26/02/2026
Chronic back pain is often blamed on discs, joints, or alignment.
But imaging findings frequently correlate poorly with pain severity.
Structure does not always equal suffering.
Some people show significant degeneration with minimal pain.
Others show minor structural change with severe pain.
The difference is often neuroinflammatory sensitization — also known as central sensitization.
Inside the spinal cord, microglia — the resident immune cells of the central nervous system — constantly monitor neural activity.
During acute injury, their activation is protective.
The problem begins when that activation fails to resolve.
In chronic pain states, spinal microglia shift from surveillance into persistent activation.
They release cytokines such as Interleukin-1 beta and Tumor Necrosis Factor alpha — along with brain-derived neurotrophic factor.
These signals alter the dorsal horn — the relay center for pain transmission.
Inhibitory signaling declines.
Excitatory glutamate signaling increases.
The brakes weaken.
The accelerator stays pressed.
Pain circuits become hypersensitive.
The tissue may have healed.
The signaling has not.
This is why chronic pain can persist long after the original structural injury has resolved.
It becomes a central nervous system signaling disorder.
Shifting that terrain means lowering neuroinflammatory tone and restoring inhibitory balance:
• Consistent sleep limits central cytokine signaling and supports glymphatic clearance. Sleep disruption is one of the strongest drivers of pain hypersensitivity.
• Moderate aerobic movement reduces microglial activation and helps recalibrate sensitized pain circuits.
• Omega-3 fatty acids provide substrates for specialized pro-resolving mediators — molecules that actively terminate inflammation within the nervous system.
• Magnesium acts as a voltage-dependent gatekeeper at NMDA receptors, limiting excessive calcium influx and dampening spinal neuronal hyperactivation. In central sensitization, inadequate magnesium lowers the threshold for excitatory firing. Forms such as magnesium glycinate may also support inhibitory tone and sleep — reinforcing two key regulators of neuroinflammatory resolution.
• Stress regulation lowers sympathetic-driven microglial activation.
Structural repair matters.
But so does immune resolution inside the spinal cord.
Chronic back pain is often a failure of resolution — not simply a failure of structure.
And resolution biology is achievable with treatment.
We often see in clinic people with a high degree of pain because their bodies have compromised nerve or joint funtion. The body learns to only feels pain signals. We regulate these signals so that the body starts recognising sensation rather than pain and then once painfree we help you build strength and resilience.
Phone for an appointment
027 420 0771