Theta binaural beat therapy reduces pain scores in adults with a moderate effect sizeTheta Binaural Beats May Reduce Pain and Anxiety Levels

BACKGROUND: Binaural beat stimulation is a non-pharmacological neuromodulatory approach with potential to influence pain, emotions and cognition. Binaural beats are auditory illusion generated when two tones of slightly different frequencies are presented simultaneously to each ear. While prior reviews have pooled heterogeneous frequency bands or outcomes, the specific therapeutic relevance of theta-frequency (4-8 Hz) binaural beats remains unclear. OBJECTIVE: To systematically evaluate and quantitatively synthesize evidence on the efficacy of theta binaural beat therapy on pain, anxiety and cognitive outcomes in adults. METHODS: PubMed, Scopus, and Web of Science were searched for relevant articles. 13 Randomized controlled trials employing theta binaural beats and assessing pain, anxiety or cognition were included. The RoB 2.0 tool and the PEDro scale were used to evaluate methodological quality. Standardized mean differences (SMDs) were calculated for pain and heterogeneity was assessed using I statistics. The certainty of evidence was graded using GRADE. RESULTS: 13 RCTs (n = 630) met inclusion criteria; four trials (n = 173) were eligible for quantitative synthesis of pain outcomes. Quantitative synthesis was not feasible for anxiety and cognition due to outcomes heterogeneity. Based on low-certainty evidence, theta binaural beats were associated with a reduction in pain compared with controls (SMD = -0.53; 95% CI -0.84 to -0.23; p = 0.001), with no heterogeneity (I² = 0%). Anxiolytic effects were observed particularly in procedural and chronic pain contexts, while cognitive findings suggested that theta entrainment favored episodic memory. CONCLUSIONS: Theta binaural beat therapy may represents a promising, safe and low-cost adjunct for pain modulation, anxiety reduction and cognitive enhancement.