Chronic Back Pain: Why the Cause Often Isn't Where It Hurts
- Patrick Wentorp
- Jan 2
- 10 min read
You lie awake at night because the pain in your lower back just won't stop. The MRI showed a herniated disc. The orthopedist said: "That's just how it is, you'll have to live with it." Physical therapy helped for a few weeks, but now everything is back to how it was. Painkillers have become a daily routine.
Does this story sound familiar? You're not alone. Millions of people go through the same frustrating odyssey. But what if I told you that the herniated disc might not actually be the real problem?
In this article, you'll learn why many chronic back pain cases don't disappear despite perfect diagnosis and treatment, what neuroplastic pain is, and how a revolutionary treatment approach made 66% of sufferers pain-free – without surgery or medication.
The Puzzle of Chronic Back Pain
Chronic back pain is a mass phenomenon. In Germany, about one in five adults suffers from it. Most have undergone comprehensive diagnostics: X-rays, MRI, sometimes even CT scans. Many have done physical therapy, taken painkillers, some have had surgery.
And yet: The pain remains. Or it returns after brief improvement.
The confusing facts:
Treatments often only help short-term
The pain persists even though "everything has been structurally treated"
Sometimes it gets worse without anything changing
This leads to an uncomfortable question: Why doesn't treatment help when we supposedly know the cause?
To understand this, we need to distinguish between two fundamentally different categories of back pain:
1. Structural or Physical Problems These are real tissue damage: fractures, acute inflammation, tumors, fresh severe injuries. These pains have a clear physical cause that must be treated.
2. Non-structural or Functional Pain These are pains where no clear physical cause is found despite thorough diagnostics – or where the found "abnormalities" don't match the severity of symptoms.
The second category accounts for about 85% of all chronic back pain. And this is where it gets interesting.
The Misalignment Myth: What Studies Really Show
The common assumption is: "Your back hurts because you have scoliosis, a herniated disc, or vertebral slippage." This explanation sounds logical – but it's often wrong.
What Happens When You Examine Pain-Free People?
A groundbreaking study by Mayo Clinic researchers did exactly that: They systematically evaluated MRI scans of over 3,000 people without back pain, looking for "damage."
The study results (Brinjikji et al., 2015) are astonishing:
37% of pain-free 20-year-olds have disc degeneration
30% of pain-free 20-year-olds have disc bulges (protrusion)
60% of pain-free 50-year-olds have herniated discs
84% of pain-free 60-year-olds have disc degeneration
96% of pain-free 80-year-olds have degenerative changes
Read that again: The majority of people over 50 have herniated discs – and no pain whatsoever.
This Also Applies to Other "Misalignments"
Similar findings exist for scoliosis and other spinal changes: Many people with significant deviations have no pain, while others with minimal abnormalities suffer from massive pain. There's no linear correlation between the degree of misalignment and pain intensity.
What Does This Mean?
The logical conclusion: If so many people with structural "damage" live pain-free, this "damage" cannot be the sole or main cause of pain.
This does not mean:
That structural problems never cause pain
That your pain is "not real"
That you're imagining it
That your complaints aren't serious
This means: There's obviously another mechanism that can generate pain – even without structural cause. And this mechanism resides in the nervous system.
The Boulder Back Pain Study: A Scientific Breakthrough
In 2021, a study was published that could revolutionize the understanding of chronic back pain. Researchers at the University of Colorado Boulder examined 151 people with chronic back pain – and achieved impressive results.
What Was Studied?
The study, published in JAMA Psychiatry, was a randomized controlled trial with three groups:
Group 1: Pain Reprocessing Therapy (PRT) – a psychological treatment
Group 2: Placebo injection (participants knew it was a placebo)
Group 3: Usual care as before
The participants:
151 people with chronic back pain
Average pain duration: over 10 years
Pain intensity: 4 out of 10 or higher
The Treatment: Pain Reprocessing Therapy (PRT)
PRT is based on a simple but radical idea: The brain can learn to generate pain even when no real injury exists – and it can also learn to stop.
The treatment consisted of:
A consultation with a doctor who explained that the pain is generated by the nervous system
8 psychological sessions over 4 weeks
Techniques to "retrain" the brain – recognizing pain as a false alarm
No medications, no physical interventions, no surgery
The Results Are Dramatic
After just 4 weeks of treatment:
66% of the PRT group were pain-free or nearly pain-free (pain scale 0-1 out of 10)
Placebo group: 20% pain-free
Control group (usual care): 10% pain-free
Even more impressive: The successes lasted. After one year, most participants in the PRT group were still pain-free.
What Did the Brain Scans Show?
The researchers also performed functional MRI scans and could detect changes in the brain:
Changed activity in pain-processing brain regions
The brain had actually "learned" to interpret signals differently
Objective, measurable changes – not a placebo effect
Important Context
This study is scientifically high-quality and was published in one of the most prestigious medical journals.
But:
It didn't work for everyone (34% still had pain)
It requires the right diagnosis: Is the pain really neuroplastic?
It doesn't mean "the pain is psychological" – it's neurobiologically real
What this study clearly shows: A substantial portion of chronic back pain arises from changes in the nervous system, not from structural damage. And this pain can be treated through targeted interventions.
Understanding Neuroplastic Pain
Now it's time to explain the term that has already appeared several times in this article: neuroplastic pain.
What Is Neuroplastic Pain?
Simply put: Your nervous system generates pain even though no tissue damage exists. The brain interprets harmless body signals as dangerous and consequently generates a pain signal – a false alarm of the nervous system.
This sounds abstract but can be well understood when you grasp how our pain experience works.
How Pain Really Develops
Unlike many think, pain isn't simply a signal sent from the injured body part to the brain. Pain is an output of the brain – an interpretation of signals that the brain classifies as threatening.
The brain constantly asks: "Is this dangerous?" If the answer is "Yes," it generates pain – as a warning signal and protective reaction.
For acute injuries, this is useful. For chronic pain, however, this mechanism often goes haywire.
Two Paths to Neuroplastic Pain
Neuroplastic pain can develop in two different ways:
Path 1: After an Injury (the pain remains)
Phase 1: Acute Pain (normal and useful)
You injure yourself, for example through a back spasm, accident, or overload
Your nervous system sends pain signals – completely normal and important
The pain warns you: "Caution, something is damaged here!"
The body heals (normally after 6-12 weeks)
Phase 2: The Pain Remains (the problem)
Even though the tissue has healed, the pain signals remain
The nervous system has changed – it's sensitized
The brain interprets harmless signals as danger
A "pain memory" has developed
Path 2: Without Previous Injury (the pain emerges)
And here it gets particularly interesting: Neuroplastic pain can also develop without any previous injury. How is this possible?
The nervous system learns pain for other reasons:
Chronic Stress and Emotional Burden
Persistent work or personal stress
Unprocessed emotions (anger, grief, fear)
The nervous system is constantly on alert
The brain interprets normal body signals as threatening
Fear of Pain or Movement
You've seen how others struggle with back pain
A doctor said: "Your spine is degenerated"
You develop fear of certain movements
This fear alone can sensitize the nervous system
Perfectionism and High Self-Demands
Constant internal pressure
The feeling of never being good enough
No permission to pause or show weakness
The nervous system responds with pain as an "emergency brake"
Earlier Traumatic Experiences
Even long-past stressful events
The nervous system remains in heightened alert
Pain can be one way the body reacts to this
A typical scenario without injury: You sit a lot at the office, you're stressed, you have high expectations of yourself. One day, without concrete injury, your back starts to hurt. At first only slightly, then increasingly stronger. No accident, no back spasm – the pain is just there. The MRI shows "age-appropriate changes," but nothing dramatic. Still, the pain becomes chronic.
The Pain Spiral
Regardless of how neuroplastic pain originated – it often creates a vicious cycle:
Pain → you fear movement or certain activities
Fear → you avoid these activities, the nervous system becomes more sensitive
Avoidance → social isolation, fear intensifies
More Pain → the spiral continues
Additionally: Stress, fear, and emotional tension further amplify the pain. The nervous system becomes increasingly sensitive – technical term: central sensitization.
Important: Psychosomatic ≠ Imagination
This point must be crystal clear:
The pain is 100% real
It's measurable in the brain (as the Boulder study showed)
"Psychosomatic" only means: Body and mind are connected
Emotional stress can generate real physical pain
This isn't weakness, not imagination, but normal neurobiology
Your brain generates the pain in an attempt to protect you. It's an over-cautious alarm system – well-intentioned but misguided.
How Do You Recognize Neuroplastic Pain?
There are typical patterns that indicate neuroplastic pain:
Signs of neuroplastic pain:
Did the pain first appear during a stressful life phase?
Is pain intensity irregular (sometimes stronger, sometimes weaker)?
Did the pain begin without physical injury?
Did the pain occur after an injury but continue beyond normal healing time?
Do you have pain in various body parts or other complaints that could have psychosomatic causes (chronic fatigue, digestive problems)?
Does the pain change over time and/or spread?
Does the pain worsen under stress?
Does pain decrease when you engage in an activity you enjoy?
Are there pain triggers unrelated to the body? (weather, certain people, work...)
Does the pain occur on both sides of the body?
Is there no clear physical diagnosis, or are there multiple (contradictory) diagnoses that haven't contributed to pain healing?
Does pain appear delayed (hours or a day after activity)?
Do these descriptions at least partially apply to you: Frequent worry, putting yourself under pressure, perfectionism, wanting to please others, general anxiety?
If several of these points apply to you, your pain could be neuroplastic.
The Good News
What the nervous system has learned, it can also unlearn. That's exactly what the Boulder study shows: With the right techniques, the brain can learn to reinterpret pain signals – as what they are: false alarms, not real threats.
A Paradigm Shift in Pain Treatment?
What do these findings mean for the future of pain therapy?
The Old Model
How pain treatment worked before:
Pain = Damage in the body
Strategy: Find the damage, repair it
If that doesn't help: "Manage" pain with medication or learn to live with it
The New Understanding
Modern pain research says:
Pain = Output of the nervous system
For chronic pain: Often a "false alarm"
The nervous system can be retrained
Pain isn't just "manageable" but often curable
What This Means for Sufferers
Hope Instead of Resignation:
You're not "broken" or "beyond treatment"
Your pain can disappear, not just be alleviated
There are concrete, scientifically-based methods
New Treatment Approaches:
Pain Reprocessing Therapy (PRT)
Emotional Awareness and Expression Therapy (EAET)
Neuroscientific pain education
Mind-body approaches like meditation, Qi Gong, breathwork
Important: The Right Diagnosis
Not every chronic pain is neuroplastic. Therefore, thorough assessment is essential:
Step 1: Rule out serious conditions
Fractures, tumors, inflammation must be treated
Careful medical examination is indispensable
Step 2: Recognize patterns
Does your profile fit neuroplastic pain?
Are there structural findings that really explain the pain? Or are they typical patterns of neuroplastic pain?
Step 3: Individual treatment plan
Which approach fits your situation?
Combination of various methods possible
The Challenge
The paradigm shift is in full swing – but hasn't arrived everywhere yet:
Many doctors don't know this approach yet
The healthcare system is strongly oriented toward structural treatment
Sufferers often have to search long before finding this approach
First Steps: What You Can Do Now
Do you recognize yourself in this description? Here are concrete next steps:
1. Learn More
Knowledge is the first step to healing:
Read about neuroplastic pain and neuroscientific foundations
Understand how your nervous system works
Recommended books: "The Way Out" by Alan Gordon, "Unlearn Your Pain" by Dr. Howard Schubiner
The Curable App offers guided programs on this approach
2. Check If Your Pain Could Be Neuroplastic
Go through the checklist from this article again:
How long have you had the pain?
Is there a clear structural cause?
Does the pain change with stress or emotion?
3. Find the Right Experts
Not every therapist works with this approach:
Pain psychologists offering PRT or similar methods
Consultants specializing in neuroplastic pain
Important: Someone who understands this approach, not just "classical" pain therapy
4. Be Patient with Yourself
Healing takes time:
The nervous system needs time to relearn
Setbacks are normal and not failure
The path isn't linear – but that's okay
What You Should Avoid
Further invasive diagnostics without clear medical indication
Endless searching for "the one missing finding"
Remaining in protective posture and fear
Accepting the diagnosis "you'll have to live with it"
Conclusion: There Is Hope and Support for You
If you've read this article to here, you're probably someone who has been struggling with chronic back pain for years. Perhaps you've tried many treatments already. Perhaps someone told you that you'd have to "learn to live with it."
The most important message of this article: This doesn't have to be so.
Science clearly shows:
Many structural "abnormalities" in the spine are normal and don't cause pain
A large portion of chronic back pain arises from changes in the nervous system
This neuroplastic pain is real, measurable, and treatable
The Boulder study shows: 66% success rate with a psychological approach
There are concrete, scientifically-based paths out of pain
This does not mean:
That your pain is "only in your head"
That you're imagining it
That you're to blame
This means:
Your nervous system has learned to generate pain
And it can also learn to stop
You're not "beyond treatment" – perhaps just the wrong cause has been treated so far
The Next Step: Free Initial Consultation
Are you wondering if your back pain could be neuroplastic?
I offer a free initial consultation where we'll look together at:
Does your profile fit neuroplastic pain?
Which approaches could help you?
What could an individual path look like?
What are the next steps for you?
No obligation, no sales pitch – just professional assessment and concrete guidance.
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