Chronic Low Back Pain is in Your Back and in Your Brain…

People often say that Chronic Low Back Pain, or CLBP is all in your head!  The implication is that the pain is psychological. While the pain certainly isn’t psychological, it turns out that there is some truth to the statement that it is in your head.

A new study looked at 14 people with Chronic Low Back Pain, and a control group of 16 healthy pain free people using sophisticated brain imaging to examine how chronic pain affects the connectivity of brain networks and the effect of treatment. fMRI was used which is a functional MRI, or a picture of the brain that allows scientists to see what’s going on in certain areas of the brain by measuring blood flow. Their findings show that two particular areas of the brain were affected by Chronic Low Back Pain. The Insula, (usually involved in control of muscles and perception) which activates the yin and yang circuitry of the brain (Task Negative and Positive Networks) had altered global connectivity.  This was verified by structural changes in the white matter found through diffusion-tensor imaging, which is a highly detailed MRI map of the tiny nerve pathways in the brain. The Dorsolateral Prefrontal Cortex ( involved in executive functions like working memory, planning and abstract reasoning) also had aberrant connectivity. The good news is, most of these Chronic LBP brain changes were resolved with successful treatment. The bad news is that not all of them were resolved.

The upshot? These days we have the ability to look into things going on inside of our brain like never before. What all of this means is that much of the medical wisdom of the 70s and 80s concerning the use of a heavy handed psychological counseling approach to treat chronic pain patients is being debunked. These patients don’t have psychological problems, they have broken parts in the spine that change the make up of their brains. So the next time someone tells you your CLBP is all in your head….tell them, “Close, its actually in my brain!”

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Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile