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Auditory Hyperresponsivity in Chronic Back Pain: A Randomized Controlled Trial of Pain Reprocessing Therapy
Alina E C Panzel1,2, Christian Büchel1,2, Andrew Leroux3
1Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Annals of Neurology
|February 27, 2026
Summary
Chronic back pain (CBP) patients exhibit heightened unpleasantness to auditory stimuli, linked to brain hyperresponsivity. Pain reprocessing therapy (PRT) showed potential for central desensitization.
Area of Science:
- Neuroscience
- Pain Research
- Psychology
Background:
- Chronic pain is characterized by heightened sensitivity to noxious stimuli.
- Emerging evidence suggests chronic pain patients also experience increased unpleasantness from non-noxious stimuli, like sounds.
- The neural underpinnings and treatment effects on this sensory hypersensitivity are not well understood.
Purpose of the Study:
- To compare behavioral and neural responses to auditory and pressure stimuli in chronic back pain (CBP) patients versus controls.
- To investigate the effects of pain reprocessing therapy (PRT) on sensory unpleasantness and neural responses in CBP patients.
Main Methods:
- 142 adults with CBP and 51 pain-free controls underwent fMRI while exposed to auditory and pressure stimuli.
- Participants rated the unpleasantness of stimuli.
- CBP patients received either PRT or placebo/usual care in a randomized trial.
- Analyses examined univariate and multivariate brain responses, including patterns associated with fibromyalgia.
Main Results:
- CBP patients reported significantly higher unpleasantness to both auditory and pressure stimuli compared to controls.
- Auditory stimulation revealed hyperresponsivity in auditory cortex and insula, and hyporesponsivity in precuneus and medial prefrontal cortex in CBP patients.
- Brain activity patterns in CBP patients overlapped with those seen in fibromyalgia, indicating shared multisensory sensitivity mechanisms.
- PRT led to reduced unpleasantness of auditory stimuli and increased medial prefrontal cortex activity compared to usual care.
Conclusions:
- Chronic back pain is associated with significant auditory hyperresponsivity, involving both modality-specific and general neural pathways.
- The neural mechanisms underlying this hypersensitivity in CBP share similarities with those in fibromyalgia.
- PRT demonstrated a modest ability to reduce auditory hypersensitivity, suggesting potential for broader central desensitization in chronic pain management.
