May 26, 2026

(Shutterstock)

People who have chronic back pain may be more affected by unpleasant sensations — including lights, tastes and sounds — than people without chronic pain. Many people may find these sensations uncomfortable, but those with chronic pain may experience them as substantially more unpleasant or even painful. A new study published in the Annals of Neurology provides neural evidence of this increased sensitivity in people with chronic back pain who listened to unpleasant sounds. “We’ve known for a while that chronic pain is driven in part by amplified pain processing, but amplified processing of other modalities, like hearing or visual processing, that’s actually more of a novel finding and a new direction to think about,” said Dr. Yoni Ashar, co-director of the Pain Science Program and assistant professor at the University of Colorado Anschutz Medical Campus, who conducted this study with funding from the NCATS Clinical and Translational Science Awards (CTSA) Program.

In this study, Ashar and his team recruited 142 patients with chronic back pain — the most common type of chronic pain — as well as 51 people without chronic pain. All participants listened to unpleasant sounds. “Chronic pain patients reported the sound was substantially more unpleasant than people without chronic pain,” Ashar explained. “I expected there to be a small to moderate sized difference between patients and controls, but there was a large difference, much more than I expected.”

Each person’s response also was measured with functional magnetic resonance imaging (fMRI), allowing the researchers to see how the brain reacted to the sounds. People with chronic back pain showed greater neural activity in the auditory cortex, the region responsible for processing sound, as well as in the insula, an area of the brain involved in many functions including multisensory processing and pain perception. “These results support people’s self-reports — they say it’s more unpleasant, and we’re seeing their brains actually responding more strongly to these sounds,” Ashar said. “The response in the insula is especially interesting because that’s an area that’s shown up time and again that might be driving chronic pain, and it’s associated with multisensory processing.”

Prior studies have shown increased responses to nonpainful sensory input in people with fibromyalgia — a condition involving widespread chronic pain — and in people experiencing migraines, who often are more sensitive to light and sound during headaches. These experiences have been studied less often in chronic back pain, suggesting that higher sensitivity to unpleasant sensations could occur across multiple chronic pain conditions.

People in this study also participated in pain reprocessing therapy, a treatment designed to reduce their chronic back pain. Most experienced large reductions in their back pain, and researchers also observed modest decreases in their sensitivity to unpleasant sounds in both self-reports and the fMRI brain scans. Although these results require further study, they suggest that this multisensory sensitization is potentially reversible or treatable.

“This is exciting because other colleagues have found that multisensory sensitivity is a predictor of who will go on to develop chronic pain in the future,” Ashar said. “If this multisensory sensitization is potentially reversible, then you could identify people who have multisensory sensitivity, who we now know are at greater risk of developing chronic pain, and try to reduce that risk factor.”

Potential future directions for this research include more studies examining how different types of chronic pain and sensory sensitization are related, as well as treatments that may help reverse chronic pain if caught early through sensory testing. By linking patients’ sensory experiences with measurable changes in brain activity, the findings may help advance researchers’ understanding of chronic pain and support future efforts to identify risk factors and develop earlier interventions. In the meantime, this research provides a fuller picture of chronic pain and the experiences of those who live with it. “I hope this research helps patients who are experiencing these multisensory symptoms feel validated,” said Ashar. “It’s a real condition that we can measure happening in their brain and provide hope that it’s treatable as well.”

Michael Kurilla, M.D., Ph.D., director of NCATS’ Division of Clinical Innovation, which administers the CTSA Program, stated, “Understanding the biological pathways that lead to and reinforce chronic pain offers the potential for safer and more effective pain management strategies.”