Why Pain Doesn't Always Make Sense — And What That Means for You
The Question Nobody Asks
You've had the MRI. You've done the stretches. You've iced it, rested it, maybe even had a procedure. And yet — the pain is still there.
If you've ever been in that situation, you're not imagining it. You're not weak. And you're definitely not broken.
But the answer to "why does pain persist?" is almost never what most people expect. And that's exactly what a growing body of research — including the latest work on neuroimmune interactions — is beginning to make clear.
Pain Is Not a Damage Report
Here's the model most of us grew up with: something hurts, that means something is broken, fix the broken thing, pain goes away.
Clean. Logical. Wrong.
Pain is not a direct readout of tissue damage. It is a conclusion your brain and body reach together — a protective output produced by your nervous system in response to a perceived threat. And that perceived threat can come from a lot of places that have nothing to do with a torn ligament or a herniated disc.
This is not a fringe idea. It is now mainstream neuroscience. But here's where it gets even more interesting: the nervous system doesn't operate alone.
Meet Your Neuroimmune System
Your nervous system and your immune system are in constant, bidirectional conversation. Immune cells respond to signals from the nervous system. Neurons respond to signals from immune cells. They share receptors, release the same signaling molecules, and influence each other at every level — from the site of an injury all the way up to the brain.
What this means practically: inflammation doesn't just cause swelling you can see. It changes how sensitive your nerves are. It shifts the thresholds for pain. It can put your central nervous system into a heightened state of vigilance — one where everyday sensations start to feel threatening.
And here's the part that gets overlooked the most: this system is also deeply influenced by everything else going on in your life.
The Web of Influence
Research now shows that the following factors directly modulate your neuroimmune system — and therefore, your pain:
• Sleep. Poor sleep amplifies inflammatory markers and increases pain sensitivity. Even a few nights of disrupted sleep can measurably raise your pain thresholds.
• Stress. Psychological stress triggers a real, measurable biological response — including elevation of pro-inflammatory cytokines and increased nervous system reactivity.
• Movement. Regular physical activity has potent anti-inflammatory effects. It literally changes the neuroimmune environment. This is one reason appropriate exercise is medicine, not just "staying active."
• Mood and mindset. Depression, anxiety, and catastrophizing are not just psychological — they are associated with changes in systemic inflammation and nervous system sensitization.
• Social connection and purpose. Isolation and perceived threat alter immune function. Belonging and meaning are biological phenomena, not just nice to haves.
None of this means your pain is "in your head." It means your head — your brain, your nervous system, your immune system — is in your pain. And that is a profoundly different thing.
Why Reductionism Fails You
The standard medical model is built for acute problems. You break a bone, you fix the bone. You tear a meniscus, you repair the meniscus. That framework makes sense when the problem is purely structural.
But chronic pain rarely is. And when you try to solve a complex system problem with a single-variable fix — another surgery, another injection, another round of the same stretches — you're treating the output while ignoring the system that produced it.
This is why so many people get MRIs that show "nothing wrong" while they're still in significant pain. And it's why so many people have findings on imaging — a herniation, arthritis, a "rotator cuff tear" — and feel no pain at all. The structural finding and the pain experience are not the same thing.
What This Changes About Treatment
At Ascension PT & Performance, this research isn't a theoretical exercise. It shapes how we assess and treat every single person who walks through the door.
It means we don't just ask where it hurts. We ask what's been going on in your life. We ask about your sleep, your stress, your history. We look at how your nervous system is behaving — not just how your tissue looks.
It means our goal isn't just to reduce pain in the moment. It's to help you build a more resilient, adaptable system. One that can handle the stressors of life — training, work, family, uncertainty — without defaulting to a pain output every time.
That is the difference between treating a symptom and treating a person.
The Bottom Line
Pain is emergent. It arises from the interaction of dozens of systems — neural, immune, hormonal, psychological, behavioral. No single structure, test, or treatment holds all the answers.
The most powerful thing you can do is work with a clinician who understands this — someone who won't reduce you to a scan or a diagnosis, but will work with the full complexity of who you are.
If you've been told there's nothing wrong but still feel like something is, you deserve a different kind of conversation. That's exactly what we're here for.
