The emergency department (ED) is an entry point to hospital admission, providing timely critical care for acutely ill and injured patients [1]. For many patients, pain is the main reason for visiting the ED [2]. In the United States alone, pain is the chief complaint of over 100 million patients presenting to the ED each year [3].

The ED environment is often noisy and crowded. Coupled with unfamiliar staff and the fear of painful tests and treatments, patients visiting the ED often feel anxious [4]. This applies to all patients regardless of their age groups [5]. Multiple studies have highlighted a significant correlation between increased pain and anxiety levels, especially for elderly and pediatric patients [6]. As a result, patients also experience increased heart rate and distress levels due to the activation of the sympathetic nervous system [7], [8]. Elderly patients experience high anxiety levels as they are more likely to have an extended stay in the ED and be admitted after their visit [9]. Pediatric patients may have increased anxiety due to environmental factors and physical discomfort [10]. They might present uncooperative behavioural symptoms, resulting in delayed treatment processes [10]. This also leads to increased waiting time for other patients, worsening the overcrowding situation [11].

Traditionally, pharmacotherapy is used to reduce pain and anxiety. However, it is associated with the risk of adverse side effects [12]. Pain medications such as opioids can increase the risk of cognitive impairment or fall risk in elderly patients [13]. Incorporating both pharmacological and non-pharmacological measures are effective in acute pain management. It can also potentially reduce the reliance on medications such as opioids [14].

Conventionally, music has been a therapeutic intervention to improve the health of patients [15]. Music interventions consist of music therapy and music listening [16]. Music therapy is defined as “the clinical & evidence-based use of music interventions to accomplish individualized goals within a therapeutic relationship” by a certified music therapist [17]. Music listening involves giving patients a playlist that helps to reduce anxiety, stress and pain [18]. The gate control theory of pain describes pain receptors that send pain signals to the brain [19]. Therefore, distractors such as music can block the pathway and diminish perceived pain [12]. Magnetic resonance imaging studies have also shown that music listening is associated with dopamine release from the brain, which has a role in central analgesia [20]. Music interventions can decrease the dosage of pain medications and shorten the recovery time for patients [14]. Therefore, music interventions are safe treatments that all patients can use, which increases the acceptability of implementing music interventions in clinical settings [16].

To date, no systematic review has focused on the effectiveness of music interventions on pediatric and adult patients with pain and anxiety in the ED. Two systematic reviews reported on non-pharmacological pain management in the ED [2], [21]. However, limited relevant studies were on music interventions. Both systematic reviews only had five studies out of 56 and 14 studies [2], [21] reporting on music interventions. As the review by Wente [21] was published years ago, it lacks the new information from the newly released articles. There are also multiple existing systematic reviews reporting on the effectiveness of music interventions focusing on other populations. However, most included studies did not differentiate between the different music interventions, making it difficult to compare the effects between music therapy and music listening [22]. Hence, this review's findings will contribute to the current knowledge on music interventions in the ED.

What is the effectiveness of music interventions in reducing pain and anxiety in pediatric and adult emergency departments?