Your MRI Doesn't Explain Your Pain (And What Actually Does)

The radiologist's report came back. Maybe it said "mild disc degeneration at L4-L5" or "moderate arthritis in the cervical spine," or "minor stenosis, age-appropriate." Your doctor looked at it, looked at you, and shrugged. "There's some wear and tear, but nothing that should be causing this level of pain. Let's try physical therapy again."

So you went home holding a piece of paper that was supposed to explain everything, but wound up explaining nothing.

Or maybe your imaging came back perfectly normal. "We don't see anything here." You know that should be reassuring, but it's not. Because nothing about your daily reality feels normal. You're still thinking about your pain from the moment you wake up to the moment you go to sleep at night. Still saying no to hikes, to dinner invitations, to the trip you've been planning for years.

Life feels like an endless slog of managing, calculating, and protecting.

Here's what I want you to consider: the problem isn't that the imaging was wrong. The problem is that it was looking in the wrong place.

You've Done Everything Right, and You're Still Hurting.

If you're reading this, you've probably already been through the circuit: orthopedist, physical therapist, chiropractor, massage, maybe injections. You've taken the anti-inflammatories. You've done the core exercises. You've tried to be patient. And somewhere along the way, you reviewed those images with your doctor. But you feel no closer to figuring out a solution than you did when your symptoms first showed up.

There's a huge divide between what those images show and what you feel every day. To make matters worse, you’ve started to doubt yourself and wonder if maybe YOU are the problem. That you're somehow exaggerating, or not trying hard enough, or that you’re just a “lightweight” who can’t handle a little discomfort.

It’s understandable for you to feel that way. But it’s also BS.

The truth I want to share with you may seem counterintuitive: You don’t have to be physically damaged to experience real (and sometimes debilitating) pain.

What Scans Actually Show. And What They Can't.

Without a doubt, MRIs and X-rays are amazing tools for identifying certain problems: fractures, tumors, serious nerve compression, and structural damage that requires surgical intervention. For those things, imaging is invaluable and saves lives every day.

But chronic pain? The kind that lingers for months or years? That spreads, that fluctuates, that gets worse when you're stressed and better when you're on vacation? That kind of pain doesn't live in your tissues. It lives in your nervous system. The part of your nervous system that doesn't show up on a scan.

There’s plenty of research to support that claim, too. For example, a landmark study published in the American Journal of Neuroradiology looked at MRI results from people with absolutely no back pain. What they found was remarkable: By the time people enter their 60s, the majority of pain-free people show disc degeneration on imaging. About 36% had bulging discs. A significant percentage showed "stenosis" and "arthritis."

These are pain-free people, with the same findings your doctor pointed to as the source of your suffering.

This isn’t a fringe finding either. It has been replicated across dozens of studies, in spine research, shoulder research, knee research, and more. The correlation between what appears on a scan and the pain a person experiences is pretty poor. Some people with severe structural findings have no pain at all, while others with pristine imaging are barely functional.

So if the structure isn't the driver, what is?

The Nervous System: Where Pain Actually Lives

Pain is not a simple readout from your body's damage sensors. It's an output produced by your brain, based on everything it knows: your history, your stress levels, your fears, and your past experiences with injury and threat. Pain is your nervous system's best attempt to protect you.

Under normal circumstances, this system works brilliantly. You touch something hot, pain fires immediately, you pull your hand away. The threat resolves, the pain resolves. Nice and straightforward.

But sometimes, particularly after an injury that doesn't heal the way we expect, or during extended periods of stress, or when we receive frightening medical information, the nervous system literally gets stuck in protection mode.

Pain researchers call this central sensitization. Think of it like a smoke alarm that was installed to alert you to a dangerous fire, but now goes off every time you make toast or steam from the shower hits it. The alarm is real. The sound is real. The inconvenience and disruption are real. But there's no fire.

Your nervous system isn't broken. It's overprotective. It learned, through a combination of the original injury, your fear response to pain, and years of reinforcement, to treat ordinary sensations as dangerous. The pain circuits fire automatically now, the way a musician's fingers find the right chord without conscious thought. It's a learned pattern.

This is what pain researchers like Dr. Howard Schubiner, Dr. John Sarno, and Alan Gordon have spent careers documenting: a category of chronic pain called neuroplastic pain, where the nervous system itself has become the primary pain generator, not the tissue it's supposedly protecting. The original trigger may have been structural, but the ongoing pain is a neural pattern.

The good news is that it’s a pattern that can be changed.

What This Actually Means for Your Pain

Your pain patterns are personal, so think about your own symptom history for a moment...

• Does your pain tend to spike during stressful weeks at work?

• Does it ease, even slightly, when you're absorbed in something you love: a good book, a long conversation with someone you care about, an engaging project?

• Does it move around, or show up in different places at different times?

• Did it start after what seemed like a relatively minor incident, but never fully resolved?

If any of that sounds familiar, it's not a coincidence. These are telltale signs of a sensitized nervous system. For years, this kind of pain pattern was dismissed or misunderstood. "It must be psychological." "Maybe you're depressed." "Have you tried stress reduction?"

What we now understand much more clearly is that the mind-body connection in pain is not a metaphor. It's neuroscience.

Stress hormones directly affect pain signaling. Emotional states change how the nervous system interprets sensation. The brain's threat-detection systems and pain-production systems are deeply intertwined.

This doesn't make your pain less real; it just shines a brighter light on what’s really happening.

"You don’t have to be physically damaged to experience real (and sometimes debilitating) pain."

The Key Reframe That Leads to Change

I know how strange this can seem. If your experience is anything like mine, you've spent

years trying to locate the source of your pain in a body part: the disc, the joint, the nerve. And hearing that your symptoms are primarily coming from a pattern that your nervous system learned can take some time to digest. At first, it may even sound like I’m telling you the pain is “all in your head.”

But I’m actually saying the opposite, and it’s very good news. 

"I have a bad back" is a fixed statement. It implies something structurally wrong, something you manage and work around for the rest of your life. But "my nervous system learned a pain pattern" is a completely different kind of statement. What the brain has learned, it can unlearn, and neural pathways that have been reinforced over months or years can be retrained. Neuroplasticity works in both directions.

You’re not damaged or broken. Your nervous system is just trying to protect you, and it’s stuck in overdrive. Fortunately, there’s a path forward that doesn't require surgery, injections, or another round of treatments aimed at tissues that were never the real source of your pain.

One Thing to Try This Week

This isn't a fix, and it's not a test. It's an invitation to start paying attention differently.

For the next few days, keep a loose, informal log of your pain. Not the intensity, but the context. Not "my pain was a 6 out of 10" but: what was happening when it spiked? What were you thinking about? What were you in the middle of? And when did it ease, even slightly? What were you doing then?

You're not trying to prove anything or catch yourself "creating" pain. You're simply gathering data about your own nervous system. Many people find, within just a few days, that they start to notice patterns they'd never seen before, such as the connection between a difficult conversation and a flare-up, or the way pain recedes during an activity that fully absorbs their attention.

This kind of awareness is not a psychological exercise. It's the beginning of understanding your nervous system. And understanding is where change starts.

Ready to Go Deeper?

If what you've read here resonates and some part of you is thinking "this might actually explain what's been happening to me," please keep coming back to this blog.

This post is the first in a series that will walk you through the full picture: the neuroscience of chronic pain, how to recognize neuroplastic patterns, what the recovery process actually looks like, and the specific practices that help retrain the nervous system.

You can sign up for my email list below to get the next post delivered directly to you.

You've already put in more effort than most people will ever understand. The appointments, the treatments, the exercises, the research at midnight, and the careful management of a body that keeps confounding you. That effort got you here, and this is where your approach finally changes.

Wishing you quick healing and good health,

---

References

1. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations. American Journal of Neuroradiology. 2015;36(4):811-816. https://www.ajnr.org/content/36/4/811

   Free full text via PubMed: https://pmc.ncbi.nlm.nih.gov/articles/PMC4464797/

   Note: This study reviewed 33 studies of 3,110 pain-free individuals and found disc degeneration prevalence rising from 37% at age 20 to 96% at age 80, with disc bulges present in 30-84% of asymptomatic people depending on age. Many common imaging findings are part of normal aging and are not associated with pain.

2. Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial. JAMA Psychiatry. 2022;79(1):13-23. https://pubmed.ncbi.nlm.nih.gov/34586357/

   Free full text via PubMed: https://pmc.ncbi.nlm.nih.gov/articles/PMC8482298/

   Note: The landmark "Boulder Back Pain Study" (University of Colorado), co-authored by Alan Gordon and Dr. Howard Schubiner. 66% of participants who completed four weeks of Pain Reprocessing Therapy were pain-free or nearly pain-free post-treatment, with gains largely maintained at one-year follow-up. fMRI scans confirmed measurable changes in pain-processing brain regions.

3. Ashar YK, Gordon A, Schubiner H, et al. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. 2025. https://pubmed.ncbi.nlm.nih.gov/40736996/

   Note: Five-year follow-up of the Boulder Back Pain Study, confirming durability of pain relief for participants who underwent Pain Reprocessing Therapy.