Classical Indian music for managing anxiety and pain among patients in a hospital setting: a systematic review and meta-analysis of randomized controlled trials

Background The quantitative impact of classical Indian music (CIM) on pain and anxiety is relatively underexplored. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) to assess whether music medicine (MM) using CIM improves anxiety and/or pain among patients of all ages in a hospital setting.Methods We searched PubMed, MEDLINE, PsychInfo, Embase, and Google Scholar from their inception until January 29, 2025. The pooled estimate of standardized mean differences (SMD) was calculated using the fixed and random-effects model and reported using Woolf's inverse variance. Data represented in standardized effect size with 95% CI. The risk of bias and the certainty of evidence were analyzed using RevMan v5.4 and GRADE.Results Nine RCTs were included in the systematic review and two RCTs (197 participants) in the meta-analysis. CIM was found not to have a significant benefit on anxiety (SMD 0.14 [-0.14 to 0.42]), systolic blood pressure (SMD -0.20 [-0.73 to 0.34]), diastolic blood pressure (SMD -0.03 [-0.39 to 0.34]), and pulse rate (SMD -0.96 [-2.50 to 0.57]). No substantial statistical heterogeneity was observed. The certainty of the evidence was very low.Conclusions Our meta-analysis could not ascertain any positive relationship between CIM and anxiety, SBP, DBP, and PR. We recommend greater research efforts through robust RCTs and policies to develop a National Medical Commission-accredited CIM-based music therapy service in India.