Fixing back pain is possible only when patients understand how much of it is produced by the brain, not just the spine.
For patient after patient seeking relief, the journey is often filled with frustration. Whether they try to treat aching muscles, bones, or ligaments through physical therapy, massage, or even surgery, long-lasting relief frequently remains out of reach. Back pain with no clear mechanical source doesn’t always come from damaged tissues—in many cases, the pain is generated by the central nervous system and actually lives within the brain.
I’ve been suffering from back pain for a couple of years, and my MRI also shows certain irregularities. But research shows that many people who have no back pain at all often have MRI images similar to mine. That fact gives me some comfort—at least the MRI rules out the possibility of serious chronic disease. While surgery is suggested as a solution for my condition, every surgery carries risks and requires significant rehabilitation. And studies show that, in many cases, patients who undergo surgery and those who don’t end up with almost the same overall outcomes.
Pain generally falls into four categories:
Acute pain – the quick, sharp kind you feel when you slam your finger in a door.
Inflammatory pain – caused by tissue damage or infection.
Neuropathic pain – resulting from nerve abnormalities or injury.
Centralized (chronic) pain – generated within the brain and nervous system.
As pain becomes more centralized, identifying the initial source becomes increasingly difficult—and often less important. Studies show that the brain of a person with chronic lower-back pain looks different from that of someone with a simple repetitive-stress injury. Instead of responding to external injury, the brain itself begins to create and amplify the sensation of pain. Genetics may also play a role, as pain hypersensitivity often runs in families.
One might assume that opioid painkillers would help, but long-term use can actually increase the body’s sensitivity to pain. Unfortunately, pain science has never received the level of investment it deserves—perhaps because better understanding would disrupt the pain-killer industry. The good news: modern research shows that a combination of Cognitive Behavioral Therapy (CBT) and targeted exercise can create real, lasting improvement.
For chronic back-pain patients, the fear of pain can feel almost life-threatening. But the key message is this: in chronic cases, hurt does not always mean harm. To move past the fear, you must be willing to follow the pain deep into its lair—to face it, understand it, and slowly retrain the brain. Those who do often discover a powerful sense of mastery over their bodies, no longer feeling like helpless victims.