Chronic Back Pain, Explained for the Person Who's Tried Everything
Quick Answer
Your back pain is real. Your MRI findings are real. What almost no one explains is that 96% of pain-free 80-year-olds have disc degeneration on MRI, that the largest brain-based back pain trial in history saw 66% of patients pain-free in 4 weeks, and that most chronic back pain isn't structural at all. This page is the version of back pain education you should have gotten on day one.
This page is for the person who's done the rounds. PT for months. Three rounds of injections that helped less each time. Opioids, then off opioids. A surgery, sometimes two. A second opinion. A third. An MRI that came back saying things you couldn't pronounce, and a doctor who couldn't tell you why your back still hurt after all of it.
You're not failing the treatments. The model behind the treatments is missing a piece. Here's the piece.
See if your back pain fits the neuroplastic pattern
A 4-minute self-screener maps your symptoms against the documented signs of neuroplastic back pain and tells you whether the brain-based frame fits your specific case. No account needed to see your result.
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Your back pain is real. Here's what your MRI findings actually mean.
If your radiology report has words like 'disc degeneration,' 'disc bulge,' 'protrusion,' 'desiccation,' 'facet arthritis,' or 'degenerative disc disease,' those words are accurate. The disc looks the way the report says it looks. What the report doesn't tell you is what those findings mean for your pain. That's the part that's been missing.
Thirty years of imaging research has settled this. Here's the evidence stack, in plain language.
Most pain-free people have the same findings. Brinjikji 2015, published in the American Journal of Neuroradiology, pooled 33 studies covering 3,110 people with no back pain. Disc degeneration showed up in 37% of pain-free 20-year-olds. By age 80, 96% of pain-free people had it. Disc bulges ran from 30% at age 20 to 84% at age 80. Disc protrusions showed up in 29% to 43% of pain-free people across every age group. Every one of those people felt fine. The disc finding on your MRI may be older than your pain. It may be older than your last birthday cake.
Jensen 1994, the New England Journal of Medicine paper that started the conversation. 98 pain-free volunteers got MRIs. Only 36% had completely normal discs at every level. 52% had at least one disc bulge. 27% had a disc protrusion. None of them had pain. The author's published conclusion: 'The discovery by MRI of bulges or protrusions in people with low back pain may frequently be coincidental.'
Boos 1995 in Spine. 46 heavy-labor workers with no back pain got MRIs. 76% had at least one disc herniation. The same finding people get surgery for. The workers had zero pain.
First-time back pain doesn't show new MRI changes. Carragee 2006, in the Spine Journal, scanned a cohort of pain-free people, then followed them. The ones who developed first-time serious back pain did not reliably show new MRI findings when they hurt. The pain came on. The imaging didn't change.
Reading the report makes pain worse. Rajasekaran 2021 in the European Spine Journal randomized 44 patients. One group got their MRI findings written in formal radiology language. The other group got the same findings explained as normal age-related changes. The patients who got the formal language reported more catastrophizing, less pain improvement, and worse function at 6 weeks. The findings were the same. The framing was different. The outcome was different. Webster 2010 looked at workers comp claims for acute back pain. Patients who got an early MRI had an 8-fold increase in surgery and a 2-fold increase in disability at one year, regardless of what the MRI actually showed.
Psychological factors predict outcome more than imaging. Carragee 2004, a 4-year prospective study in Spine, found that poor coping skills and a history of chronic pain were nearly 3 times more predictive of developing back pain than any MRI finding. Mannion 2007 looked at the variance: medical variables explained 6% to 7% of pain outcome. Psychosocial variables explained 20%.
Here's what almost no one tells back pain patients. Disc findings are common. Pain is the part that's specific. The two are weakly connected. That changes what to do next.
Why your back pain treatments keep failing
If you've cycled through PT, injections, opioids, and possibly surgery, and the pain is still here, you're not failing the treatments. The treatments are failing you. Here's what the research actually says about each one.
Physical therapy. PT works for many people, especially in the first weeks of an episode. For a substantial group of chronic back pain patients, it doesn't. The most common pattern: weeks of stretching and strengthening, modest improvement, then a plateau. Why: PT addresses muscles and movement. If your pain is being amplified by a sensitized nervous system, addressing the muscles doesn't address what's amplifying.
Epidural steroid injections. Pinto 2012, in Annals of Internal Medicine, pooled 23 trials. The conclusion was direct: epidurals 'did not have a notable effect on alleviating pain or decreasing long-term disability compared to placebo.' Most patients see relief at 6 weeks that's gone by 3 months. If you've had three injections and the pain came back each time, the research isn't surprised.
Opioids. The AHRQ systematic review found no randomized trial evidence of long-term (more than 1 year) benefit for chronic pain. Dependence rates ran 3% to 26% in primary care. The CDC guidelines specifically advise against opioids for chronic non-cancer back pain. If you've been on opioids for years and the pain is still here, the research is not surprised by that either.
Surgery. The SPORT trial (Weinstein 2006, 2008) randomized 283 patients to surgery vs. conservative care. At one year, surgery and conservative care had equivalent outcomes. Surgery sped up early relief by 6 to 12 weeks. After that the curves came together. Failed Back Surgery Syndrome rates: 30% to 46% for lumbar fusion. 19% to 25% for microdiscectomy. Success rates fall with each repeat: about 60% for the first surgery, 30% for the second, 15% for the third, 5% for the fourth. If your first surgery didn't hold, the math on the second is not a small consideration.
Chiropractic, massage, acupuncture. Mixed evidence. Helpful for many acute episodes. For chronic central sensitization, they're addressing tissue when the problem is nervous system processing. Some patients get short-term relief. Few get a durable result.
Each of these treatments was designed around the same hypothesis: the pain is coming from your tissues. For most chronic back pain, that hypothesis is incomplete. Your tissues may have started the pain. Your nervous system is what's keeping it going. If your back pain fits this pattern, our 4-minute self-screener tells you whether the brain-based approach fits your specific case.
What's actually generating chronic back pain
After enough time in pain, your nervous system can change how it processes signals from your back. Normal sensations get amplified. Pain that started in tissue keeps going long after the tissue has healed. This is called central sensitization (when the nervous system gets stuck on high alert). It happens in about 25% to 40% of chronic low back pain. It's a learned pattern. Learned patterns can be unlearned.
The metaphor is Daniel Clauw's, the University of Michigan rheumatologist who has done more to translate the central-sensitization model into mainstream medicine than anyone. Your nervous system has a volume knob for pain. After enough time under stress, sleep loss, illness, or any combination of these, the knob gets stuck on high. Normal signals from your back get turned up into pain. The signals are real. The amplification is what's added.
Three things this explains that probably confused you before.
One. Why your back pain didn't go away after the disc healed. Pain can become independent of the original injury. Tissue moves on. Brain hasn't. This is why a 'successful' surgery can leave you in the same pain a year later. The structure got fixed. The amplification didn't.
Two. Why your back hurts more during stressful weeks even when nothing physical has changed. Stress turns up the volume on the same nervous system that's already dialed up. Apprehension is fuel. The week of a deadline, a tense conversation, a bill you can't quite cover, your back pain is reading your life and reporting on it.
Three. Why pain moves around your back, or migrates between your back and other areas. Pain that moves doesn't behave like a herniated disc. Compression doesn't migrate. Sensitized pain does. Low back this week, mid-back next week, sometimes radiating into a hip, sometimes the other one. That movement is a signature of central processing, not of structural damage moving around the spine.
The mechanism, in one sentence. Your nervous system isn't broken. It's overprotective. The signals it's amplifying come from real tissue. The amplification is the problem. And amplification is a learned pattern, which means it can be unlearned.
We've written the full guide at central sensitization for readers who want the deeper mechanism. Sciatica and chronic low back pain share the same nervous-system mechanism, and about 60% to 80% of sciatica patients also have low back pain. We've written the comprehensive sciatica guide for the same reason we've written this one.
How to recognize neuroplastic back pain in your own pain
Neuroplastic back pain shows up in patterns. Pattern recognition gives you confidence in the call. If you check 4 or more of the items below, the brain-based explanation is the one to take seriously.
The 7-sign self-check for neuroplastic back pain
Check any that apply to you. Your count maps to a feedback band below.
This isn't pattern matching for marketing. The Ashar 2023 secondary analysis (JAMA Network Open) found that the patients who shifted their pain attribution from tissue damage to brain processes had the largest pain reductions. Before treatment, only 10% of pain attributions were brain-related. After PRT, 51% were. The shift in belief was the mechanism. What you believe about your pain predicts what your pain does next.
Get your full neuroplastic back pain match score
The 13-question self-screener maps your pattern across every documented sign of neuroplastic back pain and tells you what the research says about your specific match. No account needed to see your result.
See Your Match Score13 questions. 4 minutes. No credit card.
What actually works for chronic back pain
Chronic back pain has been studied under brain-based treatment frameworks more thoroughly than any other chronic pain condition. The 2022 Boulder Back Pain Study is the strongest single result in the entire field of chronic pain research. We're going to give you the unflattering parts too, because honesty about what doesn't work matters more than confidence about what does.
1. Pain Reprocessing Therapy (PRT). The strongest brain-based pain trial in history.
Ashar 2022, JAMA Psychiatry, n=151. A three-arm randomized trial. PRT vs. open-label placebo injection vs. usual care. Average pain duration before the trial: 10 years. Treatment was 4 weeks: 1 telehealth physician session and 8 one-hour psychological sessions. 66% of PRT patients were pain-free or nearly pain-free (0 or 1 on the 0-to-10 scale) at 4 weeks. 20% in the placebo group. 10% in usual care. 98% of PRT patients showed some improvement. Effect sizes were Hedges g = -1.14 vs. placebo and -1.74 vs. usual care, the largest effect sizes for any psychological treatment of chronic pain on record. fMRI scans showed reduced activation in the anterior midcingulate cortex, the anterior prefrontal cortex, and the anterior insula. The brain itself processed pain signals differently after the treatment.
Ashar 2025, JAMA Psychiatry, 5-year follow-up. 113 of the original 151 participants were retained. 55% of PRT patients were still pain-free or nearly pain-free at 5 years. 26% in the placebo group. 36% in usual care. This is the longest durable result for any psychological chronic pain treatment of this magnitude.
Ashar 2023, JAMA Network Open, mechanism analysis. The patients who shifted their pain attribution from tissue damage to brain processes had the largest pain reductions. Pre-treatment, 10% of attributions were brain-related. Post-PRT, 51%. The belief shift was the mechanism, not a side effect of feeling better.
This is the trial that earned PRT its place at the front of any honest conversation about chronic back pain.
2. Pain Neuroscience Education (PNE). Multiple meta-analyses (Louw 2016, Wood 2019) show that teaching how pain actually works reduces fear, catastrophizing, disability, and pain itself. PNE is a component of PRT, but it also stands alone with moderate effect sizes. The mechanism is direct: when you understand that hurt does not equal harm, your nervous system has less reason to keep the volume up.
3. Emotional Awareness and Expression Therapy (EAET). Strongest evidence for chronic musculoskeletal pain. Burger 2016 (Journal of Psychosomatic Research, n=72, with 74% of patients reporting back pain) found large effects (d = 0.99 to 1.30) at 6 months. Two-thirds of patients achieved at least a 30% pain reduction. One-third achieved at least 70%. Yarns 2024 (JAMA Network Open, n=126 older veterans) saw 63% of EAET patients achieve at least 30% pain reduction, vs. 17% in the CBT comparison group. Number needed to treat was about 2.2.
4. PSRT (Psychophysiologic Symptom Relief Therapy). A more recent protocol, smaller sample. Donnino 2021, run out of Beth Israel Deaconess and Harvard, randomized 35 patients with nonspecific chronic back pain. 12-week protocol. At week 4, an 83% decrease in disability in the PSRT group vs. 22% MBSR-only and 11% usual care. At 26 weeks, 63.6% of PSRT patients were completely pain-free (0 out of 10) vs. 25% in MBSR and 16.7% in usual care. The sample size is small. A 150-patient replication trial is underway.
5. What doesn't reliably work for chronic back pain (covered above): opioids long-term, repeat surgery, repeat injections.
The honest frame. About 35% to 50% of chronic back pain patients achieve substantial improvement with brain-based approaches. The Boulder trial saw 66% reach pain-free status, but that population was selected for primary chronic back pain, not back pain from active disease, fracture, or recent injury. For chronic back pain that's persisted past expected healing time and isn't from active pathology, the evidence is the strongest in the field. We tell you what doesn't transfer cleanly: results from the Boulder trial may be larger than what the average patient sees, because the trial selected for primary nociplastic presentation. Both/and, not either/or.
Where PainApp fits. PainApp adapts the PRT, EAET, and PNE evidence into a self-guided format. The AI Pain Coach plus the F.I.T. Pain Tracker plus somatic tracking adapted for back pain's specific patterns (fear of bending, fear of sitting, fear of the next flare). Curable is the closest comparison and is broadly mind-body. Lin Health requires coaching scheduling. Stanza requires a prescription and is built on ACT, not PRT. PainApp is the brain-based back pain tool you can start tonight, on your schedule, for about a dollar a day.
Talk to the AI Pain Coach about your back pain pattern
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What back pain recovery actually looks like
These are three people whose chronic back pain resolved. Different ages. Different jobs. Different paths in. One had two failed back surgeries. One had no surgery and no MRI findings her doctors could point to. One went through workers comp after a lifting injury. All three got better.
Marcus54 · Chronic back pain, 11 years after a lifting injury and a failed lumbar fusion · 11 yearsMarcus had two back surgeries. The pain came back six months after the second fusion. He'd been working construction since he was 19, and now he could barely sit through dinner.
Marcus is a Latino general contractor in Austin, Texas. February 2014. He felt something go in his lower back while setting a header beam on a kitchen remodel. He finished the day, drove home, slept on the floor. Went back to work in five days. That was how it started.
The failed treatment list ran eleven years long. Twelve weeks of physical therapy that ended in a flare so bad he couldn't get out of bed for four days. Eighteen months of chiropractic at $75 a visit. Ten rounds of acupuncture. Three epidural injections that worked for a week, then a day, then not at all. Gabapentin, Lyrica, tramadol. Two pain management clinics. Radiofrequency ablation, twice. In April 2020 he had a laminectomy and fusion at L4-L5. Three days in the hospital, six weeks in a back brace. The hardware looked textbook on the post-op MRI. By month six he was in more pain than before the surgery. He got a new label: Failed Back Surgery Syndrome. The internet told him it was lifelong. About $23,000 out of pocket across eleven years.
In February 2024, sitting in his recliner at 2 a.m., he opened the glove box of his truck and found a paint sample card with THE WAY OUT, ALAN GORDON written on it in pencil. A client had mentioned the book six weeks earlier. He ordered the audiobook. Listened to the first chapter the next morning driving to a job in South Austin and pulled the truck over into a Whataburger parking lot. His pain moved. His pain was worse on bid weeks, not on heavy-lifting weeks. His pain had started four months after his father died.
Fourteen months later he set an 8-foot header beam into a wall opening on a job in West Lake Hills. Same move that started it all, eleven years earlier. He set it, stepped back, didn't think about it. Then he did.
Read Marcus's [complete recovery story](/chronic-pain-recovery-stories/marcus-cured-chronic-back-pain).
Composite story based on common patient experiences. Not a specific individual.
Priya32 · Chronic back pain, 4 years at a desk, no surgery, no structural finding · 4 yearsPriya had no surgery. No herniation. No structural finding her doctors could point to. Her MRI was clean. Her pain was real. After four years at her startup, she'd stopped sleeping in her own bed because the floor felt safer.
Priya is an Indian-American senior product manager in San Francisco. March 2021. She had just been promoted at a Series B fintech and was running the launch of a B2B payments product. Twelve-hour days, weekend work, Chipotle bowls at her desk. The night the launch went live, her lower back seized. She told herself she'd rest that weekend and it would be fine. That was four years ago.
The failed treatment list was a ladder a 32-year-old tech worker tries. A $1,400 Herman Miller Embody chair. A $350 standing desk converter. A company ergonomic assessment. Six months of physical therapy at $2,400 out of pocket. Weekly massage in the Mission. Pilates reformer at $45 a class for eight months. Twelve acupuncture sessions. A personal trainer for seven months. Hot yoga at CorePower. A $900 out-of-network MRI in October 2022 that came back as 'mild L5-S1 disc desiccation, no herniation, no stenosis, findings non-specific and common for age.' A $500 UCSF spine specialist who told her her spine was basically normal. A functional medicine consult, $280 a month in supplements for six months. Flexeril she finally filled in late 2023, didn't help. About $18,000 out of pocket across four years. A Notion database with 486 entries: date, pain level, trigger theory, treatment that day.
August 2024 in JFK Airport, flight delayed two hours, she picked up The Way Out at a Hudson News. At 40,000 feet over Kansas she opened her Notion database and filtered pain level against her calendar. Quarterly business reviews. Performance reviews. A bad Slack with her CPO. The correlation was not subtle. It had been there the whole time.
Ten months later she sat through a team offsite in Tahoe. Ten-hour workdays, late dinners, the kind of week that used to wreck her. On the second day she noticed her back wasn't a thing. Just a back. On the flight home she wrote in her journal: 'I'm a person who has a back, not a person who has back pain.'
Read Priya's [complete recovery story](/chronic-pain-recovery-stories/priya-cured-chronic-back-pain).
Composite story based on common patient experiences. Not a specific individual.
James28 · Chronic back pain, 2 years after a workplace lifting injury, workers comp pathway · 2 yearsJames hurt his back lifting at the warehouse. Workers comp paid for the ER visit, then the muscle relaxers, then twelve weeks of PT, then nothing. Two years later he was 28, on light duty, and watching his rent get harder to make.
James is a Black warehouse associate in East Point, Georgia, just south of Atlanta. January 18, 2024, a Wednesday morning at a fulfillment center in Union City. Third box of the morning, a commercial pressure washer, about 55 pounds. The cardboard flap gave way and the weight shifted hard to his right. He felt a deep pop and went down to one knee. HR drove him to urgent care, then to the ER at Piedmont Henry. He waited five hours. Around 8 p.m. a doctor pressed on his back for ninety seconds, ordered a CT, and saw a mild disc bulge at L5-S1. The doctor said: 'You've got a bad disc. You may not fully heal. Some people never get back to full duty.' James left at 11 p.m. with a prescription for twenty Percocet, a back brace, and one ER doctor's eleven words he was about to spend two years carrying.
The failed treatment list was a workers comp ladder. Eight PT sessions at an occupational health clinic in College Park. Workers comp declined more sessions. A $38 black neoprene brace from CVS he wore at work, at home, at church, to sleep, on dates, for eighteen months straight. Fourteen chiropractor visits at $55 cash each. A roll of kinesio tape. Lidocaine patches. Gabapentin that made him foggy at work. A $3,216 permanent impairment settlement in May 2025 he signed because he needed the money. A passed-over promotion to group lead, $3 more an hour. About $1,800 out of pocket across two years.
A Sunday in December 2025 his sister Keisha sat with him on his grandmother's back porch and told him he was becoming his Uncle Ray, who hurt his back in 1998 at the Ford plant and hadn't worked since. The Monday after, James opened his phone on the MARTA train, typed 'back pain won't go away after 2 years' into Google, and found Ashar 2022. Then Webster 2010 on early MRIs in workers comp. Then Brinjikji 2015, where 30% of pain-free 20-year-olds had disc bulges. The mild bulge on his CT was something one in three people his age had and felt nothing.
A Tuesday evening in January 2026, alone in his apartment, he stood in front of the bathroom mirror and took the brace off. Not to shower. Just to take it off. He did not put it back on that night.
Ten months later he runs four mornings a week on the Panola Mountain trail, carries his daughter Amara when she gets tired, sits through full service at New Birth with no brace, and runs a team of 22 on the outbound line at $3 more an hour.
Read James's [complete recovery story](/chronic-pain-recovery-stories/james-cured-chronic-back-pain).
Composite story based on common patient experiences. Not a specific individual.
Marcus had surgery. Priya didn't. James went through workers comp. All three recovered. There isn't one path through chronic back pain. There are paths.
Pages on this topic
Different angles on the same brain-based mechanism.
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Frequently Asked Questions
Recovery is well-documented. The Boulder Back Pain Study (Ashar 2022, JAMA Psychiatry, n=151) saw 66% of chronic back pain patients pain-free or nearly pain-free at 4 weeks with Pain Reprocessing Therapy. The 5-year follow-up (Ashar 2025) showed 55% remained pain-free. About 35% to 50% of chronic back pain patients achieve substantial improvement with brain-based approaches. The word 'cure' is loaded because outcomes vary, but significant improvement and durable remission are real and well-documented in the strongest pain trials in the field.
Chronic back pain usually has two parts. An original injury or disc finding, and a nervous system that learned the pain pattern and kept it after the tissue moved on. About 25% to 40% of chronic low back pain shows clear central sensitization on testing, where the nervous system gets stuck on high alert. This is why the pain can persist after the herniation has healed (most do, per the resorption literature), after surgery worked technically, after the inflammation has settled. A learned pattern can be unlearned. That's what the Boulder trial proved.
Often yes. Chronic back pain that has lasted past expected healing time and isn't being driven by active disease, fracture, or recent injury usually has central sensitization driving the persistence. The 2022 JAMA Psychiatry trial of Pain Reprocessing Therapy was the largest test of this hypothesis ever run. 66% of patients reached pain-free status in 4 weeks. The Ashar 2023 mechanism analysis found the change in brain-based pain attributions explained the pain reduction. Pain that varies with stress while imaging stays constant points to central processing.
It means the imaging is doing exactly what the research says it does. Brinjikji 2015 (33 studies, 3,110 pain-free people) found disc degeneration in 96% of pain-free 80-year-olds and 37% of pain-free 20-year-olds. Jensen 1994 (NEJM) found 52% of pain-free volunteers had disc bulges. Imaging findings and pain are weakly connected. A normal MRI doesn't mean your pain isn't real. It means the structural model isn't the right framework for your pain. The brain-based model often is.
You're not alone. Failed Back Surgery Syndrome rates run 30% to 46% for lumbar fusion and 19% to 25% for microdiscectomy. The mechanism is usually not new structural damage. It's a nervous system that learned the pain pattern during the long pre-surgical period and kept running the program after the disc was decompressed or the segment was fused. The hardware looks textbook on the post-op MRI. The pain doesn't read MRIs. Brain-based approaches show response in this population. PRT trials specifically included patients with a history of failed back surgery.
Stress doesn't cause back pain by itself. It's one of the inputs that can push a vulnerable nervous system into central sensitization, and it reliably amplifies pain once the pattern is established. Many people identify a stressful life period (job loss, grief, divorce, postpartum, financial stress) when their back pain started or got significantly worse. Carragee 2004 (Spine, 4-year prospective) found psychosocial factors were nearly 3 times more predictive of developing back pain than any MRI finding. Pain that varies with stress while the imaging stays constant points to a central processing component.
Because they were never designed to fix the underlying problem in chronic back pain. Pinto 2012 (Annals of Internal Medicine, 23 trials) concluded epidurals 'did not have a notable effect on alleviating pain or decreasing long-term disability compared to placebo.' Most patients see relief at 6 weeks that fades by 3 months. If your second injection helped less than the first, and the third helped less than the second, the research is not surprised. The injection addresses inflammation around a structure. Central sensitization is a separate problem in a different system.
Most acute back pain resolves within weeks. Pain that has lasted longer than 3 months is, by definition, chronic. Chronic back pain often involves central sensitization, which is why time alone is less likely to resolve it. Time plus a different framework can. The Boulder trial enrolled patients with an average pain duration of 10 years and saw 66% reach pain-free status in 4 weeks. Duration is not destiny. The Ashar 2025 5-year follow-up confirmed durability: 55% of PRT patients remained pain-free at 5 years.
Partly, yes, and the imaging proves it. Hashmi 2013 (Brain) showed that as back pain becomes chronic, the representation in the brain shifts from sensory-pain regions to emotional-circuit regions. The brain isn't just receiving pain signals from the back. It's generating an experience that uses different circuits over time. The Ashar 2022 fMRI data showed that PRT specifically reduced activation in the anterior midcingulate cortex, the anterior prefrontal cortex, and the anterior insula. Treatment changed how the brain processed pain signals, and the patients felt the difference.
In the Ashar 2022 trial in JAMA Psychiatry, 66% of chronic back pain patients were pain-free or nearly pain-free at 4 weeks. 98% showed some improvement. 5-year follow-up: 55% remained pain-free. Effect sizes were the largest reported for any psychological treatment of chronic pain. In broader use outside the trial, response rates likely run somewhat lower (35% to 50% substantial improvement is the realistic frame for the average patient), because the trial selected for primary chronic back pain without active disease. For chronic back pain that fits the central sensitization profile, PRT has the best evidence base in the field.
Related Reading
References
- Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23. PubMed
- Ashar YK, Gordon A, Wager TD, et al. Long-term Pain Outcomes Following Pain Reprocessing Therapy: 5-Year Follow-up of a Randomized Clinical Trial. JAMA Psychiatry. 2025. DOI
- Ashar YK, Lumley MA, Perlis RH, et al. Reattribution to mind-brain processes and recovery from chronic back pain: a secondary analysis of a randomized clinical trial. JAMA Network Open. 2023;6(9):e2333846. PubMed
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015;36(4):811-816. PubMed
- Jensen MC, Brant-Zawadzki MN, Obuchowski N, Modic MT, Malkasian D, Ross JS. Magnetic resonance imaging of the lumbar spine in people without back pain. New England Journal of Medicine. 1994;331(2):69-73. PubMed
- Boos N, Rieder R, Schade V, et al. 1995 Volvo Award in clinical sciences. The diagnostic accuracy of magnetic resonance imaging, work perception, and psychosocial factors in identifying symptomatic disc herniations. Spine. 1995;20(24):2613-2625. PubMed
- Carragee E, Alamin T, Cheng I, Franklin T, van den Haak E, Hurwitz E. Are first-time episodes of serious LBP associated with new MRI findings? Spine Journal. 2006;6(6):624-635. PubMed
- Carragee EJ, Alamin TF, Miller JL, Carragee JM. Discographic, MRI and psychosocial determinants of low back pain disability and remission: a prospective study in subjects with benign persistent back pain. Spine Journal. 2005;5(1):24-35. PubMed
- Mannion AF, Elfering A. Predictors of surgical outcome and their assessment. European Spine Journal. 2006;15(Suppl 1):S93-S108. PubMed
- Rajasekaran S, Dilip Chand Raja S, Pushpa BT, Ananda KB, Ajoy Prasad S, Rishi MK. The catastrophization effects of an MRI report on the patient and surgeon and the benefits of 'clinical reporting': results from an RCT and blinded trials. European Spine Journal. 2021;30(7):2069-2081. PubMed
- Webster BS, Cifuentes M. Relationship of early magnetic resonance imaging for work-related acute low back pain with disability and medical utilization outcomes. Journal of Occupational and Environmental Medicine. 2010;52(9):900-907. PubMed
- Pinto RZ, Maher CG, Ferreira ML, et al. Epidural corticosteroid injections in the management of sciatica: a systematic review and meta-analysis. Annals of Internal Medicine. 2012;157(12):865-877. PubMed
- Weinstein JN, Tosteson TD, Lurie JD, et al. Surgical vs nonoperative treatment for lumbar disk herniation: the Spine Patient Outcomes Research Trial (SPORT) randomized trial. JAMA. 2006;296(20):2441-2450. PubMed
- Burger AJ, Lumley MA, Carty JN, et al. The effects of a novel psychological attribution and emotional awareness and expression therapy for chronic musculoskeletal pain: a preliminary, uncontrolled trial. Journal of Psychosomatic Research. 2016;81:1-8. PubMed
- Yarns BC, Cassidy JT, Jimenez AM. At the intersection of anger, chronic pain, and the brain: a mini-review. Neuroscience and Biobehavioral Reviews. 2024. PubMed
- Donnino MW, Thompson GS, Mehta S, et al. Psychophysiologic Symptom Relief Therapy for Chronic Back Pain: A Pilot Randomized Controlled Trial. Pain Reports. 2021;6(3):e959. PubMed
- Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review of the literature. Physiotherapy Theory and Practice. 2016;32(5):332-355. PubMed
- Hashmi JA, Baliki MN, Huang L, et al. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 2013;136(Pt 9):2751-2768. PubMed
Medical Disclaimer: This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider about your specific condition. Pain is real regardless of its source. Neuroplastic pain is a legitimate medical phenomenon, not a suggestion that pain is imaginary. If you are in crisis, contact FindAHelpline.com for immediate support.