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The trial’s design reflects a growing recognition within perioperative medicine that pain after surgery is not purely a peripheral phenomenon but a process shaped substantially by psychological state in the hours before incision. Preoperative anxiety is consistently associated with heightened pain sensitivity after surgery, a relationship thought to involve increased sympathetic tone, elevated circulating catecholamines, and amplified attention to nociceptive signals. In the specific population studied here—young women presenting for elective abortion under non-intubated general anesthesia—the emotional burden is compounded by the circumstances of the procedure itself, which can carry feelings of guilt, grief, or social pressure. The investigators therefore chose an intervention window that many pharmacological studies overlook: the thirty minutes immediately before surgery, when anxiety typically peaks and when sedative premedication is often avoided so that patients can consent and ambulate safely.

Five-element music therapy derives from the Traditional Chinese Medicine framework that maps five tones—gong, shang, jue, zhi, and yu—onto the five zang organs and their associated emotional states. In classical theory, each tone is believed to exert a regulatory influence on a corresponding organ system and its linked emotion, and therapeutic playlists are constructed to restore balance among these elements. From a modern neuroscience perspective, such structured, slow-tempo music can plausibly operate through several converging mechanisms: activation of descending inhibitory pain pathways via the periaqueductal gray, reduction of cortisol and sympathetic arousal, distraction of attentional resources away from threat appraisal, and modulation of the autonomic balance toward parasympathetic dominance. The use of noise-cancelling headphones is a methodologically meaningful detail, because ambient operating-room noise—alarms, instrument clatter, and staff conversation—can undermine the relaxation response and introduce uncontrolled variability in what patients actually hear.

The analgesic regimen against which the music was tested deserves attention. Parecoxib sodium is a water-soluble prodrug of valdecoxib that selectively inhibits cyclooxygenase-2, reducing prostaglandin-mediated sensitization of peripheral nociceptors without the platelet and gastrointestinal liabilities of non-selective NSAIDs. A single 40 mg intravenous dose given before the audio intervention positions the drug for peak effect during the operative period and the early recovery phase, consistent with the principles of preemptive and multimodal analgesia. Propofol provides the sedative-hypnotic component of the non-intubated anesthetic, while nalbuphine, a mixed opioid agonist-antagonist acting primarily at kappa and mu receptors, contributes analgesia with a comparatively favorable profile regarding respiratory depression and, importantly, postoperative nausea and vomiting. The choice of nalbuphine rather than a full mu-agonist reflects a deliberate strategy to limit emetic complications, which are a common reason for delayed discharge after short gynecological procedures.

Against this multimodal pharmacological backdrop, the observed one-point difference in peak movement-evoked pain on a ten-point scale is clinically meaningful rather than trivial. Movement-evoked pain is increasingly regarded as a more functionally relevant endpoint than pain at rest, because it captures the pain that actually limits mobilization, dressing, and discharge readiness. A reduction of this magnitude, achieved without adding any drug, suggests that the music intervention recruited endogenous modulatory systems that pharmacotherapy alone did not fully engage. The dramatic difference in rescue analgesia requirements—2 percent in the music group versus 26 percent in controls—reinforces this interpretation, since rescue medication is typically requested when patients perceive their pain as intolerable rather than merely present.

The anxiety findings warrant careful reading. Both the Self-Rating Anxiety Scale and the State-Trait Anxiety Inventory trended lower in the music group, but the confidence intervals crossed zero, and the differences were not statistically significant. Several factors may explain this. The trial enrolled 101 randomized participants, which limits power for detecting modest between-group differences in continuous psychological scores, particularly when baseline anxiety levels in a young, elective-surgery population may be relatively heterogeneous. In addition, the postoperative timing of the anxiety assessments means that the measurements were confounded by the patients’ pain experience itself; pain relief in the music group may have partially masked or absorbed the anxiety benefit, making the two outcomes difficult to disentangle. It is also possible that the anxiolytic effect of the music was most pronounced during the preoperative listening period itself and had partially waned by the time of postoperative assessment.

The absence of a difference in nausea and vomiting between groups is consistent with the pharmacology of the anesthetic protocol. Because nalbuphine was used in both arms and the emetogenic burden was already low, there was limited headroom for a psychological intervention to further reduce these events. This outcome should not be interpreted as evidence against music therapy’s broader physiological effects; rather, it illustrates the importance of the baseline event rate and the choice of comparator when evaluating adjunctive interventions.

The satisfaction gap—94 percent versus 68 percent—is among the most striking results and arguably the most relevant to routine clinical operations. Patient-reported satisfaction integrates pain control, perceived care, sense of agency, and emotional comfort into a single judgment, and it is increasingly used as a quality metric in ambulatory surgery. A non-pharmacological intervention that requires no additional drugs, carries essentially no physiological risk, and can be delivered by existing nursing staff with inexpensive equipment offers an unusually favorable risk-benefit and cost profile, provided the effect is reproducible.

Several limitations frame the interpretation. The single-center design at one Chinese hospital means that the patient population, cultural familiarity with five-element music, and institutional perioperative practices may not generalize elsewhere. The control condition—headphones without music—controls for the device and for the time spent in a quiet, isolated setting, but it cannot fully blind participants or the assessing staff, so expectancy effects on subjective outcomes such as pain scores cannot be excluded. The exclusive enrollment of women aged 18 to 35 leaves open whether the intervention works equally well in older patients or in those with chronic pain conditions. Finally, the trial tested a single standardized listening session; whether repeated or longer exposure, different musical selections, or delivery during recovery rather than before surgery would alter the results remains unexamined.

From a mechanistic standpoint, the study adds to a body of literature suggesting that music-based interventions can reduce acute postoperative pain and opioid consumption across surgical contexts, including cesarean delivery, laparoscopy, and minor orthopedic procedures. What distinguishes the present work is the combination of a TCM-derived musical framework with a modern multimodal analgesic protocol and a rigorously defined primary endpoint measured at three postoperative timepoints. The five-element framework itself has limited direct neuroscientific validation, and the trial cannot determine whether the specific tonal structure mattered or whether any calming, culturally familiar music delivered under identical conditions would have produced similar results. Disentangling the specific contribution of the five-element composition from the generic effects of preoperative music listening is a natural target for future factorial studies.

For clinicians, the practical takeaway is that a low-cost, low-risk preoperative listening session can be layered onto an existing multimodal analgesic regimen with measurable benefit in pain scores, rescue analgesia use, and patient satisfaction. For researchers, the trial highlights the value of studying the preoperative window as an active therapeutic period rather than dead time, and it underscores the need for larger multicenter trials with blinded outcome assessment where feasible, longer follow-up for persistent postoperative pain, and standardized reporting of the musical stimuli so that other groups can replicate the intervention precisely. The trial’s registration in the Chinese Clinical Trial Registry and its prospective design strengthen confidence in the primary findings, while the open-access publication supports independent scrutiny of the data as the evidence base for perioperative music therapy continues to mature.

Subject of Research: …

Article Title: Preoperative five-element music via noise-cancelling headphones as an adjunct to parecoxib-based analgesia for postoperative pain after painless induced abortion: a randomized clinical trial

Article References: Cao, X., Weng, Z., Wei, Y., Xiao, H., Ji, Y., Song, S., Li, C., Zhang, S., Lin, J., & Li, X. (2026). Preoperative five-element music via noise-cancelling headphones as an adjunct to parecoxib-based analgesia for postoperative pain after painless induced abortion: a randomized clinical trial. BMC Complementary Medicine and Therapies. https://doi.org/10.1186/s12906-026-05633-7

Image Credits: AI Generated

DOI: 10.1186/s12906-026-05633-7

Keywords: music therapy, postoperative pain, parecoxib, five-element music, randomized clinical trial, Traditional Chinese Medicine, anxiety, induced abortion, noise-cancelling headphones, analgesia, propofol, patient satisfaction