White Noise and Music Could Significantly Reduce Botulinum Toxin Pain, Especially for First-Time Injections

A new prospective controlled study suggests that listening to either favorite music or white noise during botulinum toxin injections may help reduce procedure-related pain and stress in women undergoing upper-face treatments, especially those being treated for the first time.¹

Trial Design

The study evaluated 76 women between the ages of 18 and 45 years who underwent cosmetic botulinum toxin injections to the forehead, glabella, and periocular areas. Participants were assigned to 1 of 3 groups: music (n = 20), white noise (n = 31), or control (n = 25). Patients in the music group listened to self-selected music, whereas the white noise group listened to a standardized white noise recording resembling a hair dryer sound. Both interventions began 10 minutes before injection and continued throughout the procedure and recovery period. The control group was exposed only to routine background sound.

All injections were performed by the same experienced physician using the same botulinum toxin product, injection technique, and examination room conditions. Patients also received topical cryotherapy with ice packs before and after treatment. Pain was assessed using a 10-point visual analog scale (VAS). Investigators also evaluated perceived stress reduction related to the sounds.

Pain and Stress Reductions

Mean pain scores were significantly lower in both intervention groups compared with controls. The control group reported a mean pain score of 6.80 vs 5.70 in the music group and 5.52 in the white noise group. There was no significant difference in pain reduction between the music and white noise groups, suggesting that both interventions provided comparable benefits.

The study also found that patients receiving botulinum toxin injections for the first time experienced significantly higher pain levels than patients with previous treatment experience. Mean pain scores among first-time patients were 6.57 vs 5.74 among experienced patients.

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When investigators analyzed treatment arms separately, the relationship between first-time treatment and increased pain remained significant only in the control group. In the music and white noise groups, prior treatment experience was not significantly associated with pain scores. Among botulinum toxin–naive participants, specifically, both music and white noise significantly reduced pain compared with controls. No meaningful difference was observed between the 2 sound modalities.

The study also evaluated stress reduction associated with auditory stimulation. Patients rated the stress-relieving effect of music at 6.35 on the VAS and white noise at 7.19, although the difference between groups was not statistically significant. In the white noise group, investigators identified a strong negative correlation between perceived stress reduction and pain scores, suggesting that greater stress relief was associated with lower procedural pain.

Most participants favored continuing sound interventions during future procedures. Preference for future use was reported by 85% of patients in the music group and 96.8% in the white noise group. Only 1 participant in the white noise group reported that the sound was bothersome and preferred not to use it again.

Clinical Implications for Providers

The authors discussed several potential mechanisms for the observed analgesic effects. Prior literature has suggested that music may reduce pain through distraction, emotional engagement, and modulation of pain-processing pathways. White noise may influence emotional regulation, anxiety reduction, and sensory processing. The study findings also align with previous research showing that anxiety, fear of pain, and uncertainty can amplify procedural discomfort.²

The investigators emphasized that both music and white noise represent low-cost, noninvasive, and easily implemented interventions that could improve patient comfort during minimally invasive cosmetic procedures. They also noted that combining auditory interventions with established pain reduction approaches, such as cryoanesthesia, may further improve the procedural experience.

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References

1. Ozgen Z. Do white noise or music relieve pain caused by botulinum toxin injections? Pain Res Manag. 2026;2026(1):e3007685. doi:10.1155/prm/3007685

2. Weiss RA, Lavin PT. Reduction of pain and anxiety prior to botulinum toxin injections with a new topical anesthetic method. Ophthalmic Plast Reconstr Surg. 2009;25(3):173-177. doi:10.1097/IOP.0b013e3181a145ca