Long-lasting back pain does not stay confined to one part of the body. On painful days, plans for the day change, and people find themselves weighing up what they can and cannot do. A research team at the UC San Diego School of Medicine has offered a clue to how this experience manifests in the brain. When people with chronic low back pain move and their pain surges, the brain network used when thinking about oneself lights up. The findings were published on 5 October in the international journal British Journal of Anaesthesia.
Just lifting a leg was enough to activate the self-network in the brains of 114 people
The research team recruited 114 adults who had experienced back pain for more than 12 weeks. Participants were asked to lift a leg, a standard way of deliberately provoking back pain. While they did so, the researchers measured blood flow in the brain using arterial spin labelling, a form of functional magnetic resonance imaging (fMRI).
When movement triggered pain, the brain’s default mode network (DMN) became active. This network is a circuit linking several areas of the frontal, parietal and temporal lobes, and is active when we think about ourselves. That is why the researchers call it the self-network. The more severe the pain, the stronger the connections between this network and the primary somatosensory cortex. The more pain participants felt while lifting a leg, the greater the activity in sensory and motor regions; the rise in heart rate during the test also provided an indication of how sharply the pain surged.
It switched off in response to heat, but lit up with back pain
The team also ran a comparison experiment. When they applied a painful but harmless heat stimulus to the same participants’ calves, the default mode network switched off. This is the familiar response of the brain to sudden pain.
Corresponding author Professor Fadel Zeidan said the study was the first to show that, whereas the network had switched off whenever pain was felt in every previous pain study, it instead lit up when people with chronic low back pain experienced a surge in pain. The research team interpreted this as the brain wrongly linking physical pain with a deep sense of self in chronic low back pain. Professor Zeidan said that current pain medicine focused solely on eliminating symptoms, even though they were not the root of chronic pain.
Mindfulness was not tested in this study
This study observed brain responses. It did not test whether mindfulness meditation changes them. A university press release referred to separate preliminary studies by the research team, saying that mindfulness meditation and psilocybin may help reduce pain intensity by separating the experience of pain from a person’s sense of identity. Professor Zeidan described mindfulness as a meditation technique that develops the ability to notice the present moment without judgement. The press release also made clear that these findings are preliminary and need further investigation. Professor Zeidan’s laboratory is conducting several brain imaging-based clinical trials. Psilocybin is a substance regulated as a narcotic in South Korea.
Evidence from a clinical trial of 342 people a decade ago
This is not the first study to examine mindfulness alongside back pain. A notable example is a joint study by the US Group Health Research Institute and the University of Washington, published in the Journal of the American Medical Association (JAMA) in 2016. The research team randomly assigned 342 people aged 20–70 with chronic low back pain to mindfulness-based stress reduction (MBSR), cognitive behavioural therapy or usual care. The two programmes ran for eight weeks, with one two-hour session each week.
After 26 weeks, the proportion of participants whose everyday functioning had improved meaningfully was 61% in the MBSR group, 58% in the cognitive behavioural therapy group and 44% in the usual-care group. The effects had not diminished substantially a year later. The researchers rated the size of the effect as moderate. This means mindfulness is not a treatment that eliminates pain, but one option that may be considered alongside existing care.
Rather than eliminate pain, create distance between yourself and it
For people who meditate, the message of this study is that it offers a clue to explaining, in the language of the brain, why it matters to practise not treating pain and oneself as one and the same. For people living with long-term pain, pain can become more than a sensation; it can easily turn into a story about being a person who is in pain. Practising taking a little distance from that story is central to mindfulness.
For someone with back pain, sitting in meditation for a long time may be a burden. For modern people whose lives have become increasingly sedentary, approaches that follow bodily sensations—such as a body scan while lying down, walking meditation at a slow pace, or gentle movements in time with the breath—can offer an accessible starting point. The right approach varies from person to person, and if pain is severe or long-lasting, consulting a healthcare professional first is the right order of things. Meditation is not a substitute for treatment. But it can be a way to make time for self-care in a day lived alongside pain.
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