Back pain is purely a mechanical, physical problem

What Patients Say

My back has been scanned, examined, and nothing specific has been found. So my pain must be physical — there must be something structural that everyone keeps missing. Maybe I need more imaging?

Where Did This Come From?

This myth comes from a deeply understandable place: when you're in real pain and no one can find a clear structural cause, it's frustrating and frightening. The assumption is that if the pain is real, there must be something physically wrong that we just haven't found yet. The answer must be more scans, different scans, better clinicians.

This leads to what some call the "diagnostic odyssey" — a progression of imaging, referrals, and second opinions in search of a structural explanation for pain that is, at its core, not primarily structural. It can take years. And every negative result increases frustration and, paradoxically, often pain.

What the Science Actually Says

Back pain is a biopsychosocial phenomenon. The "bio" part — tissue damage, structural problems — is only one of three domains. The "psycho" part (psychology, beliefs, fear, mood) and the "social" part (work, relationships, cultural context) are equally real contributors to the experience of pain. This isn't alternative medicine or a way of dismissing your pain — it's the consensus of pain neuroscience.

Chronic pain can persist and be profoundly disabling without any ongoing tissue damage. The central nervous system becomes sensitised — the volume of pain processing is turned up, responding to stimuli that wouldn't normally cause pain, and amplifying signals from the body. This is a real, measurable neurobiological process. It's not "all in your head." But it does mean that more imaging of the back won't find the answer.

What does help for this type of pain? A combination of physical activity (graded, supported), psychological approaches (particularly cognitive behavioural therapy adapted for chronic pain, and pain education), sleep management, and addressing social factors. These are less tangible than a "fix" but they're what the evidence supports.

The Verdict

Chronic back pain without a clear structural cause is not pain that hasn't been properly diagnosed — it's a recognised biopsychosocial condition with real, evidence-based treatments. More imaging rarely helps.

What To Do Instead

• Ask for a referral to a multidisciplinary pain service if you've been in pain for more than 3–6 months without adequate management
• Engage with pain psychology — CBT and acceptance and commitment therapy (ACT) have good evidence for chronic back pain
• Accept that a diagnosis of "chronic non-specific back pain" is not a failure to diagnose — it's an accurate description that guides the right treatment
• Focus on function (what you can do) rather than pain scores

← Back to all myths