Here’s something the healthcare system doesn’t want you to know: the majority of chronic pain has nothing to do with what’s “wrong” with your body. Not your bulging disc. Not your torn rotator cuff. Not the arthritis your surgeon circled on your MRI. In 2023, Dr. Howard Schubiner and his colleagues assessed 222 chronic back and neck pain patients and found that 97.7 percent of them had at least one spinal abnormality on imaging. Ninety-seven percent. But when they evaluated what was actually causing the pain, only 5 percent—fewer than one in twenty—had pain that was driven by those structural findings. The nervous system was the driver in almost nine out of ten cases. The pain was real. The cause was not what anyone told them it was.
This isn’t fringe science. This is published in the Journal of Pain. And it’s consistent with decades of research that the medical system has largely ignored. A landmark study in the New England Journal of Medicine performed MRI scans on people with zero back pain and found that 64 percent had disc abnormalities—herniated discs, bulging discs, degenerative changes—the same findings that are routinely used to justify surgery. In people over sixty, that number climbed to over 90 percent. These people felt nothing. The findings were there. The pain was not. So why are we still building treatment plans around them?
Because chronic pain is a massive business. In the United States alone, over one hundred million people suffer from chronic pain, and more than six hundred billion dollars is spent annually managing it. That’s more than the combined cost of diabetes, heart disease, and cancer. Orthopedic surgeons, physical therapists, chiropractors, pain clinics, imaging centers, pharmaceutical companies—entire industries are built on the assumption that your pain is structural and that the answer lives somewhere in your body waiting to be found and fixed. If the world truly understood what the science already shows—that the vast majority of chronic pain is neuroplastic, generated by learned neural pathways in the brain rather than by tissue damage—every orthopedic surgeon and physical therapist in the country would see their caseload drop by 95 percent. That’s not an exaggeration. That’s the research.
Neuroplastic pain means your brain learned to produce pain the same way it learns any habit. Fear, stress, hypervigilance, and the emotional weight of years of suffering create neural circuits that fire on repeat—not because something is broken, but because the brain got stuck in a loop. And here’s the part that should make you angry: the treatments you’ve been sold are often reinforcing that loop. Every MRI that “finds something” increases your fear. Every surgeon who says “you need this procedure” deepens your belief that your body is damaged. Every physical therapist who tells you your movement patterns are “dysfunctional” teaches your brain to monitor every step you take. The system isn’t healing you. It’s training your brain to stay in pain.
The evidence is staggering. In 2002, a study in the New England Journal of Medicine compared real arthroscopic knee surgery to a completely fake procedure—same incisions, same operating room, same post-op care, but no actual repair. The patients who received the sham surgery improved at the same rate as those who had the real thing. In 2013, the FIDELITY trial replicated this with meniscal tears: real surgery was no better than fake surgery at twelve months, and the real surgery group actually showed a slightly greater risk of osteoarthritis five years later. Up to 40 percent of spinal surgery patients develop what’s called failed back surgery syndrome—persistent pain after the procedure. Second surgeries succeed only 30 percent of the time. Third surgeries, 15 percent. Fourth, just 5 percent. Each time, the surgeon is fixing a finding. Each time, the pain comes back. Because the finding was never the cause.
Meanwhile, a 2022 study published in JAMA Psychiatry took 151 people with chronic back pain and gave one group just eight sessions of Pain Reprocessing Therapy—a technique that teaches patients their pain is generated by the brain, not by tissue damage. No surgery. No medication. No physical intervention of any kind. Sixty-six percent of that group were nearly orcompletely pain-free afterward, compared to 10 percent with usual care. And those results held at a five-year follow-up. Read that again. Two-thirds of chronic pain patients became pain-free by changing how they understood their pain. No one touched their spines.
So why isn’t this front-page news? Because there’s no money in it. You can’t bill $50,000 for a surgery that consists of teaching someone how their brain works. You can’t sell a $200-per-session physical therapy package when the answer is that the patient’s body was never broken. You can’t justify a $3,000 MRI when the finding it reveals is present in the majority of pain-free people walking around right now. The chronic pain industry isn’t a conspiracy—it’s a system full of well-meaning people operating inside a model that was never designed to ask the right question. They’re trained to find and fix. So that’s what they do. And millions of people stay in pain because of it.
If you’re someone who has been told you need surgery, who has been through rounds of physical therapy that didn’t hold, who has spent thousands on treatments that helped for a while and then stopped—I’m not telling you your pain isn’t real. It is absolutely real. What I’m telling you is that the cause is almost certainly not what you’ve been told. Your brain learned this pain. And what the brain learns, it can unlearn. That’s not wishful thinking. That’s neuroscience. And it’s the most hopeful thing anyone will ever tell you about your body.
