Back pain is often viewed as a purely mechanical issue, something caused by strain, posture, or injury. Yet pain does not originate in the spine alone. It is created, interpreted, and modulated by the brain and spinal cord, collectively known as the Central Nervous System (CNS). Dr. Larry Davidson, a board-certified neurosurgeon with fellowship training in complex spinal surgery, explains that stress can alter how this system processes pain signals. When the brain remains on high alert, nerve pathways become overactive, making normal sensations feel painful and pain feel overwhelming.
Understanding this process changes how both patients and clinicians approach spinal care. Treating the physical structure is important, but so is calming the neural network that controls pain perception. The CNS acts as both the messenger and the amplifier. When stress interferes, that amplification can keep discomfort alive long after the body has healed.
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How the Central Nervous System Interprets Pain
Pain begins with nerve endings called nociceptors that detect potential damage in muscles, joints, or tissues. These signals travel through the spinal cord to the brain, where they are analyzed and given meaning. The brain determines whether the signal indicates danger and decides how strongly to react.
Under normal conditions, this system is precise. It helps protect the body while allowing it to function without unnecessary alarm. But chronic stress disrupts this balance. The brain becomes hypervigilant, treating routine sensations, like mild pressure or movement, as threats. This process, known as central sensitization, can cause pain to persist even after the original injury has resolved.
Stress and the Brain’s Pain Pathways
Stress triggers the release of cortisol and adrenaline, preparing the body for action. These hormones activate the sympathetic nervous system, heightening awareness and muscle readiness. In short bursts, this response is protective. When stress becomes chronic, the same chemistry turns against the body.
Elevated cortisol changes how nerve cells in the spinal cord and brain communicate. Neurons that normally quiet pain become less effective, while those that amplify pain grow more active. The result is a nervous system that misreads harmless signals as painful. Patients often describe this as a “flare-up” that seems to come from nowhere.
The Emotional Layer of Pain
Pain is not experienced in isolation, it is intertwined with emotion and memory. The brain regions responsible for processing pain, including the amygdala and anterior cingulate cortex, also manage mood and stress responses. When a person feels anxious or overwhelmed, these same areas become more active, magnifying pain sensations.
Emotional distress further reinforces pain by changing attention and focus. The more the mind fixates on discomfort, the more intense it feels. This feedback loop is why chronic pain often leads to irritability, sleep problems, and fatigue. The nervous system’s constant state of arousal leaves little room for recovery.
When the Spine and Nervous System Work Against Each Other
For patients recovering from spinal injury or surgery, the CNS plays a major role in recovery outcomes. Even when structural healing progresses well, heightened neural activity can make pain feel worse than it appears on imaging. This disconnect often frustrates patients who expect pain to fade once tissue repair is complete.
Dr. Larry Davidson points out, “Chronic pain and stress can have a profound impact on both mental health and physical activity levels. When someone is living with constant pain, it often leads to depression, reduced motivation and decreased activity, all of which can further compromise spine health.” His observation underscores how persistent stress not only increases pain perception but also discourages movement, which is essential for spinal recovery and strength.
The Science Behind Increased Sensitivity
Central sensitization occurs when neurons in the spinal cord and brain remain excited for too long. This overactivity creates “memory” of pain in the nervous system. Even small triggers, like bending, twisting, or emotional distress, can reactivate the same neural circuits, recreating pain without new injury.
Researchers have identified biochemical changes that accompany this process. Excess cortisol and inflammatory molecules such as cytokines alter the way nerve cells respond to stimulation. Over time, this creates a lowered pain threshold: stimuli that were once harmless now feel sharp or burning.
Breaking the Cycle: Calming the Nervous System
Reversing stress-related hypersensitivity begins with teaching the body to return to a state of rest. Mind-body techniques such as deep breathing, meditation, or progressive muscle relaxation activate the parasympathetic nervous system, which helps counterbalance stress hormones. Movement plays an equally important role. Gentle physical activity, walking, swimming, or yoga, encourages blood flow and releases endorphins, the body’s natural pain-relieving chemicals. Consistent motion tells the nervous system that it is safe to relax and reduces fear-based avoidance behaviors.
Sleep hygiene is critical for neural repair. Establishing consistent sleep and wake times, limiting caffeine, and reducing blue-light exposure before bed help restore the circadian rhythm that regulates cortisol release. When sleep improves, the nervous system regains its ability to dampen excessive pain signals. In clinical settings, multidisciplinary care often yields the best outcomes. Combining physical therapy with psychological support, such as Cognitive Behavioral Therapy (CBT) or Mindfulness-Based Stress Reduction (MBSR), helps retrain both the body and brain. These approaches teach patients how to interrupt catastrophic thoughts and reframe their perception of pain.
Understanding Pain as Communication, Not Punishment
Pain, at its core, is a signal, a form of communication from the body that something needs attention. When stress interferes with this system, the message becomes distorted. The body may continue to send warnings long after danger has passed, not because damage remains, but because the nervous system has forgotten how to turn the alarm off.
Recognizing this distinction is empowering. It reframes pain from a life sentence to a reversible condition rooted in the brain’s adaptability. Patients who understand the role of the CNS can work with their care teams to calm the system, rebuild trust in movement, and reduce the dominance of pain in daily life. Healing involves more than correcting anatomy, it involves retraining how the brain interprets pain. When stress management, movement, and medical care work together, the nervous system can regain balance. The result is not just pain relief, but restoration of confidence and quality of life.
