203: Pain Neuroscience Rehabilitation in Low Back Pain: Chronification and Central Amplification

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Physiotherapy (e.g. exercise, rehab), Epidemiology

Background and Aims: Low back pain (LBP) is the leading cause of disability worldwide and often progresses to chronic pain. Although early LBP is mainly nociceptive, persistent symptoms may involve neuropathic features, nociplastic pain, and central sensitization driven by altered pain modulation and impaired descending inhibitory pathways (1). Repeated nociceptive input can promote pain chronification through neuroinflammation, neuroplastic changes, and central nervous system reorganization (2). These mechanisms contribute to central pain amplification, characterized by heightened neuronal excitability and disproportionate pain perception (3). Pain neuroscience–informed rehabilitation aims to reduce peripheral nociceptive input while restoring adaptive central pain modulation.

Methods: We conducted a retrospective registry-based analysis using rehabilitation service records from 2024–2025. Adults with low back pain (n=215) were included. Data collected included age, pain duration (acute vs chronic), pain characteristics, and underlying clinical etiologies.
Patients underwent multimodal rehabilitation combining therapeutic exercise (flexibility, stabilization, strengthening, breathing, and postural training), physical modalities (TENS, shortwave diathermy, and low-level laser therapy), orthotic support when needed, and pharmacologic therapy. These interventions aim to reduce peripheral nociceptive input while supporting central pain modulation. Treatment response was evaluated through documented pain reduction and functional improvement, with outcomes compared according to pain chronicity and etiology.

Results: Multimodal rehabilitation led to meaningful clinical improvement in most patients. Individuals with acute low back pain improved more rapidly than those with chronic symptoms. In contrast, chronic cases more often showed persistent pain patterns consistent with central sensitization and central pain amplification. Patients with degenerative changes or spinal canal–related conditions tended to recover more slowly than those with mechanical causes. Despite these differences, many patients reported reduced pain frequency, improved mobility, and better tolerance for daily activities. Overall, 62.3% experienced significant improvement, while 36.7% achieved partial improvement following rehabilitation.

Conclusions: Pain neuroscience–informed multimodal rehabilitation can meaningfully improve low back pain by addressing both peripheral nociceptive drivers and neuropathic pain mechanisms. Patients with chronic or degenerative conditions may respond more slowly, likely reflecting pain chronification and central pain amplification linked to altered central pain processing (4). These findings highlight the importance of looking beyond structural causes and considering how the nervous system adapts to persistent pain. Incorporating rehabilitation strategies that support central pain modulation may enhance recovery, improve function, and help prevent the progression of low back pain into long-term disabling pain.

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3. Opara, J. A., Saulicz, E., Szczygieł, J. W., & Szczygieł, K. 2025. Is the Central Sensitization in Chronic Nonspecific Low Back Pain Structural Phenomenon or Psychological Reaction? A Narrative Review. Journal of Clinical Medicine, 14(2), 577. https://doi.org/10.3390/jcm14020577.
4. Sheenam N, Gaur R, Gonnade NM, Abins TK, Ghosh A, Hussain R. 2025. Central sensitisation in chronic low back pain: A cross-sectional study. Indian J Anaesth. 2025 Oct;69(10):1033-1038. doi: 10.4103/ija.ija_433_25. Epub 2025 Sep 5. PMID: 40979767; PMCID: PMC12445777.

Presenting Author: Nanda Aulya Ramadhan
Submitting Author: Nanda Aulya Ramadhan

Senior Author: Nanda Aulya Ramadhan

IASP 2026 Global Year theme of Neuropathic Pain: Yes