{"id":12853,"date":"2026-04-04T18:25:41","date_gmt":"2026-04-04T16:25:41","guid":{"rendered":"https:\/\/neurohirurgija.in.rs\/?page_id=12853"},"modified":"2026-06-03T19:47:08","modified_gmt":"2026-06-03T17:47:08","slug":"chronic-pain-persistent-factors","status":"publish","type":"page","link":"https:\/\/neurohirurgija.in.rs\/en\/chronic-pain-persistent-factors\/","title":{"rendered":"Chronic Pain \u2014 Factors That Keep Pain Persistent (Often Overlooked)"},"content":{"rendered":"\n
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\n Author:<\/span>\n \n Dr. Zeljko Kojadinovic, MD, PhD\n <\/a>\n \u2014 Consultant Neurosurgeon and Pain Specialist\n <\/div>\n\n
\n Specialized Experience:<\/span>\n 30 years of clinical expertise in neurosurgery.\n <\/div>\n\n
\n Last medically reviewed:<\/span>\n March 08, 2026\n <\/div>\n<\/div>\n\n\n\n
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Who This Chronic Pain Page Is For<\/h3>\n <\/div>\n\n

\n This page is intended for patients with chronic pain<\/strong> (such as low back pain, neuralgia, neck pain, or post-surgical pain) in whom symptoms have persisted despite treatment, and where the exact cause of pain has not been clearly identified. In many cases, the true source of pain lies in underlying processes within joints, ligaments, muscles, fascia, or nerves \u2014 such as inflammation, micro-injury, or nerve irritation \u2014 which are not visible on standard imaging. Even incidental or age-related findings seen on scans are often incorrectly assumed to be the cause of pain.\n <\/p>\n\n

\n If you have received different diagnoses or treatments without a clear explanation of the underlying mechanism of pain, or if you are trying to understand how factors such as mechanical load, daily activities, obesity, metabolic or inflammatory disturbances, nutritional deficiencies, and nervous system changes contribute to the persistence of pain, an individualized \n \n second opinion consultation\n <\/a>\n may help identify the true source of pain and all contributing factors, and define a structured and personalized treatment approach rather than relying on isolated or symptomatic therapies.\n <\/p>\n<\/div>\n\n\n\n

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\n When patients with chronic pain seek a second opinion\n <\/div>\n\n
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\n \u2022 Pain has persisted despite medications, physical therapy, or procedures, without clear or lasting improvement\n <\/div>\n
\n \u2022 A diagnosis was given (such as low back pain, neuralgia, or post-surgical pain), but the exact cause of pain was not clearly explained\n <\/div>\n
\n \u2022 MRI or CT findings are present, but it is unclear whether they truly explain the symptoms or are incidental\n <\/div>\n
\n \u2022 There is uncertainty about which structure is actually generating pain (joint, ligament, muscle, fascia, or nerve)\n <\/div>\n
\n \u2022 Daily activities such as sitting, work, or movement may be maintaining pain, but it is unclear how to reduce load on the painful structures\n <\/div>\n
\n \u2022 There is awareness that factors such as obesity, metabolic imbalance, inflammation, or nutritional deficiencies may contribute, but they have not been fully evaluated\n <\/div>\n
\n \u2022 Pain has reduced physical activity, leading to deconditioning or weight gain, making recovery more difficult\n <\/div>\n
\n \u2022 There is a need to understand whether all contributing factors have been identified and how to combine them into an effective treatment strategy\n <\/div>\n <\/div>\n\n
\n If your situation involves persistent pain, unclear cause, or insufficient response to treatment, a detailed analysis of the pain mechanism \u2014 including the true pain generator and all contributing factors described on this page \u2014 may help define a more effective and individualized treatment approach:\n \n Request Second Opinion\n <\/a>\n <\/div>\n\n<\/div>\n\n\n\n
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\n Chronic Pain \u2014 Quick Summary (Read This First)\n <\/h3>\n\n
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  • Chronic pain usually has a specific local source.<\/strong> \n It most often originates from joints, ligaments, muscles, fascia, or peripheral nerves, even when imaging does not clearly show it.<\/li>\n\n
  • Imaging findings often do not explain the real cause of pain.<\/strong> \n Many changes seen on MRI or CT are incidental or age-related and may not be responsible for symptoms.<\/li>\n\n
  • Pain rarely persists because of a single problem.<\/strong> \n It is usually maintained by a combination of mechanical, metabolic, inflammatory, and nervous system factors.<\/li>\n\n
  • Mechanical overload is one of the most common reasons pain continues.<\/strong> \n Daily activities such as prolonged sitting, repetitive movements, poor posture, computer work, or asymmetrical loading may constantly irritate the same structure.<\/li>\n\n
  • Metabolic, hormonal, and inflammatory factors can significantly influence pain.<\/strong> \n Conditions such as insulin resistance, excess body weight, chronic low-grade inflammation, and thyroid disorders (including hypothyroidism) increase pain sensitivity and slow recovery.<\/li>\n\n
  • Nutritional deficiencies \u2014 but also excess intake \u2014 may contribute to persistent symptoms.<\/strong> \n Deficiencies in vitamin B12, vitamin D, magnesium, or iron can affect nerves and muscles, while excessive intake of vitamin B6 may itself cause or worsen neuropathic symptoms.<\/li>\n\n
  • Certain medications and previous treatments may maintain or worsen pain.<\/strong> \n Statins may cause muscle pain, long-term use of analgesics can increase pain sensitivity, corticosteroids affect tissue quality, and sedatives may reduce activity and indirectly worsen the condition.<\/li>\n\n
  • Other medical conditions often contribute to persistent pain.<\/strong> \n Diabetes, anemia, autoimmune and inflammatory diseases, sleep disorders, and hormonal imbalances may reduce the effectiveness of treatment.<\/li>\n\n
  • Over time, in chronic pain, the nervous system may become more sensitive.<\/strong> \n This process (central sensitization) can cause pain to persist even when the original tissue problem is reduced.<\/li>\n\n
  • Reduced activity and weight gain often create a cycle that maintains pain.<\/strong> \n Pain limits movement, leading to deconditioning and increased mechanical and metabolic load.<\/li>\n\n
  • Treatment often fails because it is not directed at the true pain mechanism.<\/strong> \n The problem is usually not that nothing works, but that therapy is not targeted correctly.<\/li>\n\n
  • Effective treatment requires a combined and individualized approach.<\/strong> \n It must address the local pain generator together with all contributing factors at the same time.<\/li>\n\n <\/ul>\n<\/div>\n\n

    \n Most readers benefit from reviewing this Quick Summary together with the sections on Diagnosis of the True Cause of Pain<\/strong>, Mechanical Factors<\/strong>, Metabolic and Nutritional Factors<\/strong>, and Treatment Approach<\/strong>. The following sections provide a detailed explanation of how these factors interact and how they can be addressed in a structured and individualized way.\n<\/p>\n\n\n\n