Within narrative-based video games the integration of storytelling, where experiences are necessarily directed, and of gameplay, where the player has a degree of autonomy, continues to be one of the most significant challenges that developers face. In order to mitigate this potential dichotomy a common approach is to rely upon cutscenes to progress the narrative. Within these passive episodes where interaction is not possible, or within other episodes of constrained outcome where the temporality of the episode is fixed, it is possible to score a game in exactly the same way as one might score a film or television episode. It could therefore be argued that the music in these sections of a video game is the least idiomatic of the medium. This chapter will instead focus on active gameplay episodes, and interactive music, where the unique challenges lie. When music accompanies active gameplay a number of conflicts, tensions and paradoxes arise. In this chapter these will be articulated and interrogated through three key questions:In the following discussion there are few certainties, and many more questions. The intention is to highlight the issues, to provoke discussion and to forewarn.