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A study of people with chronic lower-back pain found that a movement-triggered pain flare was associated with increased activity in the brain’s default mode network (DMN)—a system involved in self-reflection, autobiographical thought and mind wandering. That result contrasts with the reduced DMN activity typically seen during acute pain. The finding may help explain why a chronic flare can feel closely tied to a person’s sense of their body and self, but it does not yet change treatment or prove that the brain response causes pain.
What the study found
Live Science reported the findings on 14 October 2026, describing an observational brain-imaging study by Gianola and colleagues published in the British Journal of Anaesthesia on 5 October 2026. The study included 114 adults with chronic lower-back pain.
On average, participants reported a 23% increase in pain intensity after researchers provoked a flare by moving one leg. Functional MRI (fMRI) scans taken before and after the movement showed increased activity in the DMN. The scans measure changes in blood flow, which are used as an indirect indicator of brain activity rather than a direct recording of individual neurons.
The result surprised the investigators. Neuroscientist Fadel Zeidan of the University of California, San Diego, said, “We did not expect [the default mode network] to be involved at all,” adding that the team expected the network to be deactivated enough that they had to “triple-check our work to make sure that the results were legit.”
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How researchers provoked and measured a flare
- Researchers obtained an fMRI scan before the pain provocation.
- A researcher lifted a participant’s leg until the person reported that their back pain had increased.
- The leg was held in that position for 10 seconds and then lowered.
- Participants underwent another fMRI scan after the movement, while researchers recorded the change in reported pain.
- Researchers also applied painful heat to the calves as an acute-pain comparison.
The movement procedure was intended to produce the kind of flare associated with chronic back pain, rather than a brief pain signal from an unrelated stimulus. Katherine Martucci, a Duke University neuroscientist who was not involved in the work, said the design “nicely gets around” the problem that movement can make fMRI measurements harder to interpret. She said the imaging provides “solid data on how people with chronic low back pain show important changes in their brain responses after a condition provoking their pain” and visibly validates participants’ experience.
Why default mode network activity was unexpected
The DMN is commonly active during inward-directed mental activity, including self-reflection, autobiographical memories and mind wandering. Acute pain, by contrast, is generally associated with reduced activity in at least part of this network. In this study, painful heat to the calves produced that more familiar reduction, while the movement-induced back-pain flare was linked with increased DMN activity.
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| Comparison | Movement-evoked chronic back-pain flare | Acute heat pain |
|---|---|---|
| Trigger and time course | Leg raised until chronic back pain increased, held for 10 seconds, then lowered; scans followed the provocation. | Painful heat applied to the calves as a short-term experimental stimulus. |
| DMN response | Increased activity after the flare. | Reduced activity in part of the DMN. |
| Self-related processing | Consistent with stronger involvement of a network used for self-related thought. | More consistent with the usual acute-pain pattern; the study did not identify the same self-related association. |
| Causal conclusion | Shows an association between a flare and brain activity; it does not show that DMN activity causes chronic pain. | Provides a comparison condition, not proof of a different disease mechanism. |
What stronger connectivity may mean
Participants with more severe chronic back pain showed stronger connectivity between the DMN and brain regions that process sensations from the back. Connectivity describes coordinated activity between regions; it does not mean that one region is sending a confirmed pain signal to another.
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The authors interpreted the pattern as evidence that chronic pain may become intertwined with self-related body perception. Zeidan said, “This pain flare has almost become a part of who they are from an egocentric perspective.” In practical terms, a recurring flare may be represented not only as a sensory event but also in networks involved in how a person thinks about their own body and experiences. The study cannot establish whether that altered pattern develops because of long-term pain, helps maintain pain, or reflects another factor.
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Why movement might trigger your flare
This experiment shows that a specific leg movement can increase reported back pain and is followed by a distinctive brain response, but it does not explain why movement triggers pain in any particular individual. The scan was collected after the painful movement, so lingering pain, anticipation or anxiety could have contributed to the observed DMN activity. The findings therefore should not be used to infer that movement is harmful, that the pain is psychological, or that a particular exercise will cause a flare.
Does the finding change treatment?
Not yet. The investigators are studying whether mindfulness meditation or cognitive behavioral therapy can influence the DMN and reduce chronic pain. Cognitive behavioral therapy for chronic pain (CBT-CP) is already an established treatment option, but this study did not test whether CBT-CP changes the DMN or relieves an individual reader’s pain. It also did not show that mindfulness meditation will produce either outcome.
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An outside expert cautioned that it is too early to apply the imaging results directly in clinical practice. The work is best viewed as a possible explanation for how chronic pain and self-related processing can interact, not as a diagnostic scan or a treatment test.
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- The design was observational, so it identifies associations rather than cause and effect.
- fMRI blood-flow changes are an indirect measure of neural activity.
- Scans were collected after the provoked flare; residual pain, stress or anxiety could affect the result.
- The acute comparison used calf heat, while the chronic condition involved movement-evoked back pain, so the stimuli were not identical.
- The findings do not show that every person with chronic back pain has increased DMN activity or that the pattern predicts treatment response.
The main advance is a clearer picture of how the brain responds when an established chronic pain state is reactivated by movement. Whether that response is a cause, consequence or adaptation remains unresolved.
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