The myth: A clean MRI means there is nothing wrong, so the pain must be imagined.
What the evidence says: Imaging findings and pain correspond far more loosely than most people assume — in both directions.
A systematic review of imaging in asymptomatic people — individuals with no back pain at all — found degenerative changes to be extremely common and to increase steadily with age. Disc degeneration appeared in a large share of pain-free 20-year-olds and in the substantial majority of pain-free adults by their sixties. Disc bulges, disc height loss, and facet degeneration followed the same pattern.
In other words: a great many people are walking around with “abnormal” spines and no pain whatsoever.
The reverse is equally true. Plenty of people in severe, disabling pain have imaging that looks unremarkable.
This is not a puzzle about whether pain is real. It is a fact about what imaging measures. Standard clinical scans show structure, not pain itself. Pain is produced by a nervous system — one that can amplify, sustain, or dampen signals depending on inflammation, sleep, prior injury, stress, and much else that a routine scan does not capture.
“Your scan is normal” is a statement about the scan. It is not a statement about the patient.
What we study:
- Pain and Aging
- Chronic Pain Risk Factors
- Pain and the Brain
- Musculoskeletal Pain
- Pain and Exercise
- Non-Medical Treatment of Pain
Prefer to talk to a person? Call 352-273-5967 or email PRICE-CTSI@ufl.edu.
UF Study ID IRB201400126
References
- Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-816. https://doi.org/10.3174/ajnr.A4173