CHRONIC back pain has been linked to auditory hyperresponsivity, with new imaging data showing amplified brain responses to everyday sounds and evidence that targeted psychological therapy can partially reverse this sensory hypersensitivity.
Sensory Amplification in Chronic Back Pain
Chronic back pain has traditionally been framed as a musculoskeletal condition, yet mounting evidence suggests broader central nervous system involvement. Researchers investigated whether chronic back pain is associated with heightened unpleasantness to non-noxious auditory stimuli, reflecting generalised sensory amplification. Understanding whether chronic back pain alters brain processing beyond somatosensory pathways could reshape mechanistic models and inform treatment strategies targeting central sensitisation rather than peripheral tissue damage alone.
Neural Responses in Chronic Back Pain
The study compared 142 adults with chronic back pain with 51 pain free controls using functional magnetic resonance imaging. Participants rated unpleasantness during exposure to low and high intensity aversive sounds and mechanical pressure. Chronic back pain patients reported heightened unpleasantness to auditory stimuli Hedges’ g = 0.95–1.03; p < 0.001 and mechanical pressure g = 0.49–0.66; p < 0.001. Auditory stimulation revealed hyperresponsivity in primary auditory cortex and insula, alongside hyporesponsivity in the precuneus and medial prefrontal cortex g = 0.33–0.59, p < 0.05. Multivariate analyses showed increased expression of generalized and auditory specific aversive processing patterns g = 0.33–0.39, p < 0.05 and fibromyalgia derived multisensory sensitivity patterns g = 0.43–0.50, p < 0.01. In a randomized trial, pain reprocessing therapy reduced unpleasantness of low intensity auditory stimulation and increased medial prefrontal cortex responses compared with placebo and usual care.
Implications for Chronic Back Pain Treatment
These findings suggest chronic back pain is associated with cross modal sensory amplification involving both primary sensory and regulatory brain networks. Reduced medial prefrontal cortex activity may reflect impaired top-down inhibition of aversive signals. Importantly, pain reprocessing therapy demonstrated partial normalisation of auditory hyperresponsivity, indicating that central sensitisation may be modifiable. Future research should determine whether early identification of sensory hypersensitivity predicts prognosis and whether broader desensitisation strategies improve long term outcomes in chronic back pain.
Reference
Panzel AE et al. Auditory hyperresponsivity in chronic back pain: a randomized controlled trial of pain reprocessing therapy. Ann Neurol. 2026;DOI:10.1002/ana.78183.
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