Many thanks for inviting me to review “Music, Movement, and the Mind: A Neuroscientific Perspective on the Pain reducing Effects of Music and their Implications for Music Therapy and Mental Well-being”. The article provides an interesting overview of some of the neural mechanisms that mediate the analgesic benefits of pain. The review provides an overview of clinical based meta-analysis, and neuroscientific related to music for pain.

It’s notable than many studies identified in the review, do not directly investigate, or isolate the neural pathways for music analgesia, and the results should be interpreted with more caution. Additionally, it’s quite surprising that the review claims that de-activation of the default mode network is central to music based analgesia (Page 4), given that several studies have identified the default mode network both in the general pain literature and in music specific studies.
For example, Garza-Villareal (2015) initially identified that music mediated analgesia was related to top-down regulation of the pain modulatory network by the default mode network (DMN). This finding was replicated by Pando-Naude (2019) who revealed that music listening resulted in changes in resting-state functional connectivity involving the DMN and other regions related to pain processing, such as the insula and anterior cingulate cortex. These alterations suggest that music may engage the brain's pain modulatory systems, with the DMN contributing to the observed analgesic effects. Again, Usui (2020) also found that decreases in pain scores in fibroyalgia patients were linked to a significant difference in connectivity between the right insular cortex (IC) and posterior cingulate cortex (PCC)/precuneus (PCu) before and after listening to music. These results also align with the wider pain literature that identify that normal activity in the DMN has been shown to be disrupted in chronic pain patients Baliki (2008), so further reduction may not be advantageous.

The review does not acknowledge the role of agency, control, or personal choice in music in mediating the analgesic benefits of music, despite this result being found in multiple previous independent studies. A recent 2024 review (Habermann et al., 2024) provides an overview of the role of control in pain management , and this has also been found in music contexts (Fritz, 2018; Howlin, 2021)

This review could be more extensive in its representation of the current literature. It would be great to get an understanding of the selection process or context used for article inclusion, or clarification on the style of this review. There are several EEG, and MEG papers that have not been included, that directly explore the links between music and pain, but they don't feature here.

Please provide citations for the statement “In fact, many studies use pain reduction as a proxy for the activation of the endogenous opioid system”

The review reports that current music therapy clinical trials use music-making as part of their protocols. Many patients with chronic pain also report that they use music listening to alleviate pain and discomfort, especially during times when it is too difficult for them to move or during intense flare ups. Given the wealth of literature mentioned above, this review should acknowledge that the neural mechanisms underpinning music mediated analgesia are not specific to active music making.

It's possible that completely different neural pathways operate in different physical and mental health conditions, with different corresponding mechanisms. Currently the link between a suppressed default mode network, pain management, and depressive rumination is not sufficiently supported. Please provide a citation to support the statement "For example, the brain’s default mode network has been implicated in mind-wandering, including rumination, i.e. mind-wandering with repetitive negative thoughts.", and provide more details about this potential mechanism, and why we should assume that the same mechanisms involved in depression can be translated into a chronic pain context. Of course many people will have dual-diagnosis, but for those that don't have a dual diagnosis of depression and chronic pain, or for those with depression without ruminative tendencies, the case needs to be made more convincingly.

Baliki, M. N., Geha, P. Y., Apkarian, A. V., & Chialvo, D. R. (2008). Beyond feeling: chronic pain hurts the brain, disrupting the default-mode network dynamics. Journal of Neuroscience, 28(6), 1398-1403.

Fritz, T. H., Bowling, D. L., Contier, O., Grant, J., Schneider, L., Lederer, A., ... & Villringer, A. (2018). Musical agency during physical exercise decreases pain. Frontiers in psychology, 8, 2312.

Garza-Villarreal, E. A., Jiang, Z., Vuust, P., Alcauter, S., Vase, L., Pasaye, E. H., ... & Barrios, F. A. (2015). Music reduces pain and increases resting state fMRI BOLD signal amplitude in the left angular gyrus in fibromyalgia patients. Frontiers in psychology, 6, 1051.

Howlin, C., & Rooney, B. (2021). Cognitive agency in music interventions: Increased perceived control of music predicts increased pain tolerance. European journal of pain, 25(8), 1712-1722.

Habermann, M., Strube, A., & Büchel, C. (2025). How control modulates pain. Trends in Cognitive Sciences, 29, (1), 60-72.

Pando-Naude, V., Barrios, F.A., Alcauter, S. et al. Functional connectivity of music-induced analgesia in fibromyalgia. Sci Rep 9, 15486 (2019). https://doi.org/10.1038/s41598-019-51990-4

Putkinen, V., Seppälä, K., Harju, H., Hirvonen, J., Karlsson, H. K., & Nummenmaa, L. (2025). Pleasurable music activates cerebral µ-opioid receptors: a combined PET-fMRI study. European Journal of Nuclear Medicine and Molecular Imaging, 1-10.

Usui C, Kirino E, Tanaka S, et al. Music Intervention Reduces Persistent Fibromyalgia Pain and Alters Functional Connectivity Between the Insula and Default Mode Network. Pain Medicine (Malden, Mass.). 2020 Aug;21(8):1546-1552. DOI: 10.1093/pm/pnaa071. PMID: 32330259.