City Noise May Worsen Fibromyalgia Pain

Auditory environments may be a clinically relevant factor for chronic pain in patients with fibromyalgia, according to study results published this month in the journal PAIN.

In a randomized, triple-blind trial, researchers found that patients with fibromyalgia who listened to 20-minute recordings of urban environments had more pain intensity and sensitivity than when they listened to 20 minutes of silence, broadband sounds, or natural acoustic environments.

Urban Acoustic Environments and Pain Intensity

The study included 88 adults (91% women; mean age, 53.8 years) with fibromyalgia, recruited in Spain between August and October 2025. The average duration of fibromyalgia symptoms was 19 years, and all participants reported having at least moderate pain during the previous week.

Each participant completed four 20-minute listening sessions. Recordings in the natural acoustic environment session consisted of bird sounds, wind, and rain. In contrast, the urban acoustic environment session included sounds of human activity and machinery, including transportation and unintelligible speech. The broadband sound session (white or pink noise) and the silent session served as controls.

Every participant experienced all four auditory conditions in a different randomized order, with a 1-week period between each session. The study authors primarily measured pain intensity using a 100-mm visual analog scale, but also recorded participants’ overall perception of whether their condition improved or worsened, as well as their pain sensitivity.

After adjusting for baseline pain, the estimated mean pain intensity after the session was 58.66 mm for urban sounds, 48.98 mm for natural sounds, 46.78 mm for broadband sounds, and 45.83 mm for silence.

These findings are “validating” for Pavan Tankha, DO, an anesthesiologist and pain medicine specialist at Cleveland Clinic in Ohio, whose patients have anecdotally reported their pain level being influenced by their auditory environment.

“Patients will say loud sounds and different sensory input can make their pain worse,” Dr. Tankha told MedCentral, “and for the longest time, I would tell patients, ‘I believe you. I just don’t have an explanation for this.’  And so this is just another feather in the cap for those of us who treat fibromyalgia, that we should listen to the patient. We may not always have explanations for the symptoms they’re presenting with, but this goes to show that the ongoing trend of research with fibromyalgia shows that there is a biological basis for much of what patients are telling us.”

New Approaches for Fibromyalgia Management

Dr. Sammut is optimistic about this study’s use of nonpainful sensory input to assess pain response, and what the findings may mean for the future of fibromyalgia management.

“For patients with fibromyalgia, medications are only part of a plan to improve quality of life. I am enthusiastic about this article because it provides a nonmedication approach to try to help patients with fibromyalgia,” said Dr. Sammut.

Dr. Tankha pointed out that participants in this study listened to sounds without actually being in a natural or city environment. Because of this, he is hesitant to recommend significant changes to his patients, but supports clinicians asking patients with fibromyalgia about their home and work environments, and whether they notice any auditory triggers.

If a patient reports that certain sounds worsen pain, Dr. Sammut recommends having them try to avoid those sounds and minimize their pain triggers. “For instance, if a patient with fibromyalgia reports that traffic noise makes pain worse, I would take it seriously and would recommend trying to wear headphones when walking in the city,” she said.