Randy Shelerud, M.D., Mayo Clinic specialist in physical medicine and rehabilitation

To understand chronic low back pain, one needs to look at the pain pathways within the spinal cord, which connects from the low back to the brain itself. When a structure in the low back causes pain, those pain signals go along a nerve that connect to the spinal cord and several pain pathways that link up to the brain. Those pain pathways are influenced by literally millions of nerve cells that we refer to as interneurons and this brilliantly complex system then can influence those pain signals as they travel to the brain. We know that in some cases that pain signal gets ramped up as it gets to the brain and continues to send a constant signal of pain to the brain, despite the fact that the structure in the low back that caused the pain to begin with may have fully healed. So in other words, there is an imprint of that pain that occurs on the central nervous system, and chronic back pain, therefore, is thought to be a central nervous system process at that point.

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