Part 4: Neuroplasticity and Pain - Rewiring the Brain in Chronic Low Back Pain

Chronic low back pain can feel like a life sentence—like it’s baked into who you are. But as a physiotherapist, I’ve seen how the brain’s remarkable adaptability, called neuroplasticity, plays a starring role in both creating and easing that pain. Pain isn’t a simple signal zipping along a fixed “pain pathway” from your back to your brain. That’s a misnomer we need to unpack, because understanding this can shift how you see—and tackle—your pain.

Let’s clear up the “pain pathway” myth. There’s no single highway labeled “pain” in your body. Instead, we have nociceptive pathways—networks of nerves that detect potential threats (like heat, pressure, or injury) and send those signals as input to the brain. The brain then scrutinizes this input, mixing it with your past experiences, current stress levels, what you see, and even what you believe. The result? An output—the pain you feel—projected back to your lower back (or wherever it lands). It’s not a straight line; it’s a dynamic conversation. Lorimer Moseley, a pain science pioneer, drives this home in Explain Pain: pain isn’t just about tissue damage—it’s your brain’s best guess at protection.

Take this real-life example: a 1995 case study from the British Medical Journal. A builder accidentally fired a nail gun at his boot. He screamed in agony, needing strong painkillers, convinced the nail had pierced his foot. An X-ray (with the boot still on) showed the nail had gone between his toes—no injury at all. Once the boot came off and he saw the truth, the pain vanished. His brain, seeing the nail and expecting damage, had projected pain based on that credible threat—until new evidence rewrote the story.

Or consider soldiers in combat—like those in World War II accounts (noted by pain researchers like Patrick Wall). Some took bullets or shrapnel but felt nothing until the battle ended. Why? Their brains, laser-focused on survival, suppressed the pain output until it was safe to act on it. The nociceptive input was there—bullets don’t miss nerves—but the brain delayed the projection until the threat level dropped.

This plasticity—your brain’s ability to rewire—explains why chronic somatic low back pain lingers. Every time you feel that ache, the neurons involved strengthen their connections, like a trail you keep walking until it’s a rut. Moseley calls this a learned pattern. But it’s not just one process. He breaks it into peripheral sensitisation and central sensitisation:

• Peripheral sensitisation happens in the tissues—like when inflammation makes nerves more twitchy, amplifying the input from your back.

• Central sensitisation kicks in higher up, in the spinal cord or brain, where the system gets so good at firing that even harmless signals (a light touch) trigger pain. It’s why your back might hurt just sitting there, long after the original injury healed.

Here’s the kicker: neuroplasticity isn’t a one-way street. Just as your brain learned to crank up pain, it can learn to turn it down. Those stiff movement patterns—like bracing your back to stand—reinforce the pain rut. But by gently challenging them, calming the nervous system, and showing your brain it’s safe, we can rewire the output. It’s not quick, and it takes work, but I’ve seen patients loosen that grip of pain. Your brain’s a master adapter—let’s make it work for you.

This is APA Sports Physiotherapist, Darren Glendenning, signing off for now!

You can book an appointment with Darren or Newcastle Knights Physiotherapists Katie or Hayd'n at www.upnadamptphysio.com

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