Why Your Pain Isn't "All in Your Back": What New Research Says About Chronic Pain
If you've ever had a scan that didn't explain your pain, or a scan that showed "wear and tear" when you felt fine, you're not alone. A 2026 review by pain researcher Lester Jones, published in PAIN Research, pulls together decades of evidence on something I work with every day: pain is a whole-person experience, not just a tissue problem.
Pain doesn't match damage very well
The review highlights some striking findings.
In a well-known study, healthy volunteers had the same 49°C heat probe held on their skin for 30 seconds. There was no injury. Pain ratings still ranged from about 1 out of 10 to almost 9 out of 10.
Many people arriving at A&E with genuine injuries reported a period of feeling no pain at all afterwards.
Scans of people with no pain regularly show "abnormalities". Around 80% of pain-free people aged 50 to 59 have disc degeneration. Asymptomatic rotator cuff tears are twice as common as painful ones. Most pain-free knees show some change on MRI.
None of this means your pain isn't real. It means scan findings are often normal features of ageing, and they don't reliably explain why something hurts.
Pain as a protective alarm
Jones builds on an idea from pain scientist Patrick Wall. Pain exists to drive protective behaviour: resting, guarding, slowing down, seeking help. It is a response to a sense of threat, and tissue injury is only one possible source of threat.
That's why stress matters so much. When life keeps you on high alert for a long time, your nervous system can become more sensitive. The review describes how stress hormones may prime the nervous system so that pain is more easily triggered, even when the tissues themselves are healthy. The researchers call this pain vulnerability.
Fatigue, poor sleep and anxiety often travel together
People with persistent pain often also struggle with tiredness, low mood, anxiety and broken sleep. These are usually treated as separate problems. The review suggests viewing them as part of the same protective response. Fatigue slows you down. Anxiety and poor sleep keep you watchful. When several appear together, it may be a sign your system feels under threat and needs a greater sense of safety.
Rethinking "acute" and "chronic"
We usually label pain as chronic once it has lasted beyond about three months, the typical healing time. Jones argues this can delay the right help. He suggests thinking in terms of pain that is likely to resolve and pain that is more likely to persist. Importantly, people can move between the two. Repeated failed treatments, over-investigation and rising worry can push pain towards persisting. Timely, reassuring, well-matched care can pull it back the other way.
What this means for your treatment
The review supports a trauma-informed approach built on safety, choice and control, trust, collaboration and empowerment. In practice, at Complete Balance that means:
Looking at the whole picture. I'll ask about sleep, stress, work and past injuries, not just where it hurts.
You stay in control. Pressure, pace, positioning and what we focus on are always your choice, and you can pause or stop at any time.
Clear, honest explanations. Understanding that pain is not always a sign of damage can itself reduce fear and sensitivity.
Working alongside other care. If something needs medical attention, I'll tell you and point you in the right direction.
Massage can't change the past or fix everything, but it can offer something the research says matters: a calm, safe experience for a nervous system that has been on guard for too long.
Living with pain that won't settle? I'm a clinical massage therapist in Worthing, West Sussex, specialising in chronic pain, musculoskeletal pain and pre- and post-surgery care. [Book an appointment] or get in touch to talk it through.
Source: Jones LE. Pain as a whole person experience – embracing biopsychosocial clinical reasoning. PAIN Research 41: 44–56 (2026). https://doi.org/10.11154/pain.41.44
Comments