Brain Changes In Chronic Back Pain Patients

Chronic Back Pain
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David I. Graber, DC, DACBSP

As chiropractors, we have a number of chronic back pain patients under our care. In addition to causing suffering and physical disability, chronic back pain also produces detrimental changes in the brain. Researchers have described these findings:

  • Chronic low back pain (cLBP) is associated with greater brain age over chronological age.
  • Discrepancies between groups for brain age were greatest at older ages.
  • cLBP is associated with decreased cortical thickness in multiple brain areas, and regional changes in gray and white matter.
  • Individuals with cLBP have lower cerebellar gray matter density.
  • Higher brain age was linked with a widespread pattern of lower gray matter density.
  • Brain age may serve as an aggregate measure of holistic gray matter changes.
  • cLBP patients showed increased activation in specific regions, together with a disrupted default mode network.
  • cLBP is linked with deficits in tactile acuity.
  • These changes may be useful for classifying cLBP and monitoring symptom changes clinically.

Treatments for cLBP patients and their effects on brain and neurological activity have also been studied and the following findings are important for chiropractors treating these patients:

  • cLBP-induced changes of the brain are reversible after effective treatment.
  • Significant alterations in brain activity in the default mode network regions of patients with cLBP after SMT treatment have been found.
  • One of the mechanisms of SMT in cLBP patients may be to reduce pain expectancy, fear of movement, and associated brain responses.
  • In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced.
  • SMT may mechanistically act by down regulating the gain of the muscle spindles and/or the various segmental sites of the Ia reflex pathway.


Clark, B.C., Goss, D.A., Walkowski, S. et al. Neurophysiologic effects of spinal manipulation in patients with chronic low back pain. BMC Musculoskelet Disord 12, 170 (2011).

Didehdar, Daryoush & Kamali, Fahimeh & Kordi yoosefinejad, Amin & Lotfi, Mehrzad. (2019). The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial. Irish Journal of Medical Science (1971 -). 189. 10.1007/s11845-019-02140-2.

Ellingsen DM, et al.  Brain Mechanisms of Anticipated Painful Movements and Their Modulation by Manual Therapy in Chronic Low Back Pain. J Pain. 2018 Nov;19(11):1352-1365. doi: 10.1016/j.jpain.2018.05.012.

Kregel J, et al. Structural and functional brain abnormalities in chronic low back pain: A systematic review. Semin Arthritis Rheum. 2015 Oct;45(2):229-37. doi: 10.1016/j.semarthrit.2015.05.002. Epub 2015 May 16. PMID: 26092329.

Kim H, et al. Reduced tactile acuity in chronic low back pain is linked with structural neuroplasticity in primary somatosensory cortex and is modulated by acupuncture therapy. Neuroimage. 2020 Aug 15;217:116899. doi: 10.1016/j.neuroimage.2020.116899. Epub 2020 May 5. PMID: 32380138; PMCID: PMC7395964.

Luchtmann, M., & Firsching, R. (2015). Central plasticity resulting from chronic low back pain in degenerative disorders of the spine. Neural regeneration research, 10(8), 1234–1236.

Seminowicz DA, et al.  Effective treatment of chronic low back pain in humans reverses abnormal brain anatomy and function. J Neurosci. 2011 May 18;31(20):7540-50. doi: 10.1523/JNEUROSCI.5280-10.2011. PMID: 21593339; PMCID: PMC6622603.

Shin-ichi Konno, Miho Sekiguchi. Association between brain and low back pain. Journal of Orthopaedic Science, Volume 23, Issue 1,2018,Pages 3-7,ISSN 0949-2658,

Tan, W., et al. (2020). Spinal Manipulative Therapy Alters Brain Activity in Patients With Chronic Low Back Pain: A Longitudinal Brain fMRI Study. Frontiers in integrative neuroscience14, 534595.

Yu Gary, etal. Accelerated brain aging in chronic low back pain. Brain Research,2021,147263,ISSN 0006-8993.

Zhang B, et al. Identifying brain regions associated with the neuropathology of chronic low back pain: a resting-state amplitude of low-frequency fluctuation study. Br J Anaesth. 2019 Aug;123(2):e303-e311. doi: 10.1016/j.bja.2019.02.021. Epub 2019 Apr 1. PMID: 30948036; PMCID: PMC6676015.

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