According to the World Health Organization, low back pain is the most prevalent chronic pain condition and the leading cause of disability worldwide. In 2020, low back pain affected 619 million people globally.[1]
Low back pain (LBP) describes pain between the lower edge of the ribs and the buttock, and it can be acute (short-term) or chronic. Chronic low back pain (cLBP) is defined by pain that lasts more than 3 months. Chronic pain tends to have ongoing adverse effects on mental and emotional well-being, as well as overall quality of life. It can limit work and recreational activities, as well as engagement with family and friends.
Chronic low back pain can be specific or non-specific. Specific cLBP is pain caused by a particular disease or structural issue related to the spine, or when the pain radiates from another part of the body to that area. Non-specific cLBP is when no disease or structural reason to explain the pain can be identified. Importantly, cLBP is non-specific in approximately 90% of cases. Yet treatments for cLBP—and non-specific cLBP in particular—often fail to provide significant relief.
The Connection Between Chronic Pain and Sense of Self
Pain signals originate in the brain, but research has only recently begun to identify its specific neural circuitry. The Default Mode Network (DMN) is a grouping of interconnected regions of the frontal, parietal, and temporal lobes of the brain that becomes active when we are thinking about ourselves and our identity or reflecting on internal thoughts and feelings—rather than focusing on the outside world. It’s thought to be involved in building and maintaining a coherent sense of self, and, as such, it is connected to identity formation, self-reflection, and internal narrative.[2]
Ordinarily, the DMN (also known as the “self network”) effectively shuts down when a person focuses on an external stimulus or task. However, for people afflicted with chronic pain, the DMN fails to deactivate, meaning the brain is continuously engaged with internal distress and self-monitoring.[3] This activity in the DMN helps explain why chronic pain is rarely just a physical sensation.
A newly published study in the British Journal of Anaesthesia further demonstrates why typical symptom-based approaches to chronic pain are often ineffective and suggests that targeting the DMN may be a better way to treat cLBP.[4] Researchers at UC San Diego School of Medicine studied 114 cLBP patients while they performed a standard leg raise test to intentionally precipitate a spike in back pain while they measured blood flow in the brain using a specialized functional MRI technique. As a control, they also tested how the same patients’ brains responded to a painful but harmless heat stimulus to the calf, comparable to touching a hot stove.
The results indicated that movement-generated pain associated with chronic pain activated the DMN—providing evidence that the experience of chronic pain is embedded in the sense of self, with consequent effects on one’s identity. In contrast, when the participants were subjected to the painful sensation of heat, their DMN shut down—consistent with the brain’s usual response to acute pain, allowing the brain to focus entirely on the external threat.
This study provides neuroscientific evidence of how, under the influence of cLBP, present moment experience is soiled, not only by the feeling of pain, but by rumination and rapid-fire catastrophizing cognitions that drive repetitive, negative thought loops, such as “Will this pain ever stop?” “What if it gets worse?” “How will it affect my plans today?” and “What does this say about who I am?” The deviation-amplifying dynamic precipitates emotional dysregulation, most often in the forms of anxiety and depression, escalates the suffering attached to the pain signal, and completes the vicious circle by exacerbating the subjective intensity of the pain.
Implications for Treatment
These results suggest that treatment approaches that help people separate the physical experience of chronic pain from their sense of self can lead to reductions to pain intensity and may well be more effective than traditional symptom-based approaches. Such approaches include mindfulness and psychedelic-assisted treatment whose mechanisms of action impact the mind-body-spirit continuum.
Mindfulness is a range of techniques focused on cultivating radical acceptance and non-judgmental awareness of internal and external present-moment experience that considerable research shows can measurably reduce the subjective experience of pain. Psychedelics such as psilocybin are known to alter thought processes by loosening rigid, repetitive thought patterns, expanding perspectives, and inspiring spiritual experiences—including creating or deepening a sense of connection with what is beyond the self. Although the specific mechanisms of psychedelic-assisted treatments remain uncertain, the action of these substances seems to enhance neuroplasticity, altering neural pathways, cognition, affect, and behavior—in ways that increase psychological flexibility.
Chronic Pain Essential Reads
All of this points toward the value of fundamentally shifting the direction of chronic pain interventions—from attempting to eliminate the pain (which is generally unrealistic) to helping people change their relationship to their pain. When this can be accomplished in ways that separate the experience of pain from one’s personal identity, it can dramatically decrease mental-emotional-spiritual suffering and meaningfully improve quality of life.
Copyright 2026 Dan Mager, MSW, LCSW
