Effect of Telerehabilitation-Based Music Therapy and Motor Imagery on Pain, Autonomic Function, and Psychosocial Outcomes in People With Multiple Sclerosis: A Randomized Controlled Trial Protocol

Abstract

Background and Purpose Chronic pain affects approximately 63% of people with multiple sclerosis (pwMS), contributing to fatigue, depression, anxiety, poor sleep, reduced quality of life, and cognitive decline. Within the biopsychosocial model, music therapy has emerged as a promising intervention to address these complex symptoms. This study aims to examine the effects of heart rate-synchronized music therapy combined with motor imagery practice on pain, autonomic and cognitive functions, and psychosocial outcomes in patients with pwMS. We hypothesize that the combined intervention will lead to greater improvements than music therapy alone or routine care. Methods A double-blind, randomized, and three-arm parallel trial will be conducted with 45 patients with pwMS experiencing chronic pain. Participants will be randomly assigned to one of three groups: (1) heart rate-synchronized music therapy combined with motor imagery, (2) heart rate-synchronized music therapy alone, or (3) a control group receiving routine care. Interventions will be delivered twice weekly for 8 weeks, with each session lasting 20-30 min. The experimental groups will receive music therapy via videoconferencing. Assessments will be conducted at baseline, post-intervention (week 8), and follow-up (week 12). The primary outcome is pain intensity. Secondary outcomes include neuropathic pain, central sensitization, heart rate variability, anxiety, depression, fatigue, sleep quality, quality of life, and cognitive function. Sample size was calculated using G*Power; HRV data will be analyzed with Kubios software. Statistical analyses will be performed using SPSS and GraphPad Prism 10. Results Following randomization, baseline data will be collected. Blinded assessors will evaluate all outcomes at follow-up points. An independent researcher will perform statistical analyses to assess changes across time and between groups. Discussion This study may provide evidence supporting a novel, non-pharmacological, and telehealth-compatible intervention for chronic pain in pwMS.