Back Pain Flares Activate a Brain Network Linked to Self-Identity
Researchers at UC San Diego School of Medicine found that movement-triggered chronic low back pain flares increased activity in the brain’s default mode network, which is associated with identity and inward reflection. In contrast, painful heat reduced activity in that network, suggesting that familiar back pain is processed differently from a new external threat.
The study enrolled 114 adults with chronic low back pain and used a leg-raise task to provoke flares. Brain blood flow was tracked with arterial spin labeling; a harmless heat stimulus on the calf served as an acute-pain comparison.
During movement-triggered flares, the default mode network—regions across frontal, parietal, and temporal lobes tied to self-reflection and memory—became more active. Heat reduced its activity. Worse chronic pain also correlated with stronger coupling between this network and the primary somatosensory cortex.
This finding may affect people with chronic low back pain, a leading cause of disability, by shifting attention from symptom-only relief toward treatments that address how pain becomes tied to self-identity and anticipation. Clinicians and pain researchers could use it to reconsider why opioids and other symptom-focused approaches sometimes fall short. It may also influence how patients interpret flares, potentially reducing fear of movement if brain-based explanations are communicated carefully.