Background: Chronic pain and persistent opioid use are significant problems for many cancer survivors. Opioid tapering comes with major challenges. It is therefore recommended that cancer survivors learn non-pharmacological techniques to support opioid tapering. Methods: The purpose of this pilot study (N = 26) was to examine the benefits of interactive music therapy (IMT) for opioid tapering in cancer survivors with chronic pain who are persistent opioid users. Those with a history of polysubstance abuse/substance use disorder or who were receiving maintenance methadone or suboxone were excluded. Participants were randomized to 10 weekly, individual IMT (n = 14) or social attention control (n = 12) sessions. We measured daily opioid use and chronic pain outcomes (pain interference, pain-related self-efficacy, and pain intensity) at baseline, post-intervention (week 10) and 3-month follow-up (FU). We also conducted semi-structured interviews to gain understanding of participants’ perspectives on the usefulness of IMT for opioid tapering. We modeled the pattern of mean daily opioid dose change over time using multilevel models.The cross-level interaction between time and treatment was used to determine the effect of treatment condition on the pattern of change in the target outcomes. We used restricted maximum likelihood to estimate model parameters and to test the significance of random effects. Given the small sample size, we relied on effect sizes for interpretation. Interview transcripts were analyzed using thematic analysis. Results: Participants were 58±13 years old. Most participants identified as female (58%), not Hispanic or Latino (92%), and white (58%) or Black (38%), and reported to have had breast (23%), cervical (8%), lung (8%), or melanoma skin cancer (8%). A total of 85% of participants said that they were quite to very motivated to taper their opioid use. About one third had had prior opioid tapering attempts and 31% stated that they had concerns related to opioid tapering. We found a large effect of IMT on mean daily opioid use at week 10 (η²_p = 0.36) and at 3-month FU (η²_p = 0.27). There was a medium effect of IMT on pain interference at week 10 (η²_p = 0.18) and a large effect at 3-month FU (η²_p = 0.30). For pain-related self-efficacy, we found a medium effect at week 10 (η²_p = 0.21) and small effect at 3-month FU (η²_p = 0.09). IMT resulted in a small treatment effect for pain intensity at week 10 and at 3-month FU (week 10: η²_p = 0.05; 3 month: η²_p = 0.09). The quantitative results were congruent with the qualitative findings as many IMT participants reported feeling more “in control” of their pain and being able to apply the music-based self-management strategies outside of the sessions to help with pain management and improve their functioning. Conclusions: These promising findings warrant further research on the effects of IMT on opioid tapering and chronic pain management in cancer survivors. Clinical trial information: NCT03782506.