Unexpected discovery: neuroscientists at UC San Diego have found that movement-triggered chronic back pain can switch on the brain’s “self network,” suggesting that a pain flare may become woven into a person’s sense of identity rather than remaining a purely sensory signal.
The finding comes from an observational brain-imaging study of 114 adults with chronic low back pain, published on October 5 in the British Journal of Anaesthesia. Researchers used arterial-spin-labeling functional MRI while participants underwent a leg-raise test designed to provoke their familiar movement-related back pain. They compared that response with a separate painful heat stimulus applied to the calf.
The contrast was striking. Acute heat pain produced the expected pattern: the default mode network, or DMN, became less active as attention shifted toward an external threat. Movement-triggered chronic pain did the opposite. The DMN became more active, even though this network is usually associated with self-reflection, autobiographical thinking, internal narrative and the sense of “me.”
That is why the researchers describe the result as evidence that chronic pain can become deeply self-referential. Participants with more severe chronic back pain also showed stronger communication between the DMN and the primary somatosensory cortex, the region that processes bodily sensation from the back. The more intense the provoked pain, the more activity appeared in sensory and motor regions, while heart-rate changes tracked the severity of the flare.
This does not mean chronic pain is imaginary or “all in the mind.” The opposite interpretation is more accurate: the study suggests that a real physical pain state can become integrated with brain systems that maintain identity, memory, anticipation and emotional meaning. A flare is therefore not only a moment of nociception. It can arrive carrying memories of previous episodes, fear of movement, expectations about what comes next and the accumulated frustration of living around pain.
Corresponding author Fadel Zeidan and his colleagues argue that this distinction may help explain why treatments aimed only at suppressing symptoms often fail to fully resolve chronic pain. If a flare recruits self-referential brain systems, then the clinical problem may involve not only reducing nociceptive input but also changing how the brain relates that input to the self.
That is where mindfulness becomes especially relevant. Earlier work from Zeidan’s group found that mindfulness meditation can reduce pain while weakening communication between sensory pathways and parts of the default mode network involved in self-referential processing. In that framework, the sensation may still be present, but the brain may attach less ownership, narrative and emotional suffering to it.
The new study also points toward psychedelic research as another possible route for investigating self-related pain processing. UC San Diego researchers note that psilocybin is being studied for its ability to alter rigid self-referential brain patterns. That idea overlaps with another recent finding covered by Templum Dianae: psilocybin can reorganize brain activity in ways associated with unity and reduced separation between self and world.
The philosophical implication is subtle but important. Pain is normally treated as something that happens to the self. In chronic conditions, the brain may begin to encode the experience as something that says something about the self: what the body can do, what the future will contain, what activities are dangerous and even who the person has become. That distinction is closely related to contemplative traditions that train practitioners to observe sensations without making them the center of identity.
But the researchers are careful not to claim that meditation or psychedelics are simple cures. The present study is observational and does not test whether changing DMN activity directly cures chronic back pain. It identifies a neural pattern associated with movement-evoked pain and suggests a target for future clinical trials. Treatments that alter self-referential processing still need to be tested rigorously for effectiveness, durability and safety.
The most important result may therefore be conceptual. Chronic pain can be simultaneously physical, neural and autobiographical. The brain does not merely register a signal from the body; over time it may integrate that signal into the system that constructs the ongoing story of the self. Understanding that process could open a different class of treatments—ones aimed not only at reducing pain, but at loosening the bond between pain and identity.
References
https://www.bjanaesthesia.org/article/S0007-0912%2826%2900608-2/fulltext
https://today.ucsd.edu/story/uc-san-diego-researchers-discover-why-chronic-low-back-pain-feels-personal
https://today.ucsd.edu/story/mindfulness-meditation-reduces-pain-by-separating-it-from-the-self