Chronic back pain amplifies sound unpleasantness; fMRI links it to sensory circuits, and pain reprocessing therapy may help normalize responses.
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Those with chronic back pain (CBP) are more sensitive to sound, with early evidence that pain reprocessing therapy could help reduce this heightened response, according to a study published in Annals of Neurology in February 2026.
CBP affects more than 600 million people worldwide and, in many cases, doesn’t have a clear physical cause, causing curiosities amongst researchers toward changes in how the brain processes pain rather than damage in the body, according to the study. Scientists are increasingly studying this condition as part of a broader group of chronic pain disorders linked to central sensitization, a process in which the central nervous system becomes more sensitive and amplifies sensory signals over time.
This heightened sensitivity can cause people to feel pain from things that normally would not hurt, such as light, sound, smell or everyday activities, and could increase the risk of developing other pain conditions, fatigue, sleep problems and cognitive difficulties over time.
To further explore this space, researchers from the Max Planck School of Cognition in Germany, the University of Colorado Anschutz Medical Campus and Dartmouth College analyzed how the brain responds to sound in those with this condition and whether these responses can be changed with treatment. The study also looked at pain reprocessing therapy, a newer psychological approach designed to reduce this heightened sensitivity, as researchers continue to look for ways to better understand and treat chronic pain at its neurological roots.
Research shows that pain reprocessing therapy is a psychological treatment designed to help patients reframe chronic pain as a reversible brain‑generated process rather than a sign of ongoing tissue damage. It was previously found that about two-thirds of folks with CBP became pain‑free or nearly pain‑free after this therapy compared with much lower rates with placebo or usual care.
This study collected data from a clinical trial at the University of Colorado Boulder comparing not only pain reprocessing therapy but also open-label placebo and usual care in adults with CBP. Participants were 21 to 70 years old, had persistent back pain for at least six months and were screened to exclude conditions likely causing secondary pain.
A matched control group with no chronic pain was also recruited. Participants completed self-reported pain measures and underwent fMRI — a non-invasive imaging technique that measures blood flow in the brain — while receiving pressure and aversive sound stimuli. Brain responses were analyzed in sensory and integrative regions to identify patterns of heightened reactivity and changes were evaluated before and after treatment.
Overall, the study included 142 adults with CBP and 51 adults without. CBP participants reported more unpleasantness than controls during both pressure and auditory tests, with medium to large effect sizes. Higher back pain levels were linked to greater unpleasantness from sounds, and participants who had more spontaneous pain during fMRI also felt more unpleasantness across all types of stimuli.
Brain scans showed increased activity in auditory and sensory-integrative regions, including the primary auditory cortex and insula subregions. Midline areas, including the mPFC and precuneus, showed decreased activity during sound. Multivariate analyses confirmed stronger negative affect responses in CBP for auditory but not pressure stimuli, and similar results were found for fibromyalgia-related patterns.
Brain activity in A1, the dorsal insula and the mPFC was linked to reported pain. Classifiers using self-report data could distinguish CBP from controls well, while neural data alone worked less accurately. Over time, pain reprocessing therapy reduced auditory unpleasantness and increased mPFC activity compared with usual care, showing therapy can partially normalize brain responses and lower sensory amplification in CBP.
A view of a person’s spine who is holding their back as if they have back pain.
Chronic back pain heightens sound sensitivity; fMRI links brain amplification to discomfort, and pain reprocessing therapy shows early relief.
Based on the overall structure and results of the study, its strengths include a high-functioning community sample and combined behavioral and brain measures, giving insight into how CBP affects responses to pressure and sound. It also shows that sensory amplification can be altered with therapy.
Limitations include a small number of trials per person, possible racial differences between groups and weaker pressure effects that may reflect method issues. Treatment effects were minimal, and missing data may have affected the results.
The authors suggest future studies use larger, more diverse samples, additional trials and refined stimulation paradigms to improve reliability and clarify how multisensory sensitivity contributes to chronic pain and treatment response.
