If you’ve ever spent hours (or days) with back pain, you know how uncomfortable and frustrating it can be. It’s a physical discomfort, no doubt about it. But it’s also an emotional burden. Constant pain worsens your mood, reduces your ability to concentrate, and prevents you from enjoying life’s simplest pleasures.
When getting out of bed becomes an impossible mission and walking feels like climbing Mount Everest, it’s hard to put on a brave face and concentrate. And with each passing day without finding a solution, the feeling of exhaustion intensifies. It’s easy to fall into a self-perpetuating cycle of discomfort and irritability.
But it’s not all in your head, and it’s not so easy to control simply by relying on willpower. Neuroscience confirms that chronic back pain can change the structure of your brain.
The amygdala, the epicenter of pain
Researchers at Xi’an Jiao Tong University subjected 33 patients with chronic lower back pain and 33 healthy subjects to an MRI scan to assess both the volume and surface area of their brains. They found that the size of the amygdala was “Significantly smaller in the group with chronic lower back pain.”
They found no relationship between the psychological characteristics of pain or depression, meaning that atrophy was directly related to the physical aspects of pain.
The amygdala is a complex brain structure that plays a fundamental role in emotional regulation, memory, and affective disorders such as anxiety. It is also part of what is known as the “pain matrix,” a series of brain areas involved in processing painful stimuli, such as the prefrontal cortex and the thalamus.
In fact, a previous study from Harvard University had found that during chronic pain there is a great activation of the amygdala, but with some important nuances.
These neuroscientists observed that pain “induced” in the laboratory, such as when you prick or burn your finger, activates a superficial region of the amygdala. In contrast, chronic pain activates the basolateral region, meaning it has a more complex emotional dimension since it is perceived as more threatening or distressing due to its recurring nature.
More pain = Less gray matter
The impact of chronic back pain on the brain is not limited to the amygdala. Further research conducted at Northwestern University found that it also reduces the volume of gray matter, particularly in regions such as the prefrontal cortex and the insula. Again, these areas are involved not only in the physical perception of pain, but also in its emotional interpretation and in modulating the response.
At the same time, the loss of gray matter disrupts several important functions. On the one hand, it reduces the brain’s ability to process and discriminate nociceptive stimuli, which can amplify the sensation of pain or make it more diffuse. On the other hand, it affects emotional regulation, making it difficult to control the anxiety, frustration, or sense of threat associated with chronic pain.
It also impacts memory and attention, which explains why many people with persistent pain report difficulty concentrating, planning, or thinking clearly. “These changes could be related to impaired cognitive-affective and emotional processing abilities, as well as the more persistent chronic pain condition,” the researchers noted.
How to protect the brain from chronic pain?
Taken together, these structural changes show that chronic back pain is not just a physical problem that affects mobility, but a condition that reconfigures the way the brain perceives, interprets, and responds to suffering.
Transformations in brain structure can generate a vicious cycle: more pain causes more brain atrophy, which in turn makes us less able to modulate our emotional reaction to pain, ultimately amplifying it.
The good news is that we can train our attention and learn active coping strategies for pain to tell the brain that not all pain should be amplified.
Techniques such as mindfulness meditation, conscious breathing exercises, and even emotional regulation techniques can break this cycle, reducing the anxiety generated by pain and even moderating its perception, making it more bearable. In other words, learning to manage pain psychologically not only soothes the back, but also protects the brain.
References:
Gu, S. et. Al. (2024) Altered volume of the amygdala subregions in patients with chronic low back pain. Front. Neurol.; 15:10.3389.
Mao, CP & Yang, HJ (2015) Smaller Amygdala Volumes in Patients With Chronic Low Back Pain Compared With Healthy Control Individuals. J Pain; 16(12): 1366-1376.
LE Simons, et. Al. (2014) The human amygdala and pain: evidence from neuroimaging. Hum Brain Mapp; 35: 527-538.
Baliki, MN et. Al. (2011) Brain morphological signatures for chronic pain. PLoS One; 6(10): e26010.
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