If you’ve experienced low back pain, you know it can be debilitating. But what happens when that initial injury—a sudden strain, a tweak while lifting- heals, yet the pain remains? This shift, where pain lingers for months or even years, is the difference between acute and chronic pain, and it’s a critical distinction to understand.
Here at Specialist Pain International, we see countless patients frustrated by persistent back pain. The biggest mistake people make is ignoring the underlying reasons why the pain signal keeps firing long after the tissue has recovered.
Let’s dive into the core causes of chronic back pain that you should never overlook.
The Critical Shift: Acute Pain vs. Chronic Pain
To begin, we need a clear definition.
- Acute Pain: This is normal. It’s a warning signal, lasting up to three months, directly related to tissue damage (like a muscle strain or a slipped disc). Once the injury heals, the pain resolves.
- Chronic Pain: This is persistent pain lasting longer than three months. Crucially, chronic pain often becomes less about the initial injury and more about a change in how your nervous system processes pain signals.
When back pain becomes chronic, it means your body’s alarm system is stuck on high alert.
Cause 1: Central Sensitisation (The Nervous System on Overdrive)
This is the most medically significant, yet least understood, factor. Think of your nervous system as a security system. In chronic pain, the system’s sensitivity dial has been turned all the way up.
What happens:
- Nerve Rewiring: Persistent pain signals cause changes in the spinal cord and brain. Nerves become “primed” and require less stimulation to fire a pain message.
- Pain Without Damage: As a result, even normal, non-threatening movements (like bending over or sitting for too long) can be interpreted by the brain as dangerous, triggering real, intense pain—even if there is no ongoing tissue damage.
This isn’t “all in your head.” This is a genuine, measurable neurobiological change that requires specialised, comprehensive treatment to re-educate the nervous system.
Cause 2: Untreated Structural and Degenerative Issues
While not always the primary driver of chronicity, certain long-term structural issues can contribute significantly if left unaddressed.
Degenerative Disc Disease (DDD)
The discs between your vertebrae naturally wear down over time. While ageing is inevitable, if DDD leads to instability, inflammation, or puts pressure on nerves, it creates a constant source of low-level irritation that prevents the system from calming down.
Spinal Stenosis
This is the narrowing of the spaces within your spine, which can compress the nerves travelling through it. This pressure can cause persistent, chronic pain, especially when standing or walking.
Spondylolisthesis
A condition where one vertebra slips forward over the one below it. This mechanical instability can lead to chronic muscle guarding and persistent joint irritation.
Cause 3: Emotional, Lifestyle, and Fear Factors
The chronic pain experience is holistic, meaning it involves more than just the physical body. Our actions and mental state can actively prolong the cycle of pain.
Factor: Fear Avoidance
How it contributes: The fear of pain leads to reduced activity. Muscles weaken, joints stiffen, and movement becomes more painful, reinforcing the belief that the back is fragile.
Factor: Poor Sleep
How it contributes: Chronic pain disrupts sleep, and poor sleep lowers your body’s pain threshold, creating a vicious cycle where you feel pain more intensely.
Factor: Stress and Anxiety
How it contributes: Excess weight puts constant mechanical stress on the spine, while a pro-inflammatory diet can increase overall body inflammation, feeding the chronic pain cycle.
Taking Control: When to See a Pain Specialist
If your back pain has persisted for three months or more, it’s time to shift your focus from simply treating an injury to managing a chronic condition.
Dr. Nicholas Chua specialises in identifying and treating the complex factors of chronicity, especially central sensitisation. We utilise a holistic approach that moves beyond simple stretches and temporary fixes.
Don’t ignore these signs that your back pain is becoming chronic:
- Pain that lasts three months or longer.
- Fear of movement has started to limit your daily activities (e.g., you avoid lifting, bending, or exercising).
- The pain feels disproportionate to what the imaging (MRI, X-ray) shows.
- You rely heavily on medication just to get through the day.
At our clinic, we focus on treatments that calm the overactive nervous system, restore functional movement, and address all the biological and lifestyle factors contributing to your persistent pain.
