Chronic Back Pain Amplifies Everyday Sounds: New Research Reveals Treatable Brain Changes

People with chronic back pain experience everyday sounds as harsher and more intense than those without pain, according to groundbreaking research from the University of Colorado Anschutz Medical Campus. Published in Annals of Neurology, the study identifies specific changes in brain activity linked to this heightened auditory sensitivity, suggesting chronic back pain impacts far more than just the musculoskeletal system.

The Brain’s Role in Chronic Back Pain

The research, led by Yoni Ashar, PhD, assistant professor of internal medicine and co-director of the Pain Science Program at the University of Colorado Anschutz School of Medicine, validates long-held patient reports of increased sensitivity to sounds. “Our findings validate what many patients have been saying for years that everyday sounds genuinely feel harsher and more intense,” says Dr. Ashar. “Their brains are responding differently, in regions that process both the loudness of sound and its emotional impact.”

The study compared 142 adults with chronic back pain to 51 pain-free control participants. All underwent brain imaging although performing tasks involving listening to sounds and reporting their unpleasantness. Researchers measured brain activity to identify differences between the two groups.

Key Findings: How Chronic Pain Alters Sound Processing

The differences observed were significant. Individuals with chronic back pain reacted more strongly to sounds than 84% of those without pain. Brain scans revealed that these changes weren’t occurring in the initial auditory processing areas, but rather in higher-level brain regions.

Specifically, the scans showed:

• Increased activity in the auditory cortex and insula: These areas process sound and emotional sensations, respectively.
• Decreased activity in the medial prefrontal cortex: This region typically helps regulate and calm reactions.

These findings suggest a broader sensory amplification occurring in the brain, indicating chronic back pain isn’t solely a localized issue.

Pain Reprocessing Therapy Shows Promise

The study similarly investigated potential treatments. Participants with chronic back pain were assigned to one of three groups:

• Pain Reprocessing Therapy (PRT): Therapy sessions focused on helping patients reinterpret pain as a result of brain amplification, rather than structural problems.
• Placebo treatment: A saline injection delivered in a supportive clinical setting.
• Usual care: Participants continued their existing treatments.

PRT proved to be the most effective treatment. It not only reduced the heightened brain response to sound but also increased activity in brain regions involved in regulating unpleasant experiences. “This shows that the brain’s exaggerated sensory response can improve with psychological treatment so instead of being something patients are stuck with, this sensitivity is treatable,” explains Dr. Ashar.

Previous research from Dr. Ashar’s team demonstrated that PRT led to pain relief or near-complete relief in approximately two-thirds of participants with chronic back pain, significantly outperforming the roughly 20% improvement seen in the placebo group.

Future Research Directions

Researchers are now exploring whether this heightened sensory sensitivity is a cause or a pre-existing vulnerability for developing chronic pain. They also plan to investigate whether similar amplification occurs with other senses, such as light, smell, or taste, and whether this phenomenon extends to other chronic pain conditions. Future studies will test sensitivity across additional senses to determine the extent of this amplification and identify potential central brain regions responsible for it.

Reference: Panzel AEC, Büchel C, Leroux A, Wager TD, Ashar YK. Auditory hyperresponsivity in chronic back pain: a randomized controlled trial of pain reprocessing therapy. Ann Neurol. 2026. n/a(n/a). Doi: 10.1002/ana.78183