KNOWLEDGE CENTRE
Many people living with persistent pain have been told that their MRI scan, X-ray or blood tests are normal. Hearing this can be frustrating, confusing and sometimes upsetting, especially when pain is affecting every part of life. Normal tests do not mean your pain is imaginary or that nothing is wrong—they often mean the pain is not being caused by ongoing damage that can be seen on a scan.
Investigations such as MRI scans, X-rays and blood tests are incredibly important. They help identify conditions that need specific treatment, including broken bones, arthritis, slipped discs pressing on nerves, infection, inflammatory conditions, tumours and autoimmune diseases. Just as importantly, normal tests can provide reassurance that serious conditions have been excluded.
Pain is the body’s alarm system. When you sprain an ankle or cut your finger, pain warns you to protect the injured area while it heals. Normally, as healing occurs, the alarm settles down. Sometimes, however, the alarm system itself becomes more sensitive. The tissues may have healed, but the nervous system continues to send pain signals. This is known as persistent pain or chronic pain, and it is recognised as a medical condition in its own right.
Pain is not stored in your muscles, joints or spine. It is produced by your brain after receiving information from your body. Normally this system works remarkably well, helping to protect us from harm. However, after months or years of pain, the nervous system can become overly protective and react to movements, touch or everyday activities that are no longer causing damage. This is sometimes described as the body’s alarm system becoming stuck on high alert.
There is rarely one single cause. Persistent pain usually develops because several factors come together over time.
Previous injury or illness
An injury or operation may trigger pain that continues long after tissues have healed.
Living with pain for a long time
The longer pain persists, the more sensitive the nervous system can become.
Poor sleep
Sleep and pain have a close relationship. Poor sleep can increase pain sensitivity, while pain makes it harder to sleep.
Stress
Physical and emotional stress can amplify the nervous system’s response and make pain flare more easily.
Hormonal changes
Hormonal changes, including menopause, can influence pain sensitivity in some people.
Trauma and adverse life experiences
For some people, previous trauma or prolonged stress may influence how the nervous system develops and responds to threat. This does not mean trauma is the cause of everyone’s pain, but recognising its role where relevant allows care to be more compassionate and effective.
Genetics
Some people appear to inherit a nervous system that is naturally more sensitive to pain than others.
Many recognised medical conditions may have little or no abnormality on routine investigations, including fibromyalgia, chronic widespread pain, chronic pelvic pain, bladder pain syndrome, irritable bowel syndrome, migraine, tension-type headache, some neuropathic pain conditions and persistent low back pain. These conditions are genuine, common and recognised by healthcare professionals worldwide.
No. Persistent pain is a real biological condition involving changes within the nervous system. Emotions such as stress, anxiety or low mood can influence pain—just as they influence asthma, eczema, irritable bowel syndrome and many other medical conditions—but they are rarely the whole explanation. Persistent pain is best understood using a biopsychosocial approach, recognising that biological, psychological and social factors all contribute to how pain is experienced.
Absolutely not. Although we cannot always remove persistent pain completely, there is a great deal we can do to reduce its impact. The aim is to help you regain confidence, improve function and enhance your quality of life.
Understanding how pain works
Improving sleep and lifestyle medicine
Gentle physical rehabilitation
Approaches that help calm the nervous system
Appropriate medication, injections or medical cannabis where suitable
Working with other specialists when needed
Even when previous tests have been normal, new investigations may be needed if symptoms change significantly. Examples include new weakness, loss of bladder or bowel control, persistent fever, unexplained weight loss, night pain that is progressively worsening, a history of cancer, or new symptoms following significant trauma. These situations are uncommon, but they should always be assessed promptly.
Our role is not simply to look at scans or test results. We listen to your story, understand how pain affects your life, and consider the whole picture. By combining your history, examination findings, previous investigations and your personal goals, we can develop an individualised management plan that supports both symptom control and long-term wellbeing. Whether your investigations show significant changes or very little at all, our focus remains the same: understanding your pain and helping you move forward with confidence.
“One of the most difficult moments in clinic is hearing someone say, ‘My doctor told me all my tests were normal, so I don’t know why I’m in so much pain.’ I want you to know that normal investigations do not invalidate your experience. They are an important part of understanding your health, but they are only one piece of the puzzle. By looking beyond scans and blood tests and understanding the whole person, we can often make sense of persistent pain and, more importantly, help you find a way forward.”