People with chronic back pain experience everyday sounds more intensely than those without pain, according to a new study from the University of Colorado Anschutz. The research, published in Annals of Neurology, links this heightened sound sensitivity to measurable changes in the brain.
The study is among the first to show that chronic back pain affects how the brain processes not only physical discomfort but also sensory experiences like sound. Researchers say this suggests chronic back pain involves broader sensory amplification within the brain.
"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 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.
The researchers studied 142 adults with chronic back pain alongside 51 people without pain. All participants underwent MRI scans while listening to various sounds and reporting how unpleasant they felt. The scans showed stronger responses to sound in regions such as the auditory cortex and insula among those with chronic pain. There was also lower activity in areas like the medial prefrontal cortex, which usually help regulate reactions.
On average, individuals with chronic back pain responded more strongly to sounds than 84% of those without pain.
The study also explored treatment options by assigning participants with chronic back pain into three groups receiving different therapies. Of these treatments, Pain Reprocessing Therapy proved most effective—it reduced heightened brain responses to sound and increased activity in 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," 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."
Previous research led by Ashar found Pain Reprocessing Therapy enabled two-thirds of participants with chronic back pain to become nearly or completely free from their symptoms after treatment—much higher than improvements seen with placebo.
Researchers note several questions remain unanswered: it is unclear whether heightened sensitivity causes chronic back pain or if it reflects an existing vulnerability. Some early studies suggest naturally high sensitivity may increase risk for developing persistent pain after injury. Future work will examine whether this amplification extends beyond hearing to senses like light or smell and whether similar patterns appear across other types of long-term pain conditions.
