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BOTTOM-UP
Back
Just like learning a musical instrument, if you were to practice every day, you will likely get better. What is actually happening is that your nervous system is changing in response to repeated stimulus (see Neuroplasticity).(4) Unfortunately, chronic pain is very similar. The longer that you have pain, the better you get at perceiving pain...even after the peripheral tissues have healed.(5)
Prolonged exposure to painful stimuli from the periphery (arms, legs, or spine) can lead to changes within parts of the nervous system responsible perceiving pain. These central neuroplastic changes result in an increased sensitivity of pain neurons to normal sensory input (sitting, standing, or walking).
Explaining Back Pain
What about my MRI???
Addressing underlying peripheral pain generators can help reduce bottom-up nociplastic pain to a certain degree. If you do not respond with meaningful and lasting relief from peripherally focused treatments (massage, spinal manipulation, injections, or surgery), then you likely have more of a Top-Down nociplastic pain condition. Peripheral treatments are worth a try, but if they are going to work, you will know after a short course. These treatments tend to work best for focal acute pain (less than 3 months), but there are inconsistent results in people with Bottom-Up or Top-Down nociplastic pain amplification.
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