You've been experiencing pain for months or years, and you’ve had scans, x-rays, and a variety of tests, yet no discernable diagnosis, or competing medical opinions that have left you confused and without solutions. And through all that, your pain is still there, as real as ever.
Your pain is not imagined. It is real, you are not making it up, and you are far from alone. Many people live with pain that doesn't match what shows up on a scan, and it can be a very frustrating and isolating experience.
The good news is that there is a growing body of science that helps explain what may be going on, and it points to ways of working with pain that many people find helpful.
All pain is real, and it is created by the brain
Here's something that surprises a lot of people: all pain, whether from a sprained ankle or a long-standing backache, is produced by the brain. Your nerves send signals, and your brain decides whether those signals mean danger, and whether to turn on the pain to protect you.
This is a brilliant protective system: when you touch a hot stove, your brain generates pain instantly so you pull your hand away.
But sometimes this system can become oversensitive.
When the alarm system gets too sensitive
Think of a smoke alarm. A good one protects you from fire. But if it's too sensitive, it goes off every time you make toast. The alarm is working, and there's no fire, yet the noise is loud and very real.
Persistent pain can sometimes work in a similar way. After an injury, a stressful period, or a time of illness, the brain's alarm system can learn to stay on high alert. Even once the tissues have healed, or when there was never a clear structural problem to begin with, the brain may keep sounding the alarm. The pain is genuine, because the brain is genuinely producing it. But it's the alarm that is sensitive, not necessarily something happening in the body.
Why scans don't always tell the whole story
Scans are important tools. They help doctors find fractures, tumors, and many other things that need treatment, and they are an important first step.
But scans show structure, not pain. Research has found that many people with no pain at all have findings on their scans that sound alarming, such as disc bulges or signs of wear in the joints, which are common as we age. And the reverse can happen too: someone can have significant pain with a scan that looks quite ordinary.
That means a scan may not be the best indicator of your pain experience. It may mean that what you're experiencing is about how your nervous system is working, not about damage that can be seen in a picture.
What this means for you
Here's the hopeful part. If a sensitive alarm system has learned to stay on high alert, it can also learn to settle.
The brain is remarkably adaptable. Researchers call this neuroplasticity, which just means that the brain can build new connections and change how it responds, at any age. Approaches such as pain science education and Pain Reprocessing Therapy are built on this idea. They help people understand how pain works, notice their sensations with curiosity instead of fear, and gradually teach the brain that its alarm can quiet down.
Many people find that simply understanding this is a relief. Many go on to find that their pain reduces, and some find it fades away entirely. Everyone's path is different, but the science gives good reason for hope.
An important note
Please continue your medical care. If you have new pain, pain that is getting worse, or symptoms that haven't been looked at, it is important to see your doctor and rule out anything that needs treatment. Coaching is not a replacement for medical care. It works best alongside it, once your doctor has had a look and has told you there is nothing that needs urgent attention.
If this sounds like you
In my coaching practice, I help people learn how pain works, practice tools like somatic tracking and mindfulness, and add gentle movement, drawing on my background in Pilates and working alongside physiotherapists. I'm not a therapist or mental health worker, and I work within my scope of practice as a coach. If it feels right, I'm happy to work alongside the other people on your health team.
If you're curious, I offer a free 15 minute phone consultation. It's a chance to ask questions and to see whether this approach feels like a good fit for you, with no pressure at all.
Book your free 15 minute consultation
Catherine Murray is a Pilates instructor, physiotherapy assistant and Pain Reprocessing Therapy coach based in Vancouver, BC, offering coaching sessions online.