Chronic Back Pain and the Brain | New Research

Published March 3, 2026 · 10 min read

By Tauri Urbanik, Pain Science Researcher

You have tried everything for your back. Here is what no one told you.

If you're reading this, you've probably been living with chronic back pain for months. Maybe years. You've done the MRIs, the physical therapy, the injections. Maybe you've even considered surgery. And the pain is still there.

You're not imagining it. Your pain is absolutely real. But here's something that might change everything you thought you knew about it.

A growing body of research suggests that most chronic back pain is not caused by structural damage in your spine. It's generated by your brain. And that's actually the best news you've heard in a long time. Because brains can change.

The study that changed back pain science

In 2022, researchers at the University of Colorado Boulder published a study that stunned the pain world. They took 151 people with chronic back pain, average duration 10 years, and randomly assigned them to Pain Reprocessing Therapy, a placebo, or usual care (Ashar et al., JAMA Psychiatry, 2022↗).

The results? Two-thirds of the PRT group became pain-free or nearly pain-free. After just 4 weeks.

Not a little better. Not "manageable." Pain-free. And here's what makes it even more remarkable. Those results held up at one-year follow-up. The five-year data confirmed it too. This wasn't a temporary fix. These people's brains actually changed how they processed pain signals.

So what did PRT do that years of other treatments couldn't? It didn't target the spine. It targeted the brain.

Your MRI findings probably don't mean what you think

You got an MRI. Your doctor pointed to a disc bulge, some degeneration, maybe a herniation. It felt like an answer. Finally, something to explain the pain.

But here's the thing. A massive review of 33 studies looked at MRI scans of 3,110 people who had zero back pain (Brinjikji et al., AJNR, 2015↗). What they found is hard to ignore.

Read that again. By age 50, 60% of people with no pain at all have disc bulges. By 80, nearly everyone has disc degeneration. Zero pain.

These "abnormalities" are like wrinkles on the inside. They're a normal part of aging. Not a sentence to chronic pain.

So if most people with disc bulges don't have pain, and many people with pain have completely normal spines, what's actually causing the pain?

Your brain learned the pain. It can unlearn it.

Here's what researchers now understand. In many cases of chronic back pain, the original injury heals (or there was never an injury to begin with), but the brain keeps generating pain signals. It's like a car alarm that goes off when there's no thief.

Dr. Apkarian's research at Northwestern demonstrated something remarkable. Brain connectivity patterns, not injury severity, predicted who would develop chronic pain (Apkarian et al., Journal of Neuroscience, 2004↗). The same injury could heal completely in one person and become chronic in another. The difference wasn't in their backs. It was in their brains.

This is what researchers mean when they call back pain neuroplastic. The pain is real. The neural pathways firing are real. But the cause isn't a broken spine. It's a brain that has learned to produce pain and gotten stuck in that pattern.

And neuroplastic means changeable.

Why surgery and injections often don't work

If back pain isn't structural for most people, it makes sense that structural treatments wouldn't fix it. And the data backs this up.

Between 10% and 40% of people who undergo back surgery develop Failed Back Surgery Syndrome. That means they have chronic pain after the procedure that was supposed to eliminate it. Some end up worse than before.

Think about that. A surgeon removes or repairs the exact "problem" the MRI identified, and the pain stays. Or comes back. Or moves to a different spot. That doesn't make sense if the disc was the problem. It makes perfect sense if the brain was the problem.

This isn't about blaming you or your doctors. Everyone was working with the best understanding they had. The problem is that the dominant model of back pain, the structural model, is incomplete. It misses the most common cause of chronic back pain entirely.

What chronic back pain cause actually looks like

If your back pain is neuroplastic, you'll probably notice some patterns. Pain that moves around. Pain that's worse when you're stressed and better on vacation. Pain that started during a difficult period in your life. Pain that doesn't respond to structural treatments.

Here's a question worth sitting with. Does your back hurt more on bad days at work than on relaxing weekends? If a disc problem caused your pain, why would it care about your boss?

J

James, 47

back pain for 12 years

James had back pain for 12 years. Three MRIs. Two rounds of physical therapy. Epidural injections that helped for a week. He was on the waitlist for spinal fusion when a friend told him about Pain Reprocessing Therapy. He was skeptical. His MRI clearly showed two herniated discs. But then he learned that 60% of people his age have herniations with zero pain. He started PRT, and within 5 weeks, his pain dropped from a 7 to a 2. Eight months later, he's mostly pain-free. He canceled the surgery.

Composite story based on common patient patterns. Not a specific individual.

Recovery stories from people with back pain

You are not the first person to wonder if back pain could be brain generated. These are stories from people who found out it was.

The brain science behind your back pain

Your brain has a pain map. Literally. There are regions dedicated to processing sensations from every part of your body. When you have chronic pain, research shows these brain areas become more sensitive and more active. They start firing even when there's no input from the body.

Pain neuroscience education, simply learning how pain works, has been shown to reduce pain, reduce fear of movement, and improve function (Louw et al., Physiotherapy, 2016↗). Just understanding that your pain is neuroplastic can begin to change it. Reading this page is, in a small way, part of that process.

The key insight is this. Your back is almost certainly healthy. Your pain is not a warning sign of damage. It's a false alarm generated by neural pathways that learned the wrong pattern. And learning is reversible.

What you can do right now

You don't need to wait for a therapist to start. Here are concrete steps backed by research.

Learn about neuroplastic pain. You're already doing this. The more you understand how chronic back pain actually works, the more your brain's danger signals start to quiet down.

Track your patterns. Notice when your pain changes. Is it worse with stress? Better when you're distracted or happy? Does it move? These patterns are evidence that your brain, not your spine, is driving the pain.

Reduce fear of movement. If your back pain is neuroplastic, movement isn't dangerous. It's medicine. Start slowly. But start.

Consider Pain Reprocessing Therapy. The Boulder study showed that this specific approach produced the highest recovery rates for chronic back pain in any published trial.

Frequently asked questions

Can chronic back pain be neuroplastic?

Yes. A landmark study at University of Colorado Boulder found that 66% of chronic back pain patients became pain-free or nearly pain-free after 4 weeks of Pain Reprocessing Therapy. Brain-based treatment worked because their pain was generated by learned neural pathways, not structural damage.

Why does my MRI show disc problems but my doctor says it's normal?

Disc bulges, herniations, and degeneration appear in people with zero pain at remarkably high rates. By age 40, 50% of pain-free people have disc bulges. By 80, 96% show disc degeneration. These findings are often normal aging, not the cause of your pain.

What is Pain Reprocessing Therapy for back pain?

Pain Reprocessing Therapy (PRT) teaches your brain that the signals it's sending are not dangerous. A randomized controlled trial published in JAMA Psychiatry found that 66% of chronic back pain patients became pain-free after just 4 weeks of PRT, with results lasting 5 years.

Is chronic back pain caused by stress?

Not exactly by stress itself, but stress plays a major role. Research shows that brain connectivity and emotional processing predict chronic pain better than any structural finding. Stress keeps the nervous system on high alert, which can generate and maintain real back pain through neuroplastic pathways.

Can back pain go away without surgery?

For many people, yes. Research shows 10-40% of back surgery patients develop chronic pain after the procedure. Meanwhile, brain-based approaches like PRT have produced 66% pain-free rates without surgery. The key is determining whether your pain is structural or neuroplastic.

References

1. Ashar YK, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23.DOI: 10.1001/jamapsychiatry.2021.2669
2. Brinjikji W, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. AJNR Am J Neuroradiol. 2015;36(4):811-816.DOI: 10.3174/ajnr.A4173
3. Apkarian AV, et al. Chronic Back Pain Is Associated with Decreased Prefrontal and Thalamic Gray Matter Density. Journal of Neuroscience. 2004;24(46):10410-10415.DOI: 10.1523/JNEUROSCI.3623-04.2004
4. Louw A, et al. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy. 2016;102(1):2-11.DOI: 10.1016/j.physio.2015.10.007