Noise exposure in pain management: harmful disruptions to therapeutic sound

Noise exposure refers to the cumulative sound levels experienced over time, measured in decibels (dB). The World Health Organization recommends a maximum of 30 dB for hospital noise during the night, but actual measurements often exceed these recommendations.1 Noise in clinical settings acts as an environmental stressor with effects on patient physiology and recovery, activating the hypothalamic-pituitary-adrenal axis. Recent research also suggests that the thalamus and cortex process both auditory and nociceptive signals through cross-modal sensory integration.2 Finally, increased noise exposure is associated with heightened pain sensitivity and increased analgesic use in the postoperative period.3,4 However, not all sound is detrimental. Structured auditory interventions (including music therapy and natural soundscapes) have demonstrated consistent benefits in reducing pain intensity across patient populations experiencing acute or chronic pain.5,6 A hallmark study from 1960 showed that, across 5000 dental operations, sound adequately suppressed pain; during the painful portions of the procedure, patients required no additional analgesia and reported almost no discomfort.7 For pain specialists, the most clinically relevant impact of sound occurs in inpatient non-critical care units and outpatient procedural suites, where patients remain awake, anxiety is common, and environmental noise is modifiable without altering sedation or analgesic plans. Our review explores this dual role of noise exposure, both deleterious and therapeutic, on pain modulation and recovery. We examine how modifiable clinical soundscapes can be leveraged to optimize patient outcomes and support evidence-based healing environments.