12 Back Pain Facts

Persistent lower back pain is extremely common but very rarely is it dangerous or life-threatening.  Less than 5% of people with chronic back pain have something seriously medically wrong with them.

Patients often tell us that they want another scan to see what is causing their pain.  But you cannot scan pain; pain is a perception or a conscious inference that your brain makes about the state of your tissues or your body condition.  You cannot scan hunger or tiredness either for the same reasons.

MRI scans do not diagnose what is causing your pain.  Remember, pain is all about your brain’s interpretation of threat rather than a sensation directly from nerve endings in your tissues. MRI scans have actually been shown to worsen the prognosis for chronic back pain if the findings are not put into context accurately. They are useful to screen for potentially serious medical problems that could contribute to pain.

Chronic back pain is only loosely associated with the health or structural integrity of your spine.  This is not to say that tissue quality is unimportant, just that it is just one of the many factors that can have an influence on pain perception.

All chronic pain, not just back pain, is less to do with structural changes in the body and more to do with a sensitised nervous system, one with the dial turned up even though the body’s tissues are out of danger.

And the nervous system is only one part of this protective response.  It works in concert with the immune system (combating infection), autonomic nervous system (fight, flight or freeze) and the endocrine system (hormonal responses that mobilise the energy systems required in response to injury).  This is why we often feel familiar aches and pains more when we have a cold or flu.  It is also likely to be part of the explanation for ‘long covid’ and other post-viral fatigue syndromes.

So, if we want to treat persistent back pain effectively, we need to focus more on treating these systems and less on the actual body part that we feel complaining.  

You are safe to exercise and move normally even if you have some pain - remember, as pain becomes more persistent, it is not a reliable marker of harm.

It is a myth that loading, bending and exercising wears tissues out.  Just like going to the gym, exercising makes you stronger and your tissues more resilient.

Unless you have a disease process or something like osteoporosis, your back is not a weak or vulnerable part of your body. It is actually very strong and tough.

Pain can encourage you to move awkwardly.  Most people with chronic back pain have learned to adopt overly protective postures and ways of moving that are unhelpful and lead to continued pain sensitivity.  Learning to relax your back during movement rather than bracing and tensing to protect your spine is often very helpful.

Surgery for most lower back pain is not effective and also comes with inherent risk.  Get a second opinion if you are considering surgery.