Music and Medicine Come Together Over Pain in the Air Medical Transport Environment

•Patient-selected music may be a distractor to stressors of flight including pain.•Music may reduce the amount of medications needed to control plain in flight.•Distraction from pain with music provides improved subjective transport experience.•The effect music has on pain is most profound in the pediatric population. This study aimed to determine if noise-canceling headphones (NCHs) with music supersedes pain reduction of other hearing protection for patients transported by Guardian Air Transport via rotor or fixed wing aircraft from 2017 to 2019. We designed a randomized pilot study in which patients who received NCHs with or without music were compared with controls who received non-NCH hearing protection alone. Four hundred fifty-four adults 19 to 64 years of age and 36 pediatric patients 4 to 18 years old who received ≥ 1 dose of opioids were included. In the aggregate population, opioid use was reduced by 31% from 14.3 to 10.0 morphine milligram equivalent/h transport (P = .131) with music compared with controls. The mean total pain reduction in the aggregate population from −2.5 (standard deviation [SD] = 3.2) to −4.0 (SD = 2.9) was 1.6-fold more than controls compared with NCH and music (P = .008). This effect was most profound in the pediatric population where the mean total pain reduction with NCHs and music (−5.4, SD = 3.1) was 3.4-fold more than controls (−1.6, SD = 2.7, P = .021). Music may provide greater subjective pain relief when combined with NCHs in the air transport environment; further research is required.