Why Your Back Still Hurts: The Modern Neuroscience of Chronic Back Pain (The Pain Science Series)

Still in pain after the scan, the injections, the physio, and maybe even surgery? The problem may not be your spine.If you have been told your back pain is structural, been shown an MRI with findings circled as the source of your suffering, and followed every recommendation that came after it without lasting relief, this book was written for you. Why Your Back Still Hurts is a research-grounded, plainly written guide to what the neuroscience and clinical evidence actually show about chronic back pain and why the structural model that dominates most back pain treatment has been systematically challenged by decades of published research.Drawing on landmark population imaging studies, sham surgery trials, and the growing body of neuroscience evidence, R. V. Langford explains why a disc herniation visible on a scan may have nothing to do with the pain you feel every day, why the words a clinician uses when presenting imaging results have a documented, measurable effect on pain and recovery outcomes, and why the cycle of investigations, injections, and procedures so many people with chronic back pain are caught in is far less evidence-based than patients are typically told.What this book covers:Why population studies consistently find disc degeneration, bulges, and herniations in adults who have no pain at all, and what that means for structural diagnosesHow the language used to describe imaging findings changes pain intensity and recovery expectations, and the research behind that effectWhat central sensitisation is, how the nervous system changes in the presence of persistent pain, and why the spine itself is sometimes not the primary site of the problemWhat the sham surgery trials showed about vertebroplasty and other spinal procedures, and why those findings are not more widely communicated to patientsWhat the evidence actually shows about physiotherapy, spinal injections, surgery, opioids, and multidisciplinary pain programmesWhy the standard ergonomics advice most people receive at work is supported by weaker evidence than the confidence with which it is delivered impliesHow psychosocial factors predict recovery outcomes without this meaning the pain is imagined or psychological in originWhat good, evidence-based back pain care looks like, and the questions worth asking before any procedure is agreed toThis is not a treatment programme. It is an honest, precise account of where the evidence stands and why so many people with chronic back pain have been given an incomplete picture of their own condition. The structural explanation was the clinical consensus for decades and was applied in good faith. This book explains where the research diverged from those assumptions, and why understanding that divergence matters for every person still living with persistent back pain.This book is for you if:You have been given a structural diagnosis such as disc herniation, degenerative disc disease, spinal stenosis, or spondylolisthesis and want to understand what the research actually shows about those findingsYou have been through physiotherapy, injections, or surgery and are still in painYou are currently being recommended a spinal procedure and want to understand the evidence before decidingYou have been told your back pain is chronic and that managing it is the realistic goal, and you want to know whether that conclusion is evidence-basedYou are a clinician, general practitioner, or allied health professional who wants an accessible, accurate summary of the modern back pain evidence base Read more