Acoustic stimulation in pain management: neurobiological mechanisms and clinical applications, a narrative review

Pain affects over 30% of the global population, with an underlying pathogenesis involving a complex interplay of biopsychosocial factors. Despite the availability of conventional pharmacological and interventional therapies, their clinical utility is frequently constrained by concerns regarding substance misuse, surgical complications, and other adverse sequelae. Acoustic stimulation (AS) has emerged as a promising alternative in pain management, characterized by its non-invasive nature, favorable safety profile, and high cost-effectiveness. However, current literature lacks a comprehensive evaluation of cutting-edge AS technologies and a profound decryption of its pleiotropic analgesic mechanisms, which has hindered the integration of AS into multimodal analgesic strategies. This review provides the first comprehensive synthesis of the neurobiological mechanisms and clinical applications of AS. We comprehensively evaluate the analgesic efficacy of diverse modalities, ranging from established interventions, such as music therapy (MT), natural sounds (NS)/noise, and auditory beat stimulation (ABS), to emerging approaches, including vibroacoustic therapy (VAT) and immersive interactive technologies that integrate multisensory acoustic information. Emerging evidence suggests that AS exerts its therapeutic effects via a multidimensional neurobiological framework, notably through the modulation of corticothalamic circuits, the activation of descending pain-inhibitory systems, and the dynamic regulation of neurochemical mediators. Clinical data consistently highlight the adjunctive value of MT, NS/noise, and VAT in the management of both acute and chronic pain. Furthermore, the convergence of AS with immersive interactive technologies is pioneering a novel digital intervention paradigm, facilitating the seamless integration of AS into multimodal analgesic frameworks. Collectively, these findings suggest that AS represents a robust, non-pharmacological strategy that warrants further exploration as a cornerstone of future personalized, multimodal pain management.