Annals of Neurology: Chronic Back Pain Alters How the Brain Processes Sounds

Chronic back pain can affect not only a person’s physical condition but also how the brain perceives everyday sounds in the environment.

A new study, published in Annals of Neurology, shows that people with chronic pain may process ordinary auditory signals differently—perceiving them as sharper, more intense, and more unpleasant.

The study involved 193 participants, including 142 individuals with chronic back pain and 51 without such issues, who served as a control group. During the experiment, researchers scanned participants’ brains using neuroimaging while they listened to various sounds and rated how unpleasant they found them.

The results revealed a clear difference between the groups. On average, people with chronic pain reacted more strongly to sounds, rating them as more irritating and uncomfortable. Brain scans helped identify mechanisms that may underlie this effect.

Participants with chronic pain showed increased activity in brain regions responsible for perceiving loudness and the emotional quality of sounds. The most notable changes were observed in the auditory cortex and the insular cortex. At the same time, reduced activity was detected in the medial prefrontal cortex—a region that normally helps regulate emotional responses and dampen negative sensations.

The researchers also explored potential interventions. The most effective approach was Pain Reprocessing Therapy, which not only reduced the brain’s exaggerated response to auditory stimuli but also enhanced activity in areas responsible for controlling and regulating unpleasant experiences.

According to the lead author, the findings confirm that the brain plays a key role in maintaining chronic pain, amplifying not only pain signals but also other sensory experiences. In the future, scientists plan to investigate whether similar heightened sensitivity occurs in other chronic pain conditions and whether it extends to other senses, such as vision, smell, or taste.

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