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Chronic Pain
Chronic Back Pain May Arise From Nociplastic Pain
Back pain may be perpetuated by the way the brain processes pain signals.
Posted November 27, 2023 Reviewed by Monica Vilhauer
Key points
- Chronic back pain does not always arise from the joint, it can arise from the way the brain processes pain.
- Chronic back pain can arise from nerve sensitization or nociplastic pain.
- Nociplastic pain is the abnormal processing of pain signals by the brain, which amplifies pain levels.
Melissa suffered a seemingly minor back injury at work. After leaning forward for eight hours applying bridal makeup, she felt a pull and stabbing sensation in her low back. She suffered a back strain, an injury that should have healed after four weeks. Instead, the discomfort worsened month after month until it became so unbearable she could no longer work.
Lifting a bag of groceries felt like moving a concrete block. The pain had started in the middle of her lower back, a tender area about the size of a golf ball. Now, the stabbing and spasm spread across her back and down her thighs covering her in a blanket of misery.
Over a year later, her doctors still hadn’t found the reason.
A Common Problem With an Uncommon Diagnosis
Back pain is an everyday complaint in a doctor's office but the cause of back pain is not always straightforward. And, the underlying cause can change. Melissa’s doctor diagnosed her with a back strain and started her on the standard treatment regimen. He reassured her she would be better in four weeks.
After four weeks, Melissa returned no better. Her doctor referred her to physical therapy, but the pain continued and had spread. Given her continued decline, her provider ordered an X-ray, and then an MRI. Both showed mild arthritis.
Mild arthritis is not typically disabling. A back strain should have healed at this point. Confused, her doctor sent her for a few types of back injections. They didn’t help.
Her exams continued to be normal, other than sensitivity to touch and discomfort when bending forward or backward. The doctor could not see an explanation for her debility.
When standard treatments for back pain aren’t working, that is a clue the cause is more complex than a muscle or joint problem.
Mistreated and Misunderstood
For the next two years, Melissa avoided activities that required a lot of movement fearing the pain would worsen. She could not live her life. She no longer worked and needed help caring for her kids. How had a back strain stolen her health?
During this time, Melissa saw multiple doctors who all prescribed the same standard approach of physical therapy, ibuprofen, and injections. The pain continued without relief; the blanket of misery wrapped tight around her.
She feared her doctors thought she was just there for drugs. Her tests and physical exam were mostly normal. She didn’t respond to standard treatment. It took six doctor visits before the staff believed her pain was real and provided pain management beyond ibuprofen.
She felt shamed by some of the medical staff at the clinic. She recalled one particularly hard day when she called the clinic with a question and the staff condescendingly retorted, “Aren’t you on enough medicine? What else do you want?”
The struggle wasn’t just in the clinic, but also with the people around her. Friends and family members were annoyed by her pain issues. When she talked about her struggle, she received comments like, “You just need to move more,” or “You spend too much time on your butt.”
Melissa endured years of physical and emotional suffering due to the underlying cause of her chronic back pain not being identified.
Treating the Right Cause Made All the Difference
When Melissa shared her story with me, I spoke with her about a cause of back pain that had not been considered. Her pain no longer stemmed from a strain or mild arthritis; it was no longer as simple as a muscle or joint issue.
Another process had been triggered — nerve sensitization or nociplastic pain, which is the abnormal processing of pain signals by the brain and nerves.
Sensitization amplifies pain signals, making every movement and activity hurt more. When Melissa understood the role sensitization played in her pain levels, she got into a better mindset to manage her symptoms.
Once she knew her symptoms were related to sensitization rather than a worsening injury, she wasn’t afraid of moving anymore. Just understanding what was happening was a relief.
We switched her treatment to the actual target — the nervous system. I recommended medications that calm over-reactive nerves, which reduces pain signals from sensitization-related pain.
I recommended therapies that build the mind-body connection, since sensitization pain is sensitive to our emotional state and stress levels. Therapies such as yoga and meditation are examples.
I expand on treatment further in my book, Sunbreak: Healing the Pain No One Can Explain.
Melissa regained hope. She understood that her struggles were real and she wasn’t just imagining them or being overly dramatic. After a year, with the right treatment, Melissa reclaimed her life. She still uses medication therapy, but she functions now.
She cares for her family and has re-entered the workforce. She opened a house painting business and enjoys the movement and artistry that comes with painting.
If you have disabling pain and mostly normal medical tests, consider nociplastic pain as a source.
References
Mary-Ann Fitzcharles et al., “Nociplastic Pain: Towards an Understanding of Prevalent Pain Conditions,” The Lancet 397, no. 10289 (May 2021): 2098–2110.
