Pain without Injury, you aren’t nuts, it’s not in your head, but it isn’t in your photo either!
One of the most frustrating experiences for people living with persistent pain is being told, “Your scan looks fine, so there’s nothing wrong with you.” For many, this leads to feelings of doubt, frustration, and even shame, as though they need visible proof of pain to be taken seriously.
The assumption behind this statement is that if medical imaging—like MRIs, X-rays, or CT scans—does not show anything significant, then the pain must not be real. Some may even imply that it’s psychological or exaggerated. This outdated belief has left countless people searching for validation and relief, often leading to years of unnecessary suffering.
The science of pain tells us something very different. Pain is real, and it does not need imaging to show a clear cause. Pain is not just about visible tissue damage; it is a complex experience influenced by multiple factors, including the nervous system, stress, emotions, and past experiences.
If you have ever been dismissed because your scans came back normal, know this: Your pain is real, and you are not alone. Understanding why imaging does not always explain pain can be a crucial step toward finding real solutions and reclaiming your life.
Where Did This Belief Come From?
For decades, medical professionals have been trained under the biomedical model of pain, which assumes that pain is always linked to a physical injury or abnormality. This model works well in cases where there is an acute injury, such as a broken bone or a torn ligament, but it does not explain many cases of persistent pain.
The biomedical model suggests that if pain exists, there must be a physical cause that can be seen and fixed. This belief leads to an over-reliance on medical imaging. If a scan does not reveal a structural issue, doctors may conclude that there is no real problem, often leaving patients without a clear path forward.
The problem is that this model does not account for how pain actually works in the body. Pain is not simply a measure of tissue damage. It is an output of the nervous system, influenced by a wide range of factors beyond what can be seen on a scan.
Why Imaging Doesn’t Tell the Whole Story
Scans Show Structure, Not Function
Medical imaging provides a static picture of the body’s structures. While this is useful for identifying fractures, tumors, or major structural damage, it does not show how the body is functioning.
Pain is not just about structure—it is about how the brain and nervous system are interpreting and responding to sensory information. A scan cannot show how sensitized the nervous system has become, how stress or past trauma might be influencing pain, or how the brain is processing pain signals.
This means that someone can have a scan that looks completely normal while experiencing significant pain. Conversely, many people have major structural findings on scans yet feel no pain at all.
Many People Have Structural Changes Without Pain
If pain were always caused by structural damage, then everyone with an abnormal scan would experience pain. However, research has shown that this is not the case.
Studies on asymptomatic individuals (people who do not report any pain) have found high rates of “abnormal” findings on imaging, including:
- Disc bulges and herniations: More than 50% of people over 40 have bulging discs on MRIs, even if they have no back pain.
- Arthritis and degenerative changes: Osteoarthritis and “wear and tear” are common in people who feel completely fine.
- Rotator cuff tears: Many people over 50 have rotator cuff tears, yet experience no shoulder pain.
If structural abnormalities always caused pain, these people would be in agony. But they are not. This tells us that pain is more than just what appears on a scan.
Introducing Nociplastic Pain: When the Nervous System Becomes Overprotective
In some cases, pain exists even when there is no clear injury or the original injury has healed. This is known as nociplastic pain—a term used to describe pain that arises due to changes in how the nervous system processes pain signals rather than ongoing tissue damage.
Nociplastic pain is common in conditions such as:
- Fibromyalgia
- Complex Regional Pain Syndrome (CRPS)
- Chronic low back pain without a clear injury
- Persistent pain after surgery or injury, even after tissues have healed
This type of pain occurs when the nervous system becomes more sensitive, amplifying pain signals even when there is no ongoing harm. This is not “made-up” pain—it is a biological response that has become dysregulated. Understanding nociplastic pain is key to shifting the focus from searching for tissue damage to working with the nervous system to restore balance.
The Trap of Searching for the “Thing” That Explains Pain
When pain persists for months or years, many people become trapped in a cycle of searching for a single, definitive cause. If only they could find the one thing responsible for their pain, they could fix it and move on with their lives.
This search often leads to:
- Repeated scans and medical tests that provide no clear answers
- Visits to multiple specialists, each with their own theories
- A growing sense of frustration and hopelessness as no single cause is identified
How This Cycle Steals Hope
Each time a scan comes back normal or inconclusive, it can feel like another door has closed. The more time spent searching for a structural cause, the more discouraged people become. Some start to question their own experiences or worry that their pain is being dismissed as psychological.
The Reality of Chronic Pain
When pain lasts beyond the typical healing time for an injury—usually 3 to 6 months—it is no longer just about the tissue. The nervous system itself has adapted to keep pain going. This does not mean the pain is imaginary. It means that the focus of treatment needs to shift from fixing damaged tissue to addressing the whole person.
What to Do If Your Scans Show Nothing, But You’re Still in Pain
Validate Your Own Experience
Pain is real, regardless of what a scan shows. You do not need imaging to prove your pain is legitimate. Understanding this can be an important first step in moving forward.
Find a Provider Who Understands Pain Neuroscience
Not all healthcare providers are up to date on the latest pain science. Look for practitioners who use a biopsychosocial approach, which considers the physical, emotional, and neurological aspects of pain.
Focus on Functional Assessments
Instead of relying solely on imaging, consider:
- Movement-based assessments to see how your body functions
- Pain neuroscience education to understand how pain works
- Graded exposure therapy to help retrain the nervous system
Shift Focus from “Fixing” Tissue to Supporting the Nervous System
Rather than searching for a missing structural cause, explore strategies that help your body feel safe and supported. This may include:
- Breathing exercises to regulate the nervous system
- Gentle movement to rebuild confidence in the body
- Cognitive approaches to shift focus from fear of pain to functional improvement
- Emotional support through counseling, journaling, or support groups
Advocate for Yourself
If a doctor dismisses your pain because imaging is clear, do not hesitate to seek a second opinion. You deserve to work with someone who takes your pain seriously and offers solutions beyond “learn to live with it.”
Conclusion: You Are Not Broken
Pain without a clear injury is still pain. Just because nothing significant appears on a scan does not mean your experience is invalid. Pain is complex, influenced by multiple factors beyond what can be captured in a static image.
If you’ve been told “nothing is wrong” because your scans look fine, know this: Pain is real, and it does not need imaging to prove it.
Instead of searching for a missing “thing,” shift your focus toward what helps your entire system feel safer and more supported. Healing is possible—not by chasing endless tests but by working with your body and nervous system in new ways.
You are not broken. Your pain is real. And there is hope.
📢 Have you ever been told your scans look fine, despite being in pain? Share your experience in the Facebook group (you can click the photo above)—I’d love to hear from you!
