Why Do I Hurt When My Scans Are 'Clear'?

It is the most confusing part of chronic pain. You bump your arm lightly, but it feels like you've been hit with a hammer. You have a stressful day at work, and suddenly your old back injury flares up. You get a hug, and it feels like burning.
Your doctor orders an MRI. It comes back "clean." Your X-rays show "mild wear and tear," nothing that explains the agony you are in.
This is usually the moment patients are told: "It's just stress" or "You need to relax."
But the pain is 100% real. It isn't tissue damage. It is central sensitization—a recognized medical condition where your nervous system amplifies pain signals.

Understanding Central Sensitization

Think of your nervous system like a car alarm.
Normal Pain System: You kick the tire, the alarm chirps. This is helpful. It tells you to stop kicking the tire.
Central Sensitization: The alarm system is malfunctioning. Now, a leaf falls on the hood, and the siren screams. The wind blows, and the siren screams.
In central sensitization, your brain and spinal cord have turned the "volume knob" on your pain receptors all the way up. Your body isn't "broken"—it is over-protected. It is interpreting safe signals (like light touch, movement, or weather changes) as dangerous threats.

This is not "all in your head." Central sensitization involves real structural, functional, and neurochemical changes in your central nervous system. Research from institutions like the Mayo Clinic has shown that in conditions like fibromyalgia—a prototypical central sensitization syndrome—there are measurable imbalances in brain neurotransmitters that amplify pain signals while reducing the brain's natural pain-dampening systems.

How Did We Get Here?

Central sensitization often starts with a real injury or a prolonged period of high stress.
The Trigger: You get injured, experience an infection, or endure a traumatic time.
The Learning: Your nervous system gets good at detecting danger. It becomes more sensitive to keep you safe.
The Stuck Switch: The original injury heals, but the nervous system forgets to turn the sensitivity off. It stays in "high alert" mode.
When persistent or repeated pain signals from the body cause alterations in how the brain and spinal cord process sensory information, the result is amplified pain perception even in the absence of ongoing tissue damage. This explains why pain can extend beyond the original injury site, move around your body, and occur in patterns that don't match typical anatomy.
This mechanism is the engine behind fibromyalgia, chronic fatigue syndrome, many cases of chronic back pain, irritable bowel syndrome, and some presentations of Long COVID. It is why "pushing through" often makes symptoms worse rather than better.

What Central Sensitization Feels Like

Patients with central sensitization typically experience:

- Allodynia: Things that normally don't hurt now cause pain (like light touch or clothing against skin)
- Hyperalgesia: Things that used to hurt a little now hurt much more
- Widespread, migratory pain: Pain that moves around and doesn't follow typical injury patterns
- Sensory hypersensitivity: Increased sensitivity to light, sound, odors, or temperature
- Associated symptoms: Brain fog, disturbed sleep, chronic fatigue, anxiety, or depression

These symptoms are often vague, wax and wane unpredictably, and may be unrelated to your activities—which is why traditional diagnostic tests often come back "normal."

You Can Turn the Volume Down

The most important thing to know is that central sensitization is reversible. Just as your nervous system learned to amplify pain, it can learn to process signals normally again.

At Whole Health Rheumatology, treating central sensitization is one of our specialties. We don't just mask symptoms with painkillers (which often stop working and can even worsen central sensitization). We help you recalibrate your nervous system.

Pain Reprocessing: We use evidence-based approaches to help your brain relearn that "hurt does not equal harm." Recent research has shown that psychological treatments focused on changing beliefs about pain—teaching patients to reconceptualize pain as reversible brain activity rather than tissue damage—can produce substantial and lasting pain relief. In one major study, 66% of patients with chronic back pain who received this type of therapy were pain-free or nearly pain-free after treatment, with benefits maintained at one-year follow-up.

Sleep Lifestyle: A tired, stressed brain is a sensitive brain. We work to rebuild your sleep foundation, manage stress, and promote healthy movement patterns to lower your nervous system's threat level.

Medical Management: When necessary, we use targeted non-opioid medications that work on the central nervous system—such as certain antidepressants and nerve-stabilizing medications—to help dampen excessive nerve firing. These medications can provide a window of relief that allows you to engage more effectively in other therapeutic approaches. Importantly, traditional painkillers and opioids are generally less effective for central sensitization and may even worsen symptoms over time.

Multimodal Approach: The most effective treatment combines education, cognitive and behavioral strategies, appropriate physical activity, stress reduction techniques, and when needed, centrally-acting medications. This comprehensive approach addresses the multiple factors that maintain central sensitization.

Your Hardware is Fine. It's a Software Update.

If you are tired of chasing structural diagnoses for a nervous system problem, it's time for a different approach. Central sensitization is a recognized medical condition with a growing body of scientific evidence supporting effective treatments. You deserve care that addresses the actual source of your pain.

To learn more, listen to my podcast "Mind Your Fibromyalgia"…

Schedule your evaluation today. Let’s start turning the volume down together.