Neuroplasticity and Chronic Pain Pathways in Low Backache

Chronic low back pain is increasingly understood as a disorder of maladaptive neuroplasticity rather than a purely structural condition. Persistent nociceptive input induces peripheral sensitization, spinal cord changes, and central sensitization, leading to amplified pain perception. Supraspinal reorganization, including altered cortical mapping and enhanced activity in affective-emotional circuits, further sustains pain independent of tissue pathology. Cognitive and psychological factors such as fear and catastrophizing contribute to pain persistence through top-down modulation. These mechanisms explain the frequent discordance between imaging findings and symptom severity. A neurobiological approach to low back pain is essential for developing effective, multidisciplinary treatment strategies targeting both peripheral and central pathways.