Chronic back pain may reshape how the brain processes more than just signals from the spine.
People living with chronic back pain may experience ordinary sounds as unusually intense, according to new research from the University of Colorado Anschutz.
The study, published in Annals of Neurology, links this increased sound sensitivity to measurable differences in brain activity. The findings suggest that chronic back pain involves changes in the brain that extend beyond the spine. Researchers also report that a targeted therapy may help reduce this heightened response.
“Our findings validate what many patients have been saying for years that everyday sounds genuinely feel harsher and more intense. Their brains are responding differently, in regions that process both the loudness of sound and its emotional impact. This tells us chronic back pain isn’t just about the back. There’s a broader sensory amplification happening in the brain, and that opens the door for treatments that can help turn that volume down,” said the paper’s senior author 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.
Brain Imaging Reveals Sensory Amplification
The research team examined both self-reported experiences and brain activity in 142 adults with chronic back pain and compared them with 51 adults who did not have pain. Every participant underwent MRI scanning.
During the scans, participants completed listening tasks and rated how unpleasant they found various sounds. At the same time, researchers measured activity in brain regions involved in processing sound and emotion.
The contrast between the two groups was striking. On average, people with chronic back pain showed stronger reactions to sound than 84 percent of pain-free participants.
Importantly, the differences did not appear in the brain’s earliest sound processing centers. Instead, they were observed in higher-level regions. Participants with chronic pain showed increased activity in the auditory cortex, which interprets sound, and in the insula, which plays a role in emotional and bodily awareness. They also showed reduced activity in the medial prefrontal cortex, an area that helps regulate emotional responses.
Testing Treatments for Sensory Hypersensitivity
The researchers also tested whether treatment could influence these brain responses. Participants with chronic back pain were assigned to one of three groups:
- Pain Reprocessing Therapy (PRT), which teaches individuals to understand pain as a product of brain-based amplification rather than solely a structural back problem.
- Placebo treatment, consisting of a saline injection administered in a supportive clinical environment.
- Usual care, in which participants continued their existing treatments.
Among the three approaches, Pain Reprocessing Therapy produced the strongest effects. It reduced the heightened brain responses to sound and increased activity in regions that help regulate 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,” said Ashar. “These findings add to growing evidence that chronic back pain is not just a problem in the back, the brain plays a central role in driving chronic pain, by amplifying a range of sensations – sensory signals from the back, sounds, and likely other sensations as well.”
Past research from Ashar found that Pain Reprocessing Therapy led two-thirds of participants with chronic back pain to become pain‑free or nearly so after treatment, far outperforming the roughly 20% improvement seen in the placebo group.
Unanswered Questions About Cause and Scope
The findings raise important questions about cause and effect. Researchers do not yet know whether increased sensory sensitivity contributes to the development of chronic back pain or reflects an existing vulnerability.
Some early studies suggest that people who are naturally more sensitive to sensory input may face a higher risk of developing chronic pain after an injury.
It is also unclear whether this amplification affects other senses, including light, smell, or taste, or whether similar patterns are present in other chronic pain conditions. The team plans to explore these possibilities in future research, examining multiple senses to determine how widespread the effect may be and whether a single central brain region plays a coordinating role across sensory systems.
Reference: “Auditory Hyperresponsivity in Chronic Back Pain: A Randomized Controlled Trial of Pain Reprocessing Therapy” by Alina E. C. Panzel, Christian Büchel, Andrew Leroux, Tor D. Wager and Yoni K. Ashar, 27 February 2026, Annals of Neurology.
DOI: 10.1002/ana.78183
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3 Comments
OR….the pain killers that people take are ototoxic.
OR…people prone to a lot of pain are also prone to damage to their inner ear. Possibly from low aldosterone.
Chronic back pain, two spinal surgeries so far.
Sounds can be bothersome, but my sense of smell is so sensitive that I actually taste the things most people only get a whiff of. Occurs with or without medication.
I concur