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As you suggest, it is clear now that chronic back pain affects more than just the spinal joints and muscles. Newer, more advanced imaging studies have shown that chronic pain results in changes seen in the spinal cord and brain. This new information helps confirm that chronic pain is a neurologic, not a psychologic problem.
Having said that, we are also aware that there are psychologic effects of chronic pain. Patients in pain stop moving. They are afraid to move in the ways and patterns that they know will increase their pain. This is called fear avoidance behavior (FAB).
Decreased motion will actually cause even more pain. New ideas for treatment include helping patients overcome FAB and resume more normal motion. Physical therapists and behavioral psychologists work together to retrain patients to move and think differently.
Whether or not this method will result in a return to normal in the spinal cord and brain remains to be seen. We now have the technology and research skills to conduct large studies that will answer some of these questions.
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