Table 1 Characteristics of 16 included studies

Bae et al. (2023) (42)

Single-blind, 3-arm, parallel-group

M/F

BB = 15/49

C = 14/46

BB = 67 (64–72)

C = 65 (58–70)

Adult underwent sedation with dexmedetomidine during spinal anesthesia for elective surgery

BB = 63

C = 60

Real-time binaural modulated music/

frequencies of 8, 6, and 3 Hz

During surgery/

duration of surgery

BB = 80 [68–100]^a

C = 88 [70–110]

Blank tape

Dexmedetomidine loading dose/PBW, dexmedetomidine loading dose (μg), dexmedetomidine total dose (μg), and total loading time

Real-time binaural music reduced the loading dose of dexmedetomidine for adequate sedation

Nelson et al. (2023) (44)

Non-blind,3-arm, parallel-group

Female

Mean age not reported

(Over 40 y/o)

Patients who attended for mammography

BB = 20

C = 20

Binaural beat/ NR

Before procedure/

5 min

Standard care

Pain using a validated numerical rating scale

immediately after the compression was released

5 min exposure prior to mammographic compression gave an improvement in the perception of patient pain from reported pain scales in the BB group

Loong et al. (2022) (41)

Double-blind, 2-arm, parallel-group

M/F

BB = 14/17

C = 19/11

BB = 67.7 (9)

C = 63.9 (6.2)

Subjects with senile cataracts undergoing phacoemulsification under topical anesthesia

BB = 31

C = 30

Binaural beats/ 10 Hz

Before surgery/ 10 min

Blank tape

The Patient’s pain scores using VAS immediately after the surgery

The binaural beat group had significantly lower pain scores than the control group

Tani et al. (2022) (24)

Double-blind, 2-arm, parallel-group

M/F

BB = 24/18

C = 26/22

BB = 58.8 (12.83)

C = 61.6 (9.72)

Patients underwent colonoscopy examination

BB = 42

C = 48

Binaural beat with a white noise background/ 4 Hz

Five min before and during the procedure/ duration

not reported

Background white noise alone

Level of the feeling of pain during the procedure using VAS

The BB group perceived a lower feeling of pain than the control group

Thanyawinichkul et al. (2022) (28)

Double-blind, 2-arm, parallel-group

M/F

BB = 4/6

C = 2/10

BB = 51.3 (16.34)

C = 53.5 (12.99)

Patients with moderate to severe chronic back pain

BB = 10

C = 12

Binaural beat combined with acoustic piano music/

6 Hz

20-minutes per day for 14 days

Acoustic piano music with a frequency of 300 Hz.

Measurement of two aspects of pain including pain severity and pain interference comprised of: - Body pain mapping - Pain intensity using Thai BPI

No intergroup differences were found in any of the outcomes

Olcucu et al(2021) (25)

Non-blind,3-arm, parallel-group

Male

BB = 56.26 (14.93)

C = 55.56 (16.41)

Patients undergoing cystoscopy

BB = 61

C = 75

Binaural beats without background/

10 Hz

10 min before and during procedures/ duration of procedures BB = 6.31 (1.08)^b

C = 5.97 (0.9)

Blank tape

The Patient’s pain scores using VAS

Significantly lower VAS scores in the BB group compared to the control after the procedure

Non-blind,3-arm, parallel-group

Male

BB = 41.95 (14.54)

C = 48.53 (14.19)

Patients undergoing ureteral stent removal

BB = 41

C = 52

Binaural beats without background/

10 Hz

10 min before and during procedures/ duration of procedures BB = 2.92 (0.52)^b

C = 2.84 (0.63)

Blank tape

The Patient’s pain scores using VAS

Significantly lower VAS scores in the BB group compared to the control after the procedure

Tani et al. (2021) (30)

Double-blind, 2-arm, parallel-group

M/F

BB = 6/14

C = 7/13

BB = 75.65 (5.2)

C = 73.65 (6)

Patients underwent total knee joint replacement with spinal anesthesia

BB = 20

C = 20

Binaural beats/

4 Hz

Before surgery/

20 min

Acoustical stimulation at 256 Hz

The amount of morphine consumption displayed on the PCA device and the NRS values fat 8, 16, and 24 h after surgery

PCA morphine consumption in the intervention group after surgery was significantly lower than that of the control group,

No significant difference in pain perception after surgery

Gkolias et al. (2020) (27)

Double-blind, 2-arm, cross-over

48% male

58.76 (14.63)

Patients with chronic pain

(pain due to cervical or lumbar spine disorders, neuralgia, rheumatic disease, or other diseases )

BB = 20

C = 20

Binaural beat with soft music in the background/ 5 Hz

30 min for a single-session study,

using on-demand during a week for long-term effect

Soft music at 400 Hz

Self-reported pain in NRS at baseline and both after the brief 30-minute intervention and at the end of the intervention week, everyday mean levels of pain and analgesic medication during baseline and the intervention week

Theta rhythm binaural beat application significantly reduced pain intensity and everyday analgesic medication use, compared to sham intervention

Roshani et al. (2019) (26)

Non-blind,2-arm, parallel-group

M/F

BB = 16/14

C = 13/17

BB = 57.46 (4.26)

C = 57.56 (6.03)

Patients underwent eye surgery with anesthesia

BB = 30

C = 30

Binaural beat/ NR

5 min before and during surgery/ duration of surgery not reported

conventional treatment

The patient’s severity of pain assessed by VAS

The decreased pain level in the BB group after surgery, while pain scores showed no between-group difference before and after surgery

Kurdi and Gasti (2018) (39)

Non-blind,3-arm, parallel-group

Female

BB = 24.6 (2.9)

C = 24.5 (2.7)

Parturient underwent emergency cesarean section delivery under spinal anesthesia

BB = 59

C = 62

Binaural beat/ NR

During the surgery/ duration not reported

Blank tape

The intensity of pain using VAS at 1, 6, and 24 h after surgery and the mean time required for the first rescue analgesic

Mean pain scores at 6 and 24 h post-surgery were significantly lower in the BB group, a significant between-group difference at the mean time required for the 1st rescue analgesia

Ecsy et al. (2017) (20)

Blinded, 2-arm, cross over

M/F = 16/16

23.25 (7.9)

Healthy

BB = 32

C = 32

Binaural beat/ 8,10, and 12 Hz

10 min for each frequency, a total of 30 min

10 min of white noise, 3 times, a total of 30 min

Perception of acute pain using rating the pain induced by 30 painful heat laser pulses

Pain ratings after all alpha frequency entrainment were all significantly different from all three control conditions with the largest after 10 Hz stimulation

Zampi (2015) (21)

Single-blind ,2-arm, cross over

M/F=

19%/81%

47

(26–69)

Chronic pain based on patients’ self-report ( headaches, back and lower-back pain, fibromyalgia, lower-spinal birth defects, sciatica, myofascial pain, neck/ knee/ hip pain, joint aches)

BB = 32

C = 32

Binaural beat/ 6-Hz

20 min daily, 14 consecutive days for each situation

A single tone at 300 Hz

Haven-Yale MPI’s average score on the subscale for pain severity

pre-test, and the average of 2 post-test scores

A significant main effect on the change in perceived pain severity for the binaural beat group

Bălan (2014) (37)

Non-blind,3-arm, parallel-group

M/F = 20/27

BB = 43 (7.01)

C = 30.68 (2.12)

Healthy

BB = 16

C = 15

Binaural beat / combination of tones within delta to the alpha range

5 min

No intervention

The level of perceived discomfort caused by a painful stimulus during each situation using a 10-point Likert

The participants exposed to binaural beats, reported lower levels of perceived pain, compared to those who did not receive any treatment

Dabu-Bondoc et al. (2010) (36)

Double-blind, 3-arm, parallel-group

M/F%

H = 38/62

C = 28/72

H = 42 (14)

C = 41(10)

Outpatients underwent surgery requiring general anesthesia

H = 20

C = 20

Binaural beat (Hemi-sync)/ NR

30 min Before surgery and during surgery

/duration of surgery not mentioned

Blank cassette tape producing white noise

Intraoperative fentanyl, Perioperative analgesic consumption at PACU and home, measurement of pain scores using VAS at 10, 20,30, 60 min, and 24 h post operation

The Hemi-sync group required significantly less fentanyl during the anesthetic procedure compared with control group.

Pain VAS scores at 1 h in the PACU and at 24 h after surgery were significantly lower in the treatment group compared with and control.

Lewis et al. (2004) (35)

Double-blind, 2-arm, parallel-group

NR

H = 56 (16)

C = 52 (11)

Patients underwent lumbar spine surgical procedures

H = 15

C = 15

Binaural beat (Hemi-sync)/ NR

Before and during surgery/ duration of surgery

H = 170 (61)^b

C = 176 (73)

Blank tape

Fentanyl administration during operation

No significant difference in fentanyl requirements between

Double-blind, 2-arm, parallel-group

NR

H = 38 (10)

C = 41 (10)

Patients underwent bariatric surgical procedures

H = 15

C = 15

Binaural beat (Hemi-sync)/ NR

Before and during surgery/ duration of surgery

H = 130 (74)^b

C = 136 (26)

Blank tape

Fentanyl administration during operation

Bariatric patients who listened to Hemi-Sync received less fentanyl per kilogram per minute

Kliempt et al.(1999) (22)

Double-blind, 3-arm, parallel-group

M/F

H = 15/10

C = 9/17

18–76

F/m

H = 49 (12.6)/37 (15.6

)

C = 49 (11.5)4/ 3(19.9)

Patients underwent general surgical operations requiring general anesthesia

H = 25

C = 26

Binaural beat (Hemi-sync)/ NR

During surgery/ duration of surgery

H = 63 (41)^b

C = 48 (28)

Blank tape

Fentanyl administration during operation

Patients in the Hemi-Sync group required less fentanyl compared with the blank tape group