Why Imaging Can’t Accurately Predict Your Chronic Pain

Why Imaging Is Not a Good Indicator of Pain

Traditional imaging techniques like MRIs, X-rays, and CT scans have long been used to assess chronic pain. However, emerging research challenges the assumption that structural problems identified in these scans are the primary cause of pain. In fact, imaging of body parts often fails to provide a consistent correlation with pain intensity or presence, leading us to reconsider how we understand chronic pain.

Why Imaging of Body Parts Misses the Mark

Imaging techniques, such as MRIs, are often used to investigate structural abnormalities that might be causing pain. However, these findings do not reliably correspond with the experience of pain. For example, studies have shown that degenerative changes in the spine, such as disc degeneration or facet joint arthritis, are common even among individuals who report no pain at all. The 2012 JAMA study and a 2013 study in The Lancet found that MRI findings, such as spinal degeneration, did not consistently align with the presence or severity of pain. In many cases, people with severe pain show little or no significant structural abnormalities, and others with significant structural issues experience little to no pain.

A 2011 study in The Spine Journal found that many individuals with chronic low back pain showed no significant abnormalities on imaging. This suggests that structural changes may not always be the main cause of pain, and that pain itself is influenced by many factors beyond physical damage. A 2007 study in Clinical Orthopaedics and Related Research echoed this point, revealing that rotator cuff tears are often asymptomatic, which means the structural change alone does not explain the presence of pain.

This disconnect suggests that pain is influenced by factors beyond structural damage and highlights the complexity of pain perception.

Why Brain Scans Are More Relevant for Chronic Pain

When it comes to chronic pain, brain imaging (such as fMRI or PET scans) has shown more consistent correlations with pain levels. Unlike traditional body scans, brain scans capture neuroplastic changes—alterations in the brain’s structure and function that occur in response to long-term pain. This process is linked to central sensitization, where the central nervous system becomes more sensitive to stimuli, even in the absence of visible damage in the body.

Studies, such as those published in The Lancet (2013), have shown that pain intensity is more closely linked to these brain changes than to physical damage in tissues or joints. Brain areas involved in pain processing, like the thalamus and primary somatosensory cortex, can undergo significant changes in people with chronic pain. These brain changes offer a more accurate reflection of pain intensity and its persistence than traditional body imaging, which focuses solely on structural changes.

Nervous System Treatment has been shown to, over time, reverse these changes in the brain.

The Problem with Relying on Imaging for Treatment Decisions

Relying too heavily on imaging can lead to unnecessary treatments or interventions that may not address the true cause of pain. For example, some patients undergo surgery based on MRI findings that show structural abnormalities, even though these abnormalities may not be the actual source of their pain. A study published in JAMA in 2010 found that patients with low back pain who had unnecessary spinal surgeries based on MRI results often did not experience better outcomes than those who did not undergo surgery.

Focusing on imaging findings alone can also prevent people from exploring more effective treatment options, such as physical therapy, cognitive-behavioral therapy (CBT), and mindfulness practices. These therapies can help address the psychological and emotional factors that contribute to pain, rather than just focusing on physical damage.

The Role of Psychological and Neurological Factors

Beyond the structural and neuroplastic factors, psychological influences play a key role in how pain is perceived and processed. Chronic pain is often influenced by factors like stress, trauma, emotional well-being, and past experiences. For example, the presence of depression or anxiety can amplify pain perception, a phenomenon observed in studies like the one published in Pain (2014). These psychological factors, combined with neuroplastic changes in the brain, help explain why pain may persist even when there is no significant physical injury.

This is where the biopsychosocial model of pain becomes crucial. It recognizes that pain is not just a physical phenomenon but is shaped by a complex interaction of biological, psychological, and social factors. Addressing chronic pain effectively requires considering all these elements, rather than focusing exclusively on the body’s structure.

Shifting the Focus: Nervous System Healing

Understanding pain through the lens of the nervous system rather than just focusing on structural abnormalities opens the door to more effective treatments. Nervous system regulation, a key aspect of my healing program, focuses on healing the nervous system’s response to pain. Practices that encourage neuroplasticity and regulate the nervous system, such as mindfulness, somatic movement, and emotional awareness, can help reduce chronic pain by reshaping the brain’s response to pain signals.

By focusing on healing the brain’s response to pain, rather than solely addressing physical structures, we can move toward a more holistic and effective approach to chronic pain management.