BackgroundThe present systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate the effects of music on pain management in preterm neonates during painful procedures.MethodsThe PubMed, Embase, Web of Science, EBSCO and Cochrane Library databases were searched to identify relevant articles published from their inception to September 2023. The study search strategy and all other processes were implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement.ResultsFour RCTs that satisfied the inclusion criteria were included in this meta-analysis. The music group had significantly lower Premature Infant Pain Profile (PIPP) scores during (RR = −1.21; 95% CI = −2.02–−0.40, p = 0.0032) and after painful procedures (RR = −0.65; 95% CI = −1.06–−0.23, p = 0.002). The music group showed fewer changes in PIPP scores after invasive operations than did the control group (RR = −2.06; 95% CI −3.16–−0.96; p = 0.0002). Moreover, our results showed that music improved oxygen saturation during (RR = 3.04, 95% CI = 1.64–4.44, p