Chronic Pain Demands More Than a Scan and a Prescription

Chronic pain is often treated as a problem to be found on a scan. If an MRI shows a disc, a joint, or a tear, treatment follows the image. But many people experience persistent pain that cannot be fully explained by an identifiable injury or disease. After nearly a decade treating pain in New York City, I believe our understanding of chronic pain is narrower than the evidence supports. Research cited by the Association for the Treatment of Neuroplastic Symptoms suggests that one in six adults experiences unexplained, ongoing pain. Understanding the difference between structural pain, caused by injury or disease, and neuroplastic pain, which can persist when the brain and nervous system continue generating pain signals without ongoing tissue damage, is an important step towards helping these patients.

Pain is real. That is the first thing I tell patients. But pain is not always evidence of structural damage. Sometimes an injury heals, yet the pain persists. The nervous system can remain protective long after the original cause has resolved. Women carry a particular share of this burden. Research on chronic pain before and after menopause has found that older women report higher pain levels than men of the same age, across racial and ethnic groups, according to PubMed. Yet midlife pain is often dismissed as inevitable, while hormonal transitions and their influence on pain remain under-researched.

Modern medicine is extraordinary at identifying structural abnormalities, but bones, joints, and nerves are not the only factors involved in musculoskeletal pain. Myofascial pain, which involves muscles and surrounding connective tissues, can be underdiagnosed and undertreated. Recognizing these less visible contributors matters when a patient's symptoms cannot be fully explained by imaging alone.

This is not an argument against conventional medicine. It helps rule out conditions that must not be missed. An MRI can reveal a serious problem that no one expected, or help confirm that one has been excluded. The problem is not the scan. It is what happens when the scan comes back clear, or shows unrelated abnormalities, and a patient is left without an explanation or a meaningful plan for managing their pain.

For some patients, the next steps may involve medication, injections, or surgery. Sometimes such interventions only mask the pain and do not resolve the cause of it. Persistent pain can also lead to inactivity because movement hurts. Each option has potential costs and long-term risks. Chronic use of nonsteroidal anti-inflammatory drugs can increase the risk of gastrointestinal, kidney, and cardiovascular complications, according to research indexed by PubMed. Long-term opioid therapy also carries significant risks, while evidence of its benefits for chronic pain remains limited in important respects.

These treatments can be appropriate, but they may not fully address all the factors, such as trauma, emotional considerations, depression, and sleep problems that cause or contribute to persistent pain. The consequences affect patients and the healthcare system. Healthcare systems face repeated consultations, procedures, and medication costs, while insurance disputes consume clinicians' time and attention.

Doctors are caught in this system, too. Clinicians must navigate an ever-expanding body of research, increasingly complex diagnostic tools, and a vast range of conditions, often while seeing more patients in less time. No doctor, however skilled, can absorb every new development or give every patient the time their circumstances deserve.

When appointments are rushed, it becomes harder to explore a patient's circumstances or consider why symptoms persist when scans offer no clear explanation. This is not necessarily a failure of individual doctors. It is a system that places enormous demands on them while leaving too little room for the careful listening and clinical judgment complex conditions require.

Most of the physicians I work with want to offer more than the system allows. They must move quickly between patients while navigating insurance restrictions and administrative demands. I have watched doctors fight insurers for medications their patients need and seek samples to bridge gaps in care. These pressures make individualized treatment harder to deliver, even when clinicians recognize that patients need more time and support.

Being believed is itself part of treatment. I have had patients whose pain improved substantially when someone sat with them, looked them in the eye, and acknowledged that what they were experiencing made sense. The needles matter. The listening matters, too.

What I am arguing for is not a replacement for modern medicine, but an expansion of what counts as treatment. Evidence-based medicine should not become evidence-limited medicine. The absence of a complete explanation for how a treatment works does not prove it has no value, just as tradition alone does not prove that it is the best intervention. Both conventional and complementary approaches must be assessed with humility and a commitment to evidence.

In my practice, I combine traditional acupuncture with orthopedic techniques targeting muscle dysfunction, including trigger points, motor points, and electrical stimulation. I see the body and brain as part of a continuous conversation: the brain sends signals that influence the body, while sensory signals from the body travel back to the brain. Acupuncture stimulates sensory input, engaging this two-way communication in ways that help regulate pain.

Pain Reprocessing Therapy approaches pain differently, helping patients understand how the brain interprets signals and how the nervous system can sometimes continue generating protective responses after an injury has healed. The aim is not to suggest that pain is imaginary, but to recognize that pain can be real without always indicating physical damage.

Research suggests that the nervous system deserves greater attention in pain treatment. In a randomized clinical trial published in PubMed, 66% of participants with primary chronic back pain who received four weeks of Pain Reprocessing Therapy reported being pain-free or nearly pain-free afterwards, compared with 20% who received placebo injections and 10% who received usual care. Improvements were largely maintained at one-year follow-up. These findings cannot be generalized to every pain condition or treatment, but they demonstrate why understanding how the brain processes pain should be part of the wider conversation about care.

The benefits may extend beyond pain itself. When patients better understand how their nervous system, stress, and symptoms interact, they may feel less frightened by their pain and more able to participate in recovery. In my experience, patients sometimes report improvements in sleep, stress management, and everyday functioning alongside changes in pain. Listening and explaining what may be happening can also help patients feel understood rather than dismissed.

In practice, primary care physicians should build relationships with qualified mind-body and complementary practitioners and consider referrals earlier when appropriate, rather than only after other treatment options have failed. Insurers should evaluate and cover evidence-supported approaches when clinically appropriate and cost-effective. Investment in research into pain mechanisms and treatments such as acupuncture and Pain Reprocessing Therapy can help ensure that decisions reflect the available evidence and individual patient needs.

The answer is not to choose between conventional and complementary care. It is to stop treating them as opponents. Patients do not experience pain in categories. They experience it in a body, in a life, with a history. The care that helps them should reflect that complexity.

About the Author

Annalisa Brown of AB Acupuncture is an acupuncturist in New York City, practicing since 2015. Her work combines traditional acupuncture and motor point acupuncture, electroacupuncture, and Pain Reprocessing Therapy principles, with a focus on chronic pain, stress, sleep, and the changes that accompany perimenopause and menopause.