Why Pain Isn't Always About The Injury
- Ada Kuang
- Mar 23
- 4 min read
Updated: Mar 23
When the Pain Doesn’t Match the Scan
It’s not uncommon for people to be told that their scans are “clear,” their injury has “healed,” or that there’s “nothing structurally wrong", yet the pain remains.
For many, this experience is confusing, frustrating, and at times deeply invalidating.
How can pain still be present if the body appears physically recovered?
This is where our understanding of pain needs to expand beyond a purely structural model. Pain is not only influenced by tissues and injury, it is also shaped by the nervous system, past experiences, and the way the body processes threat and safety (IASP, 2020).
Pain Is Real—But It’s Not Always Structural
Pain is always real. It is a genuine sensory and emotional experience.
However, pain does not always mean that there is ongoing tissue damage.
Modern pain science shows that the intensity and persistence of pain are not always proportional to the degree of physical injury (Baliki & Apkarian, 2015; Woolf, 2011).
For example:
Structural changes on imaging are often present in people without pain (Brinjikji et al., 2015)
Persistent pain can occur in the absence of clear tissue damage
This is not because the pain is “in the mind,” but because pain is produced by the nervous system—not directly by tissues.
What Is Sensitisation?
One of the key processes involved in persistent pain is sensitisation.
Sensitisation refers to increased responsiveness of the nervous system to stimulation (Woolf, 2011).
Peripheral Sensitisation
Increased sensitivity at the site of injury
Common in acute or early healing phases
Central Sensitisation
Increased sensitivity within the central nervous system (brain and spinal cord)
Amplification of pain signals
Pain may persist even after tissue healing
In central sensitisation, the nervous system becomes more efficient at producing pain—even when there is no ongoing damage (Nijs et al., 2021).
The Nervous System’s Role: Protection, Not Just Damage
The nervous system’s primary role is protection.
It continuously evaluates signals from the body and environment to determine whether something is safe or threatening (Moseley & Butler, 2015).
When threat is perceived whether physical, emotional, or contextual—the nervous system can increase pain as a protective response.
Pain can therefore be influenced by:
Stress and emotional load
Previous injury or trauma
Fear of movement (kinesiophobia)
Learned protective patterns
Over time, repeated activation of these responses can lead to persistent pain patterns (Apkarian et al., 2009).
When Medical Tests Are Clear, But the Pain Persists
One of the most challenging experiences for individuals is being told:
“There’s nothing wrong.”
Clinically, this often means there is no ongoing structural damage sufficient to explain the pain.
However, research shows that persistent pain conditions such as chronic low back pain, fibromyalgia, and some headache disorders—are associated with altered central pain processing (Clauw, 2015; Nijs et al., 2021).
This highlights a key limitation of a purely biomedical model of pain.
The Loop Between Pain, Stress, and the Body
Persistent pain is often maintained by a feedback loop:
Pain is experienced
The body responds with tension and protective behaviours
Stress and vigilance increase
The nervous system becomes more sensitised
Pain signals are amplified
Neuroimaging research suggests that chronic pain is associated with changes in brain networks involved in emotion, attention, and threat processing (Baliki & Apkarian, 2015).
Over time, this loop can sustain pain even in the absence of tissue injury.
So What Actually Helps?
If pain is influenced by the nervous system, then treatment needs to reflect this complexity.
Evidence-based approaches to persistent pain often include:
Pain neuroscience education (Moseley & Butler, 2015)
Graded exposure to movement
Nervous system regulation strategies
Psychological interventions targeting emotional and cognitive processes
Multidisciplinary approaches are consistently recommended in clinical guidelines for chronic pain (Nicholas et al., 2019).
The Role of Psychological Therapy in Pain
Psychological therapy is not about suggesting pain is psychological in origin.
Rather, it recognises that:
Pain is shaped by brain–body interactions
Emotional processes can influence pain perception
The nervous system can become sensitised—and can also be retrained
Therapy may involve:
Increasing awareness of internal bodily signals
Identifying patterns of tension, avoidance, or overprotection
Processing emotional responses linked to pain
Supporting the nervous system to tolerate sensations safely
There is strong evidence supporting psychological therapies as part of effective pain management (Eccleston et al., 2014).
A Different Way of Understanding Pain
For many people, this shift in understanding is both confronting and relieving.
Confronting—because it challenges the assumption that pain must always reflect structural damage.
Relieving—because it opens up additional pathways for treatment and recovery.
Pain is not just a reflection of injury.
It is an output of the nervous system shaped by multiple interacting factors.
Where to From Here?
If you’ve been experiencing pain that does not fully align with medical findings, you are not alone and there are well-established explanations that extend beyond structural injury.
At Reconnect Centre, we take a mind–body approach that considers both nervous system processes and emotional factors involved in persistent pain.
If this perspective resonates, you may wish to:
Learn more about how persistent pain works
Explore whether this approach aligns with your experience
Speak with your GP or healthcare provider about integrated care options
References
Apkarian, A. V., Baliki, M. N., & Geha, P. Y. (2009). Towards a theory of chronic pain. Progress in Neurobiology, 87(2), 81–97.
Baliki, M. N., & Apkarian, A. V. (2015). Nociception, pain, negative moods, and behavior selection. Neuron, 87(3), 474–491.
Brinjikji, W., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology, 36(4), 811–816.
Clauw, D. J. (2015). Diagnosing and treating chronic musculoskeletal pain based on the underlying mechanism. Best Practice & Research Clinical Rheumatology, 29(1), 6–19.
Eccleston, C., et al. (2014). Psychological therapies for the management of chronic pain in adults. Cochrane Database of Systematic Reviews, (2), CD007407.
International Association for the Study of Pain (IASP). (2020). IASP revised definition of pain.
Moseley, G. L., & Butler, D. S. (2015). Fifteen years of explaining pain: The past, present, and future. The Journal of Pain, 16(9), 807–813.
Nicholas, M., et al. (2019). The IASP classification of chronic pain for ICD-11. Pain, 160(1), 28–37.
Nijs, J., et al. (2021). Treatment of central sensitization in patients with chronic pain: Time for change. The Lancet Rheumatology, 3(5), e383–e392.
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2–S15.
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