Research shows most chronic neck & back pain is non-structural or nociplastic pain

A recent 2023 study authored by Dr. Howard Schubiner in the Journal of Pain  assessed 222 chronic low back and neck pain patients in a primary care clinic. A physician was trained to diagnose for structural nociceptive or neuropathic casues (clear peripheral etiology) vs non-structural (nociplastic or neuroplastic) causes to the symptoms. What they found was although almost all patients (97.7%) had at least 1 spinal anomaly on imaging, the diagnostic approach estimated that 88.3% of patients had nociplastic or neuroplastic non-structural pain, 5.0% had nociceptive or neuropathic structurally produced pain, and 6.8% had mixed pain. So the overwhelming majority of these 222 chronic neck and back pain patients did not have a structurally driven pain issue.

Futhermore patients with nociplastic or neuroplastic non-structural pain were more likely than the other 2 groups of patients (combined as “non-primary pain”) to report certain functional conditions, central sensitization, and features such as sensitivity to light touch, spreading pain, and pain worsening with stress. Dr. Schubiner and the researchers state ‘the potential for better outcomes if patients are offered pain neuroscience education and several emerging psychological therapies.’

Once we can rule out structural causes in chronic neck and back pain, we can rule in the brain and nervous system as the main culprit in causing the symptoms. We can then shift our attention and focus away from treating the back or neck to focusing on strategies that target the central and autonomic nervous system from a psychological and emotional perspective.