If you've been told your back is "wearing out," or that your nervous system has simply become too sensitive, you've probably landed on one of two explanations that dominate conversations about persistent pain right now: either something is broken in your body, or your brain has started overreacting. Both explanations have some truth in them. Neither tells the whole story.
I want to offer a different way of thinking about pain, one I've come to over more than 25 years of treating people whose pain doesn't add up on a scan, and one grounded in what's often called an ecological-enactive approach to understanding how people actually function.
Where the usual explanations fall short
Here's the starting point: your body never exists on its own. It exists doing something, somewhere: sitting in a car, reaching for a shelf, standing at the sink, picking up a child. A body only really makes sense in relation to a world it's acting in. So if pain is going to be properly understood, it can't just be explained by pointing at tissue (this disc, this tendon) or by pointing at the brain (this pathway, this alarm system). It has to be understood at the level where a person and their world actually meet.
This is why explanations that live entirely inside the body (tissue damage) or entirely inside the brain (a sensitised nervous system) tend to fall short, even where they're partly true. They leave out the actual place where pain plays out: the ongoing, moment-to-moment relationship between you and the situations you're trying to live your life in.
What your world offers you to do
There's a useful idea from psychology for this: the things your surroundings offer you to do are called affordances. A chair affords sitting. A set of stairs affords climbing. A jar affords opening. Which of these possibilities stand out to you, feel inviting, or feel available at any given moment depends on who you are, what state your body is in, and what you've come to expect. Together, that shifting set of possibilities is sometimes called your field of affordances: the live, personal map of what feels doable in your world right now.
What changes when pain becomes persistent
When pain becomes persistent, what changes isn't only a number on a pain scale. It's this field. Actions that used to be unremarkable, sitting through a meeting, driving to see a friend, lifting the shopping, can start to feel closed off, risky, or simply not worth attempting. The chair stops being somewhere you sit without thinking; it becomes something to be managed, negotiated, braced against. That's not you being dramatic, and it isn't a fault in your wiring. It's a body and a world that have stopped fitting together the way they used to.
It also helps explain a few things purely biomedical or purely neurological explanations often struggle with: why the same scan finding can mean nothing to one person and everything to another, why pain can turn up in situations that have nothing to do with the original injury, and why "fixing" a structure doesn't always fix the pain.
Real, and made of more than one ingredient
None of this means your pain isn't real, or that it's "all in your head." It means the opposite: pain is exactly as real as the relationship between you and your world is real, which is to say, completely real, and built from more than one ingredient.
Over the next few weeks I'll build on this idea: what actually changes when someone's field of affordances closes down, why there's rarely a single root cause worth hunting for, and, most importantly, what it genuinely looks like to open that field back up again.