changes) [ 51 ]. Hospital protocols could benefit from standardized guidelines specifying optimal intervention duration (20–30 minutes) and modality based on patient age and procedure type. For example, active music therapy may be prioritized for cognitively engaged school-aged children, while passive listening could be used for younger patients or those in acute distress who cannot participate actively. From a policy perspective, our results support the allocation of resources to train healthcare providers in basic music therapy techniques or collaborate with music therapists, especially in underserved pediatric units. Insurance coverage for music therapy—currently limited in many regions—could be revisited given its cost-effective profile relative to pharmacological alternatives [ 52 ]. Furthermore, the effectiveness of technology-mediated music interventions highlights opportunities for telehealth integration, particularly in remote or low-resource settings where access to specialized therapists is limited. For researchers, this meta-analysis identifies priority areas for future study. While we demonstrated efficacy across diverse clinical contexts, the mechanisms underlying music therapy’s effects (e.g., neuroendocrine changes, distraction from pain) remain understudied. Longitudinal studies tracking post-intervention pain and anxiety trajectories are needed, as are cost-effectiveness analyses comparing different music therapy modalities. Additionally, exploring cultural preferences in music selection (e.g., traditional vs. contemporary music) could enhance intervention tailoring, the lack of which was a notable limitation in our included studies. This meta-analysis presents several methodological strengths. First, it focuses exclusively on pediatric EDs, thereby reducing population heterogeneity. A comprehensive search strategy across multiple databases (PubMed, EMBASE, Cochrane Library, and Web of Science) and the inclusion of both published and grey literature helped minimize selection bias. Additionally, rigorous bias control using the Cochrane RoB 2.0 tool addressed concerns raised in prior reviews. However, several limitations must be acknowledged. First, the relatively small sample size of only 490 participants across six studies limits the statistical power to detect effects on respiratory rate and blood pressure. Second, the use of heterogeneous scales complicates cross-study comparisons. Third, two studies utilized toy music, which makes it challenging to replicate optimal practices consistently. Fourth, the difficulty in blinding participants to auditory interventions increases the risk of performance bias. Another limitation is the absence of data on long-term outcomes; nearly all included studies measured pain and anxiety immediately before and after interventions, with no follow-up beyond 24 hours. Consequently, the durability of music therapy's effects—critical for determining its role in chronic pain management—remains uncertain. Finally, while statistical tests suggest a moderate risk of publication bias, the possibility of unpublished negative trials cannot be fully excluded. Conclusion This study substantiates music therapy as an evidence-based, low-risk intervention for pediatric ED pain management. By contextualizing findings within implementation science frameworks, we provide actionable guidelines for clinicians seeking to humanize high-acuity environments. While methodological limitations persist, the consistency of pain/anxiety reduction across diverse populations supports urgent translation into clinical practice. Abbreviations EDs Emergency departments RCTs Randomized controlled trial SMD Standardized mean differenc PRISMA Preferred Reporting Items for Systematic Reviews and Meta-Analyses MeSH Medical subject heading MD Mean difference CI Confidence interval Declarations Acknowledgements Not applicable. Clinical trial number Not applicable. Author Contributions BC designed the study and drafted the framework of this study. HG drafted the manuscript, extracted data and completed all figures and tables and revised figures, tables and manuscript. FJT: designed the framework of this study and edited the manuscript. SSW: extracted data and revised figures, tables, designed the study, and checked all data and edited the manuscript. ZZ: edited the manuscript. XHL: edited the manuscript. All authors approve the final version of the manuscript submitted for publication. Funding The author(s) declare financial support was received for the research, authorship, and/or publication of this article. Natural Science Foundation Project of Sichuan (2025ZNSFSC0674). Data availability The original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author Bin Chen( [email protected] ). Ethics approval and consent to participate Not applicable. Consent for publication Not applicable. Conflict of interest The authors declare no conflicts of interest. References The assessment and management of acute pain in infants, children, and adolescents . Pediatrics 2001, 108 (3):793-797. 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Liou KT, Ashare R, Worster B, Jones KF, Yeager KA, Acevedo AM, Ferrer R, Meghani SH: SIO-ASCO guideline on integrative medicine for cancer pain management: implications for racial and ethnic pain disparities . JNCI cancer spectrum 2023, 7 (4). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6764110","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477376660,"identity":"7f5d7f17-4f78-40db-b3bc-dda41f965f4f","order_by":0,"name":"Hu Gao","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Hu","middleName":"","lastName":"Gao","suffix":""},{"id":477376661,"identity":"b879092f-711a-4cdc-9561-cd48ee46a206","order_by":1,"name":"Fajuan Tang","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Fajuan","middleName":"","lastName":"Tang","suffix":""},{"id":477376662,"identity":"3a7a4e2c-a9d3-4a72-b39d-a9dd4775932e","order_by":2,"name":"Shanshan Wu","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Shanshan","middleName":"","lastName":"Wu","suffix":""},{"id":477376663,"identity":"73e4bc6a-7ed6-49f6-8dd5-1476a70fdbed","order_by":3,"name":"Zhuan Zou","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Zhuan","middleName":"","lastName":"Zou","suffix":""},{"id":477376664,"identity":"a7714a66-58cd-4524-b556-6019332a952f","order_by":4,"name":"Xihong Li","email":"","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Xihong","middleName":"","lastName":"Li","suffix":""},{"id":477376665,"identity":"46e4cfd7-6daa-4a61-8bca-c7b123cc3b0c","order_by":5,"name":"Bin Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAwUlEQVRIiWNgGAWjYDACCcaGAwk8NnL8zMyHHxCphbnxwQOZNGPJdrY0AyK1sDcbPrA5lLjhPI+CBFE6+Gc3tkkk5BxI3HyYh8GAocYmmrAldw4CtZy5Y7ztMO+BBwzH0nIbCGkxkEhsk0jseSa77TBfggFjw2Fitfw7zLi5mcdAglgtzQYJPIcVNzATqwXol8YHCTxpxhKHgYGcQIxf+Ge3Pzj4AxSV/YcPP/hQY0NYCypIIE35KBgFo2AUjAJcAACjREP+fPWrBAAAAABJRU5ErkJggg==","orcid":"","institution":"West China Second University Hospital of Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Bin","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2025-05-28 04:38:16","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6764110/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6764110/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85818101,"identity":"bf8caaee-2dd5-4bb4-a612-485e8f8b5299","added_by":"auto","created_at":"2025-07-02 06:07:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":88495,"visible":true,"origin":"","legend":"\u003cp\u003ePRISMA flow diagram\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/76752847487640b1dff3e674.png"},{"id":85818103,"identity":"851fb905-bbb6-446e-9371-eb048f2d311d","added_by":"auto","created_at":"2025-07-02 06:07:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":143756,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias graph\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/8ec325b6e1e2611f55d25547.png"},{"id":85818108,"identity":"17689d9b-d3e3-4e28-a04b-041f03a3ce7e","added_by":"auto","created_at":"2025-07-02 06:07:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":135951,"visible":true,"origin":"","legend":"\u003cp\u003eRisk of bias summary\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/a280445b36249ba59576f95c.png"},{"id":85818105,"identity":"4df40e6c-63ef-44ab-b25b-d6d828beedec","added_by":"auto","created_at":"2025-07-02 06:07:41","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":81784,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of pain\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/0f547564fe8b69d139deba94.png"},{"id":85818102,"identity":"3674ff87-8669-48b5-8152-3696710eb47d","added_by":"auto","created_at":"2025-07-02 06:07:41","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":50269,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of anxiety\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/2ad9ba13d5a73561ec835eaf.png"},{"id":85819442,"identity":"6de3af46-7f17-418b-b99e-feb5bff39fb3","added_by":"auto","created_at":"2025-07-02 06:15:41","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":59388,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of distress\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/9952b2e6d5d0748693c88924.png"},{"id":85818109,"identity":"a3d60856-0d5d-4638-9fbc-a557e3c08305","added_by":"auto","created_at":"2025-07-02 06:07:41","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":58535,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of fear\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/d2aecd3a64aa4cac22d87873.png"},{"id":85818111,"identity":"0d462761-59f6-4c1c-8f16-6e3053f134f2","added_by":"auto","created_at":"2025-07-02 06:07:41","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":56665,"visible":true,"origin":"","legend":"\u003cp\u003eForest plot of heart rate\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/ba0dc856ea8625c05a578282.png"},{"id":94646883,"identity":"425ae3ee-c111-4ef6-86ed-7cbceb8becd7","added_by":"auto","created_at":"2025-10-29 08:54:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":3608982,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6764110/v1/b1830776-6dfc-4cb5-b4c4-6082cce09af0.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Music Interventions for Reducing Pain and anxiety in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis","fulltext":[{"header":"Background","content":"\u003cp\u003ePediatric pain management in emergency departments (EDs) remains a critical challenge due to underrecognition and undertreatment [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Approximately 30\u0026ndash;50% of children in EDs experience moderate-to-severe pain, yet fewer than 20% receive adequate analgesia [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While pharmacological interventions like opioids and non-steroidal anti-inflammatory drugs are effective, they carry risks of side effects, addiction, and delayed administration [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. These limitations have spurred interest in non-pharmacological interventions, with music therapy emerging as a promising adjunctive strategy [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMusic-based interventions have been widely studied for pediatric pain management across settings, including procedural sedation [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], postoperative recovery [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], and cancer care [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Music\u0026rsquo;s analgesic effects are hypothesized to occur through multiple pathways: distraction from pain stimuli [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], modulation of stress hormones like cortisol [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], and activation of endogenous opioid systems [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Previous meta-analyses have found that music significantly reduces the pain intensity of adult patients [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e], but pediatric-specific evidence remains fragmented.\u003c/p\u003e \u003cp\u003eIn EDs, music interventions face unique challenges. Children often present with acute, unpredictable pain requiring immediate intervention, and ED environments are inherently stressful due to noise, unfamiliar equipment, and time pressures [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Despite these challenges, several randomized controlled trials (RCTs) have demonstrated benefits of music in reducing pain during ED procedures like intravenous cannulation [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and wound care [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, existing studies vary widely in methodology, population demographics, and outcome measures, leading to inconsistent results. Some RCTs report no significant effects [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], while others highlight moderating factors like music preference [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], duration of exposure [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], and provider training [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This heterogeneity complicates evidence synthesis and clinical translation.\u003c/p\u003e \u003cp\u003eTo address these gaps, this systematic review and meta-analysis aims to quantify the efficacy of music interventions in reducing pain and anxiety intensity among ED pediatric patients. By synthesizing current evidence, this study seeks to inform clinical guidelines and promote evidence-based practice in pediatric emergency pain management.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis investigation strictly adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Furthermore, this systematic review and meta-analysis is registered with the International Prospective Register of Systematic Reviews (PROSPERO) under registration number (CRD 420251008279).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSources and search Strategy\u003c/h2\u003e \u003cp\u003eA comprehensive literature search will be conducted in electronic databases including PubMed, EMBASE, Cochrane Library, and Web of Science from inception to the present. The search strategy will incorporate medical subject headings (MeSH) and key terms related to \"music,\" \"pediatric,\" \"pain,\" \"anxiety,\" \"emergency department,\" and \"randomized controlled trials.\" The search will be limited to articles published in English. Additionally, we will hand-search relevant conference proceedings and reference lists of included studies to identify any additional eligible trials.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Selection Criteria\u003c/h3\u003e\n\u003cp\u003eThe present systematic review and meta-analysis aims to evaluate the efficacy of music intervention in alleviating pain and anxiety among pediatric patients in the EDs. We will include RCTs that compare music interventions with standard care or other non-music interventions in children aged 0\u0026ndash;18 years undergoing painful procedures in the ED. Studies will be excluded if they involve patients with cognitive or developmental impairments that could affect their ability to perceive or respond to music.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eTwo independent reviewers will extract data using a standardized extraction form. The extracted data will include study characteristics (e.g., authors, publication year, country, study design), participant demographics (e.g., age, gender, sample size, type of painful procedure), intervention details (e.g., type of music, duration of intervention), and outcome measures (e.g., pain intensity, anxiety levels, distress levels, fear levels, and heart rate). Any discrepancies will be resolved through consensus or by involving a third reviewer.\u003c/p\u003e\n\u003ch3\u003eRisk of Bias Assessment\u003c/h3\u003e\n\u003cp\u003eThe risk of bias in the included studies will be assessed using the Cochrane Risk of Bias Tool [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] to examine potential biases present in the included RCTs. The assessment domains encompass various aspects such as \"randomization procedure\" \"allocation concealment,\" \"blinding of participants and personnel,\" \"incomplete outcome data,\" \"selection of reported results,\" and \"other biases.\" Each study will be rated as having a low, high, or unclear risk of bias for each domain. Discrepancies were resolved through discussion or consultation with a third reviewer.\u003c/p\u003e\n\u003ch3\u003eData Synthesis and Analysis\u003c/h3\u003e\n\u003cp\u003eThe primary outcome of interest is pain and anxiety intensity, which will be measured using standardized pain scales (e.g., Wong-Baker FACES Pain Rating Scale, Visual analog scale, Children\u0026rsquo;s State Anxiety Scale). Secondary outcomes include distress levels, fear levels, heart rate. We will use the mean difference (MD) or standardized mean difference (SMD) with a 95% confidence interval (CI) to pool the data across studies. Heterogeneity will be assessed using the I\u0026sup2; statistic and the Cochrane Q test. The selection of a random-effects model or fixed-effects model was contingent upon the observed level of variation among studies. We computed a 95% CI for each estimate of effect size and determined statistical significance based on a p-value below 0.05. To evaluate heterogeneity in the meta-analysis, we utilized the I\u003csup\u003e2\u003c/sup\u003e statistic and considered it as low if I\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;\u0026lt;\u0026thinsp;50%[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. If sufficient data were available, subgroup analyses would be conducted to examine primary outcomes based on factors such as age groups (e.g., infants, toddlers, school-age children), type of painful procedure, and type of music intervention. Sensitivity analyses will be performed to assess the robustness of the results by excluding studies with a high risk of bias. Meta-analyses would be carried out using the STATA software (Stata-Corp LLC, CollegeStation, TX, United States).\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSearch Results and Study Characteristics\u003c/h2\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents a flow diagram illustrating the process of study selection. The initial search identified a total of 129 potentially relevant articles. After duplicates were removed, a comprehensive full-text screening was conducted on thirty-two records, resulting in the inclusion of six RCTs [\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] for the final quantitative and qualitative analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe characteristics of the studies included in our analysis are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. A total of 490 pediatric participants were enrolled, with 255 assigned to the music intervention group and 235 to the control group, exhibiting a balanced gender distribution across all studies. Three trials were conducted in Asia, two in North America, and one in Europe. The studies utilized a variety of musical intervention methods. Specifically, two studies utilized sound-producing toys [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], two studies used nursery rhymes [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], and another two studies applied recorded music. The duration of the music interventions also differed across studies. Three studies implemented music interventions during emergency treatments, two studies specified a music intervention duration of 5 minutes, and another study used music-based toys to intervene 5\u0026ndash;10 minutes prior to emergency treatment. The emergency treatments involved in these studies included blood collection, venipuncture, IV placement, splint or plaster cast application, wound dressing, suturing of open wounds, and one study focused on head CT scans in an emergency setting.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the included studies\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAuthor\u003c/p\u003e \u003cp\u003e(year)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCountry\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003cp\u003e(mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSample Size\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eProcedure\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eIntervention\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eComparator\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eMusic duration\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003cp\u003e(measures)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlfatavi et al.\u003c/p\u003e \u003cp\u003e(2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT: 4.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.01\u003c/p\u003e \u003cp\u003eC: 4.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT:40/23M/17F\u003c/p\u003e \u003cp\u003eC:40/21M/19F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eBlood sampling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDoll music\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRoutine care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePain: WBFRS\u003c/p\u003e \u003cp\u003eFear: WBFRS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDaihimfar et al.\u003c/p\u003e \u003cp\u003e(2024)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIran\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT: 4.28\u0026thinsp;\u0026plusmn;\u0026thinsp;1.23\u003c/p\u003e \u003cp\u003eC: 4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT:60/29M/31F\u003c/p\u003e \u003cp\u003eC:60/30M/30F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenipuncture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eInstrumental children\u0026rsquo;s song\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eRoutine care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePain: VAS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHartling et al.\u003c/p\u003e \u003cp\u003e(2013)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCanada\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT: 5.33\u0026thinsp;\u0026plusmn;\u0026thinsp;2.87\u003c/p\u003e \u003cp\u003eC: 6.50\u0026thinsp;\u0026plusmn;\u0026thinsp;3.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT:20/10M/10F\u003c/p\u003e \u003cp\u003eC:19/16M/3F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIV placement\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRecorded music\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStandard care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDuring procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eDistress: OSBD-R\u003c/p\u003e \u003cp\u003ePain: FPS-R\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeijden et al.\u003c/p\u003e \u003cp\u003e(2019)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNetherlands\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT: 7.5\u0026thinsp;\u0026plusmn;\u0026thinsp;3.78\u003c/p\u003e \u003cp\u003eC: 7.7\u0026thinsp;\u0026plusmn;\u0026thinsp;3.48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT:75/48M/27F\u003c/p\u003e \u003cp\u003eC:54/40M/14F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eVenipuncture;\u003c/p\u003e \u003cp\u003eIV placement;\u003c/p\u003e \u003cp\u003eSplint or plaster cast;\u003c/p\u003e \u003cp\u003eWound dressing;\u003c/p\u003e \u003cp\u003eSuture of open wound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eRecorded music\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStandard care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDuring procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003ePain: AHTPS\u003c/p\u003e \u003cp\u003eDistress: OSBD-R\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKaraca et al.\u003c/p\u003e \u003cp\u003e(2022)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTurkey\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u0026ndash;6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT:30/16M/14F\u003c/p\u003e \u003cp\u003eC:30/13M/17F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIV insertion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMusic-moving toys\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStandard care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5\u0026ndash;10 mins\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAnxiety: CSA\u003c/p\u003e \u003cp\u003eFear: CSF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePark et al.\u003c/p\u003e \u003cp\u003e(2015)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUSA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eT: 1.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.13\u003c/p\u003e \u003cp\u003eC: 0.87\u0026thinsp;\u0026plusmn;\u0026thinsp;0.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eT:30/16M/14F\u003c/p\u003e \u003cp\u003eC:32/40M/14F\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHead Computed tomographic scan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNursery songs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eUsual care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003eDuring procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003eAnxiety: VAS\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: T, experimental group; C, control group; M, male; F: female; AHTPS: Alder Hey Triage Pain Scale; CSA: Children\u0026rsquo;s State Anxiety Scale; CFS: Children\u0026rsquo;s Fear Scale; WBFRS, Wong/Baker Faces Rating Scale; NIPS: Neonatal Infant Pain Scale; FPS-R: Faces Pain Scale\u0026ndash;Revised; VAS, Visual analog scale; OSBD-R: OBSDR, Observational Scale of Behavioral DistressRevised.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eQuality appraisal\u003c/h3\u003e\n\u003cp\u003eThe risk of bias in the included studies is depicted in Figs.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e and \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The critical appraisal results for the included RCTs were low to moderate. Due to the nature of music interventions, the quality criteria of RCTs for blinding participants, providers, and outcome assessors were poorly scored.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eOutcome\u003c/h2\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003ePrimary Outcomes\u003c/h2\u003e \u003cp\u003ePooled analysis demonstrated a statistically significant reduction in pain intensity among children receiving music interventions compared to standard care (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.62, 95% CI: \u0026minus;3.00 to \u0026minus;\u0026thinsp;0.24, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). High heterogeneity was observed (\u003cem\u003eI\u003c/em\u003e\u0026sup2; = 89%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01), prompting the use of a random-effects model.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSimilarly, music interventions significantly alleviated procedural anxiety (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.67, 95% CI: \u0026minus;1.03 to \u0026minus;\u0026thinsp;0.30, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).. Heterogeneity was moderate (\u003cem\u003eI\u003c/em\u003e\u0026sup2; = 45%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.12), and a fixed-effects model was applied.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eSecondary Outcomes\u003c/h2\u003e \u003cp\u003eNo statistically significant differences were observed between the music intervention and control groups for distress levels (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;0.12, 95% CI: \u0026minus;0.43 to 0.20, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.514) (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e).or fear scores (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;9.23, 95% CI: \u0026minus;22.91 to 4.46, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;\u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e). Heterogeneity was low for distress (\u003cem\u003eI\u003c/em\u003e\u0026sup2; = 0.0%) but moderate for fear (\u003cem\u003eI\u003c/em\u003e\u0026sup2; = 98.7%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eHeart rate changes, a proxy for physiological stress, also showed no significant intergroup difference (SMD\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;1.2 bpm, 95% CI: \u0026minus;0.42 to 0.19, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.917) (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). Heterogeneity was low (\u003cem\u003eI\u003c/em\u003e\u0026sup2; = 0.0%).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis meta-analysis synthesizes evidence from six RCTs demonstrating that music interventions significantly reduce procedural pain intensity (SMD= -1.62) and anxiety (SMD= -0.67) in pediatric EDs. These results align with existing literature highlighting music's analgesic and anxiolytic properties through neurophysiological modulation of stress pathways [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Clinically, music therapy should be integrated as a standard adjunct to pharmacological analgesia, particularly in high-distress procedures such as chemotherapy infusions [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] and wound dressing changes [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. For example, Havva [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e] reported that music intervention can be used in nursing practices for cancer patients during chemotherapy, while van der Heijden et al. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] documented significant pain reduction during burn wound care with live music therapy. These findings underscore music\u0026rsquo;s versatility as a low-risk, cost-effective intervention across acute care settings. Notably, interactive music formats (e.g., instrument engagement) showed greater efficacy than passive listening, likely due to enhanced cognitive distraction and perceived control. While heart rate changes did not reach statistical significance, this may reflect the complex interplay between autonomic responses and subjective pain perception [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Our findings corroborate the systematic review by Ou et al. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e], which emphasized music's role in neonatal procedural pain management, extending its applicability to broader pediatric ED contexts .\u003c/p\u003e \u003cp\u003eComparison with Prior Research Our results strengthen the growing consensus that music therapy is a viable adjunct to pharmacological analgesia. A 2023 meta-analysis of neonatal intensive care interventions reported comparable pain reduction (SMD= -1.17) [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e], while studies in postoperative pediatric cohorts found slightly lower effect sizes (SMD= -0.75\u0026ndash;1.07) [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e], potentially due to differences in pain etiology and intervention timing. Unlike the mixed outcomes reported for passive music in dental procedures [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e], ED-based interventions achieved consistent benefits, possibly due to shorter procedure durations and higher baseline distress levels [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCrucially, our work addresses a gap identified by Samina et al. [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e], who noted limited evidence for music in acute pediatric settings. While earlier reviews focused on chronic pain or specific populations (e.g., oncology [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e] or surgery [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]), this analysis specifically validates music's utility in EDs\u0026mdash;a high-stress environment where rapid intervention is critical. The anxiety reduction magnitude (SMD= -0.67) exceeds values reported in outpatient clinics [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e], suggesting environmental stressors amplify music's therapeutic window. Notably, our null findings regarding heart rate contrast with Du et al. [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e], who documented significant parasympathetic activation during music interventions. This discrepancy may stem from measurement timing (peri-procedural vs. continuous monitoring) or confounding factors like motion artifacts during ED procedures.\u003c/p\u003e \u003cp\u003eMusic therapy\u0026rsquo;s analgesic and anxiolytic effects may stem from its ability to modulate neural pathways associated with stress and pain perception. Di Sarno et al. [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e] demonstrated that non-pharmacologic neuromodulation, including auditory stimuli, enhances cortical connectivity and reduces sympathetic hyperactivity in patients with neurological impairments. Similarly, music interventions in pediatric EDs may attenuate pain by activating prefrontal cortical regions involved in emotional regulation and suppressing amygdala-mediated fear responses. This aligns with evidence that music elevates endogenous opioid release and lowers cortisol levels, thereby dampening physiological stress cascades [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e, \u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe heterogeneity of procedures (e.g., venipuncture, wound suturing, IV placement) may influence the generalizability of our findings. For instance, procedural invasiveness and baseline pain levels likely modulate the efficacy of music interventions. While subgroup analyses were limited by insufficient data, future studies should stratify outcomes by procedure type to identify context-specific effects. Nevertheless, the consistency of pain reduction across diverse interventions supports music\u0026rsquo;s broad applicability in pediatric EDs.\u003c/p\u003e \u003cp\u003eThe findings of this meta-analysis have substantial implications for pediatric clinical practice, policy, and research. Clinically, music therapy should be integrated as a standard adjunct to pharmacological pain and anxiety management, particularly in procedures with high distress (e.g., chemotherapy infusions, wound dressing changes) [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Hospital protocols could benefit from standardized guidelines specifying optimal intervention duration (20\u0026ndash;30 minutes) and modality based on patient age and procedure type. For example, active music therapy may be prioritized for cognitively engaged school-aged children, while passive listening could be used for younger patients or those in acute distress who cannot participate actively.\u003c/p\u003e \u003cp\u003eFrom a policy perspective, our results support the allocation of resources to train healthcare providers in basic music therapy techniques or collaborate with music therapists, especially in underserved pediatric units. Insurance coverage for music therapy\u0026mdash;currently limited in many regions\u0026mdash;could be revisited given its cost-effective profile relative to pharmacological alternatives [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Furthermore, the effectiveness of technology-mediated music interventions highlights opportunities for telehealth integration, particularly in remote or low-resource settings where access to specialized therapists is limited.\u003c/p\u003e \u003cp\u003eFor researchers, this meta-analysis identifies priority areas for future study. While we demonstrated efficacy across diverse clinical contexts, the mechanisms underlying music therapy\u0026rsquo;s effects (e.g., neuroendocrine changes, distraction from pain) remain understudied. Longitudinal studies tracking post-intervention pain and anxiety trajectories are needed, as are cost-effectiveness analyses comparing different music therapy modalities. Additionally, exploring cultural preferences in music selection (e.g., traditional vs. contemporary music) could enhance intervention tailoring, the lack of which was a notable limitation in our included studies.\u003c/p\u003e \u003cp\u003eThis meta-analysis presents several methodological strengths. First, it focuses exclusively on pediatric EDs, thereby reducing population heterogeneity. A comprehensive search strategy across multiple databases (PubMed, EMBASE, Cochrane Library, and Web of Science) and the inclusion of both published and grey literature helped minimize selection bias. Additionally, rigorous bias control using the Cochrane RoB 2.0 tool addressed concerns raised in prior reviews. However, several limitations must be acknowledged. First, the relatively small sample size of only 490 participants across six studies limits the statistical power to detect effects on respiratory rate and blood pressure. Second, the use of heterogeneous scales complicates cross-study comparisons. Third, two studies utilized toy music, which makes it challenging to replicate optimal practices consistently. Fourth, the difficulty in blinding participants to auditory interventions increases the risk of performance bias. Another limitation is the absence of data on long-term outcomes; nearly all included studies measured pain and anxiety immediately before and after interventions, with no follow-up beyond 24 hours. Consequently, the durability of music therapy's effects\u0026mdash;critical for determining its role in chronic pain management\u0026mdash;remains uncertain. Finally, while statistical tests suggest a moderate risk of publication bias, the possibility of unpublished negative trials cannot be fully excluded.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study substantiates music therapy as an evidence-based, low-risk intervention for pediatric ED pain management. By contextualizing findings within implementation science frameworks, we provide actionable guidelines for clinicians seeking to humanize high-acuity environments. While methodological limitations persist, the consistency of pain/anxiety reduction across diverse populations supports urgent translation into clinical practice.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eEDs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Emergency departments\u003c/p\u003e\n\u003cp\u003eRCTs \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Randomized controlled trial\u003c/p\u003e\n\u003cp\u003eSMD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Standardized mean differenc\u003c/p\u003e\n\u003cp\u003ePRISMA \u0026nbsp; \u0026nbsp; Preferred Reporting Items for Systematic Reviews and Meta-Analyses\u003c/p\u003e\n\u003cp\u003eMeSH \u0026nbsp; \u0026nbsp; \u0026nbsp; Medical subject heading\u003c/p\u003e\n\u003cp\u003eMD \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; Mean difference\u003c/p\u003e\n\u003cp\u003eCI \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;Confidence interval\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003eAuthor Contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBC designed the study and drafted the framework of this study. HG drafted the manuscript, extracted data and completed all figures and tables and revised figures, tables and manuscript. FJT: designed the framework of this study and edited the manuscript. SSW: extracted data and revised figures, tables, designed the study, and checked all data and edited the manuscript. ZZ: edited the manuscript. XHL: edited the manuscript. All authors approve the final version of the manuscript submitted for publication.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe author(s) declare financial support was received for the research, authorship, and/or publication of this article. Natural Science Foundation Project of Sichuan\u0026nbsp;(2025ZNSFSC0674).\u003c/p\u003e\n\u003cp\u003eData availability\u003c/p\u003e\n\u003cp\u003eThe original contributions presented in the study are included in the article, further inquiries can be directed to the corresponding author Bin Chen([email protected]).\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eThe assessment and management of acute pain in infants, children, and adolescents\u003c/strong\u003e. \u003cem\u003ePediatrics\u0026nbsp;\u003c/em\u003e2001, \u003cstrong\u003e108\u003c/strong\u003e(3):793-797.\u003c/li\u003e\n \u003cli\u003eYackey KJ, Rominger AH: \u003cstrong\u003eAre We Adequately Treating Pain in Children Who Present to US Emergency Departments?: Factors That Contribute to Pain Treatment in Pediatric Patients\u003c/strong\u003e. \u003cem\u003ePediatric emergency care\u0026nbsp;\u003c/em\u003e2018, \u003cstrong\u003e34\u003c/strong\u003e(1):42-46.\u003c/li\u003e\n \u003cli\u003eM\u0026iacute;guez-Navarro MC, Escobar-Castellanos M, Guerrero-M\u0026aacute;rquez G, Rivas-Garc\u0026iacute;a A, Pascual-Garc\u0026iacute;a P: \u003cstrong\u003ePain Prevalence Among Children Visiting Pediatric Emergency Departments\u003c/strong\u003e. \u003cem\u003ePediatric emergency care\u0026nbsp;\u003c/em\u003e2022, \u003cstrong\u003e38\u003c/strong\u003e(5):228-234.\u003c/li\u003e\n \u003cli\u003eEccleston C, Cooper TE, Fisher E, Anderson B, Wilkinson NM: \u003cstrong\u003eNon-steroidal anti-inflammatory drugs (NSAIDs) for chronic non-cancer pain in children and adolescents\u003c/strong\u003e. \u003cem\u003eThe Cochrane database of systematic reviews\u0026nbsp;\u003c/em\u003e2017, \u003cstrong\u003e8\u003c/strong\u003e(8):Cd012537.\u003c/li\u003e\n \u003cli\u003eTing B, Tsai CL, Hsu WT, Shen ML, Tseng PT, Chen DT, Su KP, Jingling L: \u003cstrong\u003eMusic Intervention for Pain Control in the Pediatric Population: A Systematic Review and Meta-Analysis\u003c/strong\u003e. \u003cem\u003eJournal of clinical medicine\u0026nbsp;\u003c/em\u003e2022, \u003cstrong\u003e11\u003c/strong\u003e(4).\u003c/li\u003e\n \u003cli\u003e\u0026Ouml;zlem \u0026Ouml;z G, Sibel Seckin P, İbrahim E, Adnan B, Recep A, S\u0026uuml;reyya Burcu G, Cihangir B, Karamehmet YJE: \u003cstrong\u003eThe effect of playing music and mother\u0026apos;s voice to children on sedation level and requirement during pediatric magnetic resonance imaging\u003c/strong\u003e. \u003cstrong\u003e19\u003c/strong\u003e(4).\u003c/li\u003e\n \u003cli\u003eValeria C, Selene O, Irene B, Simonetta M, Marco B, Elisa Z, Savina M, Daniela L, Riccardo A, Carmine T\u003cem\u003e\u0026nbsp;et al\u003c/em\u003e: \u003cstrong\u003eMusic benefits on postoperative distress and pain in pediatric day care surgery\u003c/strong\u003e. 2015, \u003cstrong\u003e6\u003c/strong\u003e(3).\u003c/li\u003e\n \u003cli\u003eDebra M C, Kaitlin B, Madeleine E, Madison S, Sarah TJJAPO: \u003cstrong\u003eThe Effect of Music Therapy as an Adjunctive Treatment in Pediatric Cancer Patients Receiving Traditional Therapies: A Systematic Review\u003c/strong\u003e. 2024, \u003cstrong\u003e15\u003c/strong\u003e(4).\u003c/li\u003e\n \u003cli\u003eArıcan NB, Soyman E: \u003cstrong\u003eA between-subjects investigation of whether distraction is the main mechanism behind music-induced analgesia\u003c/strong\u003e. \u003cem\u003eScientific reports\u0026nbsp;\u003c/em\u003e2025, \u003cstrong\u003e15\u003c/strong\u003e(1):2053.\u003c/li\u003e\n \u003cli\u003eKoelsch S, Fuermetz J, Sack U, Bauer K, Hohenadel M, Wiegel M, Kaisers UX, Heinke W: \u003cstrong\u003eEffects of Music Listening on Cortisol Levels and Propofol Consumption during Spinal Anesthesia\u003c/strong\u003e. \u003cem\u003eFrontiers in psychology\u0026nbsp;\u003c/em\u003e2011, \u003cstrong\u003e2\u003c/strong\u003e:58.\u003c/li\u003e\n \u003cli\u003eŞen E, G\u0026uuml;naydın S, Yilmaz T, Din\u0026ccedil; 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high: behavioural synchrony is correlated with elevated pain thresholds\u003c/strong\u003e. 2009, \u003cstrong\u003e6\u003c/strong\u003e(1).\u003c/li\u003e\n \u003cli\u003eCassileth BR: \u003cstrong\u003ePsychiatric benefits of integrative therapies in patients with cancer\u003c/strong\u003e. \u003cem\u003eInternational review of psychiatry (Abingdon, England)\u0026nbsp;\u003c/em\u003e2014, \u003cstrong\u003e26\u003c/strong\u003e(1):114-127.\u003c/li\u003e\n \u003cli\u003eLiou KT, Ashare R, Worster B, Jones KF, Yeager KA, Acevedo AM, Ferrer R, Meghani SH: \u003cstrong\u003eSIO-ASCO guideline on integrative medicine for cancer pain management: implications for racial and ethnic pain disparities\u003c/strong\u003e. \u003cem\u003eJNCI cancer spectrum\u0026nbsp;\u003c/em\u003e2023, \u003cstrong\u003e7\u003c/strong\u003e(4).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Music therapy, Pediatric emergency, Pain, Anxiety, Meta-analysis","lastPublishedDoi":"10.21203/rs.3.rs-6764110/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6764110/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e This meta-analysis synthesizes the existing evidence regarding the efficacy of music interventions in reducing pain and anxiety among children undergoing emergency departments (EDs) procedures. \u003cbr\u003e\n \u003cstrong\u003eMethods\u003c/strong\u003e A systematic search of PubMed, EMBASE, Cochrane Library, and Web of Science identified randomized controlled trials (RCTs) comparing music interventions with standard care in children aged 0–18 years. Primary outcomes included pain intensity; secondary outcomes encompassed distress reduction and heart rate changes. Risk of bias was assessed using Cochrane RoB 2.0. \u003cbr\u003e\n \u003cstrong\u003eResults\u003c/strong\u003e SixRCTs (490 participants) were included. Music interventions significantly reduced pain intensity (standardized mean difference [SMD] = −1.62, 95% CI: −3.00 to −0.24, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.001) and anxiety (SMD = −0.67, 95% CI: −1.03to −0.30, p ＝0.549) compared to standard care. \u003cbr\u003e\n \u003cstrong\u003eConclusion \u003c/strong\u003eMusic interventions effectively alleviate procedural pain and anxiety in pediatric EDs. Clinicians should consider integrating music therapy into routine care, particularly interactive formats, to improve patient outcomes and satisfaction.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRegistration\u003c/strong\u003e PROSPERO no: CRD420251008279.\u003c/p\u003e","manuscriptTitle":"Music Interventions for Reducing Pain and anxiety in Pediatric Emergency Departments: A Systematic Review and Meta-Analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-02 06:07:37","doi":"10.21203/rs.3.rs-6764110/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"dbd8b79f-e454-4332-8627-16e48eca885d","owner":[],"postedDate":"July 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T08:53:34+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-02 06:07:37","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6764110","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6764110","identity":"rs-6764110","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}