Music therapy versus recorded music in pain treatment in a pediatric intensive care unit: a systematic review with meta-analysis.
Pain Management; Pediatric Intensive Care Units; Music; Music Therapy; Systematic Review; Evidence-Based Nursing.
Pain in children admitted to Pediatric Intensive Care Units (PICUs) remains highly prevalent despite structured pharmacological protocols. Clinical complexity, frequent invasive procedures, and limitations in self-report make pain management a significant challenge, requiring multimodal approaches that integrate non-pharmacological interventions into critical care. Among these strategies, music-based interventions have been described as potentially effective; however, conceptual heterogeneity persists, particularly regarding the distinction between recorded music and live music therapy. This doctoral thesis aimed to critically analyze and synthesize the scientific evidence on music-based interventions for pain management in pediatric patients admitted to PICUs, comparing live music therapy and recorded music in order to support evidence-based nursing practice. The methodological pathway consisted of three interdependent studies: (1) development of a scoping review protocol prospectively registered; (2) a scoping review conducted according to Joanna Briggs Institute methodology and PRISMA-ScR guidelines, which mapped non-pharmacological interventions in PICUs and identified methodological heterogeneity and specific gaps related to music interventions; and (3) a comparative systematic review analyzing the effectiveness of live music therapy versus recorded music for pain control in PICU settings. Findings suggest that music-based interventions are feasible and potentially beneficial as adjuncts to pharmacological analgesia, with trends toward reduced pain scores. Nevertheless, the evidence remains fragmented, characterized by variability in intervention protocols, heterogeneity in pain assessment instruments, and a scarcity of studies conducted specifically in PICUs—particularly those directly comparing live and recorded modalities. Although music represents a promising multimodal strategy for pediatric intensive care pain management, the consolidation of clinical recommendations requires robust comparative studies, methodological standardization, and multicenter designs. This thesis contributes to conceptual clarification of music interventions, strengthens evidence-based pediatric critical care nursing, and advances scientific knowledge in the field.