Individuals with Chronic Back Pain may exhibit Increased Auditory Sensitivity: Study

A study published in Annals of Neurology has found that individuals with chronic back pain exhibit significantly higher auditory sensitivity compared with pain-free controls. These patients also showed greater sensitivity to mechanical pressure. The findings suggest that treatment of chronic pain may help reduce this heightened sensory sensitivity.

Chronic pain is already known for its hallmark symptom like elevated sensitivity to painful or noxious stimulation. However, studies have increasingly suspected that this heightened sensitivity may extend beyond pain itself. Thus, this study investigated how individuals with chronic back pain respond to both physical and auditory stimuli.

To explore this possibility, the study compared 142 adults with chronic back pain to 51 pain-free participants. Using functional magnetic resonance imaging (fMRI), this research measured the brain activity of participants while they were exposed to low- and high-intensity aversive sounds as well as mechanical pressure applied to the body. Participants also rated how unpleasant each stimulus felt.

When compared with healthy controls, people with chronic back pain reported significantly greater unpleasantness when listening to aversive sounds. The effect size for auditory stimuli was particularly large, suggesting that increased sensitivity to sound may be a prominent feature of chronic pain. Participants with chronic back pain also reported increased unpleasantness in response to mechanical pressure, though the difference was more moderate.

The individuals with chronic back pain showed elevated responses in regions involved in sensory and emotional processing, including the primary auditory cortex and the insula, when listening to aversive sounds. At the same time, they showed reduced activity in areas linked to self-referential thinking and regulation, like the precuneus and medial prefrontal cortex.

Further analysis revealed patterns of brain activity associated with generalized aversive processing and multisensory sensitivity. Notably, these neural signatures overlapped with patterns previously identified in people with Fibromyalgia. The overlap suggests that chronic back pain and fibromyalgia may share common brain mechanisms that amplify sensory unpleasantness.

Over time, individuals who received pain reprocessing therapy (PRT) reported modest reductions in unpleasantness when listening to low-intensity aversive sounds. Brain imaging showed increased activity in the medial prefrontal cortex when compared to patients receiving usual care, suggesting that the therapy may help restore regulatory brain processes.

Overall, the findings highlighted chronic pain not simply as a problem of injured tissues, but as a condition involving widespread changes in how the brain processes and evaluates sensory information. 

Reference: 

Panzel, A. E. C., Büchel, C., Leroux, A., Wager, T. D., & Ashar, Y. K. (2026). Auditory hyperresponsivity in chronic back pain: A randomized controlled trial of pain reprocessing therapy. Annals of Neurology, ana.78183. https://doi.org/10.1002/ana.78183