Chronic Pain but a Normal MRI or Scan: What It Can and Can't Tell You

If your scan came back "normal" or "unremarkable" but you're still in pain then this article is for you. A scan is a picture of your body's structure. Not a picture of your pain. Pain is something your nervous system produces, shaped by many factors, not limited to: your tissues, your movement, your injury history, your stressors, your sleep and your beliefs about your body. A clear scan rules some things out. And that's useful. But it certainly can't show you the whole picture.

People are often left with one of three messages after a scan, and all three can do harm.

The first is: "Your scan is clear, so there's nothing wrong with you." Hear that enough times and it's easy to wonder if the pain is all in your head. It isn't. It's real and a scan and someone's opinion about your symptoms does not get to define you or make you define yourself in a way that invalidates your experience.

The second is the opposite: a scan report full of words like "degeneration", "wear and tear" or "bulge", and the belief that those words fully explain the pain. The hard part about the whole experience of getting an MRI is that some people will get the scan report that seems full of findings and a good health care professional will help them understand what it means. For the most part, those findings are generally normal for your age and activity levels and can be found in people who have no pain. So this might read as scary initially but once it's explained you are reassured that those findings aren't the source of your pain.

The third group - they won't get an adequate explanation about their scan's findings and that can leave them feeling more worried, more afraid and more protective of their body because their MRI "found lots of stuff" and that "can't be a good thing". I despair a little inside when I meet people in this situation because they have often spent years minding themselves, which slowly reduces their activity levels and leaves them ultimately with more work to do to make progress. An unintended consequence for this group is that upon receiving their MRI results, they often end up believing that this is the sole problem with their body and the reason that they have pain. That's kinda like shining the searchlight in completely the wrong direction and hoping you'll find your way out of the maze.

All three groups are no better off in understanding what IS influencing their pain. The second group just knows one more thing that isn't. If you are getting a scan or have had one, what I've written above might seem dismissive of imaging. It's not intended to be. I wanted to highlight that imaging can cause problems for people, especially where persistent pain is concerned.

Scans do have lots of useful functions, such as:

• Scans are good at finding some things, such as fractures, serious structural problems, infections and other conditions your doctor needs to rule out. That's a big part of why they're done so if your GP or consultant recommends one, that's a conversation to have with them.
• Lots of scan findings are common in people with no pain at all (as mentioned above). For example, in a large review of over 3,000 people without back pain, disc degeneration and disc bulges became more common with age, much like the way we accumulate more and more grey hair as we age. Many people in their 50s and 60s have them and do not have pain.
• Some findings are a bit more common in people with pain. A follow-up review found certain disc changes turn up more often in adults with back pain than without it. So findings aren't meaningless, but they're also not a simple "this is the cause".
• Not everyone with persistent pain has a normal scan. Some people have findings that matter, and some have conditions that need medical care.

The point isn't that scans are useless. It's that persistent pain is rarely captured on a piece of photographic film.

Leading on from the point that persistent pain is rarely captured in an image is the follow-up point: there is no "one thing" we need to find or solve to overcome persistent pain.

That is an idea that fills a lot of clinic rooms, sitting rooms and bedrooms. I hear it all the time in clinic; it casually slips out in conversation from clients.

It's a seductive idea that if we could just find THE THING that's causing the pain, we could deal with it once and for all.

The well-meaning therapist will hunt for it while you're on the treatment table. You might lie awake at night trying to work out if the latest thing you saw on social media might be THE THING that's happening in your body.

One client asked me recently whether we "just had to find the thing causing the pain, or if it was a bit of everything that's been going on". I nodded and said: "Well, it's rarely the one thing..."

If pain were that simplistic, it would be simple to solve and it would probably be easily identifiable on a scan too. Persistent pain is multifactorial and personal (influenced heavily by your story to date) and the good thing with a clear MRI is that you can be reassured that your structures are ok and focus your time and energy on the influences that matter most.

This article is general education, not a diagnosis or a substitute for care from your GP or healthcare team. If your pain is new, getting worse, or comes with symptoms that worry you, please get it checked.