The authors examined the effects of preferred music, visual distraction, and silence on pain perception. Visual distraction was provided by participants' choice of painting from a selection of 15 popular artworks. Eighty participants (43 females) underwent 3 trials of cold pressor pain induction with measurement of tolerance, pain intensity, perceived control, and anxiety, and a music listening patterns questionnaire. Preferred music was found to significantly increase tolerance and perceived control over the painful stimulus and to decrease anxiety compared with both the visual distraction and silence conditions. Pain intensity rating was decreased by music listening when compared with silence. During the music condition, frequent listening to the chosen piece in everyday life was found to negatively correlate with anxiety level, and extent of knowledge of the lyrics further positively correlated with tolerance of the stimulus and perceived control. That general importance of music in everyday life also correlated with perceived control reiterates the importance of relationship and familiarity with favorite music as key to its therapeutic effect. There was no relationship between structural features of the selected music and any of the significant effects. It is suggested that preference may render music with different structural aspects functionally equivalent.