Why Chronic Pain is More than Just Inflammation
If you’ve had back, neck, shoulder, hip, knee, or foot pain for months—or even years—you’ve probably heard the word inflammation.
And inflammation can absolutely be part of the problem.
But chronic pain is often more complicated than that.
Pain can be affected by the health of your joints and tissues, your nervous system, strength and movement, previous injuries, sleep, stress, and other factors.
That helps explain something we see frequently:
The place that hurts isn't always the whole story.
What Is Chronic Pain?
Chronic pain is generally defined as pain that lasts or keeps coming back for more than three months.
Unlike a new injury, chronic pain may no longer be explained by one simple problem.
The International Association for the Study of Pain (IASP) recognizes chronic pain as a complex experience that can involve biological, psychological, and social factors. [1]
That doesn't mean chronic pain is "in your head."
The pain is real.
It means that pain is more complicated than simply measuring how much damage or inflammation exists in one part of the body.
Pain Starts as a Protective System
Pain has an important job.
Imagine you step on something sharp.
Pain tells you to move your foot.
Or you injure your shoulder and certain movements hurt. Pain may encourage you to protect that area while it heals.
In situations like these, pain acts like an alarm system.
But sometimes the alarm doesn't settle down as expected.
When pain continues for a long time, the way the body processes pain signals can change.
The nervous system may become more responsive to certain signals. Researchers use terms such as sensitization and nociplastic pain to describe some of these changes. [2]
This does not mean every person with chronic pain has central sensitization. In fact, researchers continue to debate exactly how central sensitization should be identified and how much it contributes to chronic pain in humans. [3]
But we do know something important:
Pain intensity and tissue damage don't always match perfectly.
Your MRI Doesn't Tell the Whole Story
This is one of the most important things to understand about chronic musculoskeletal pain.
An X-ray or MRI can be extremely useful.
But imaging shows us structure.
It doesn't measure your pain.
A well-known systematic review looked at spine imaging in people who had no back pain at all.
Researchers found that disc degeneration, disc bulges, and other age-related changes were common even in people without symptoms. [4]
For example, disc degeneration was found in:
37% of pain-free 20-year-olds
52% of pain-free 30-year-olds
68% of pain-free 40-year-olds
80% of pain-free 50-year-olds
88% of pain-free 60-year-olds
That doesn't mean MRI findings should be ignored.
Some findings are very important and may help explain a person's symptoms.
It simply means an MRI should be interpreted along with your symptoms, history, physical examination, strength, movement, and other findings.
We treat people—not pictures.
Why Doesn't Reducing Inflammation Always Fix the Pain?
If chronic pain were always caused by inflammation alone, reducing inflammation should eliminate the problem.
Sometimes it does help.
But many people have experienced a familiar cycle:
Pain starts.
They rest.
They use ice or anti-inflammatory medication.
They feel better.
They become active again.
And the pain comes back.
Why?
Because inflammation may have been only one piece of the puzzle.
The original injury may have also resulted in weakness, reduced mobility, altered movement, loss of tolerance to activity, or changes in how pain signals are processed.
Simply reducing inflammation doesn't necessarily correct those problems.
Chronic Pain Can Have Several Contributors
There isn't one explanation that applies to everyone with chronic pain.
For one person, an irritated joint may be the main problem.
For another, it may be an unhealthy tendon.
Someone else may have weakness and poor movement following an old injury.
And another person may have a combination of several factors.
Chronic pain can be influenced by:
Joint and tissue health
Arthritis, tendon problems, previous injuries, and other tissue changes can contribute to pain.
Nervous system sensitivity
In some chronic pain conditions, the way pain signals are processed may become altered or more sensitive.
Strength and movement
Weakness, loss of mobility, and reduced tolerance to activity may make everyday movements more difficult.
Sleep
Poor sleep and pain can influence one another, creating a difficult cycle.
Stress and emotional health
Stress doesn't mean pain is imaginary. But the brain and nervous system are part of the pain system, and stress can influence how pain is experienced.
Previous injuries
An injury that happened years ago may leave behind changes in strength, mobility, movement, or sensitivity.
That's why treating chronic pain often requires looking at the whole picture.
What Does the Research Say About Treating Chronic Pain?
Modern guidelines increasingly recommend a broader approach rather than relying on one treatment alone.
For example, the World Health Organization's guideline for chronic primary low back pain recommends an individualized approach that may include education, exercise, certain physical treatments, psychological approaches, and appropriate medications. [5]
The WHO specifically includes exercise programs and some physical therapies—including spinal manipulation and massage—among the nonsurgical options that may be appropriate for chronic primary low back pain. [5]
The important point isn't that everyone needs every treatment.
They don't.
The point is that chronic pain often needs to be approached from more than one direction.
Our Approach at Thrive
At Thrive Chiropractic & Functional Health, our goal isn't simply to ask:
"Where does it hurt?"
We also want to ask:
"Why might it still be hurting?"
That starts with understanding your history, your symptoms, how you move, what makes the problem better or worse, and what you've already tried.
Depending on what we find, your care may include:
Manual therapy
Targeted exercise and rehabilitation
The right approach depends on the person and the condition.
There is no single treatment that fixes every type of chronic pain.
The Bottom Line
Inflammation matters.
But when pain has been present for months or years, inflammation may only be one part of the story.
The health of the tissue, strength, movement, previous injuries, activity levels, sleep, and the nervous system can all influence the pain experience.
That's why repeatedly treating inflammation without looking at the bigger picture may not be enough.
If you've been struggling with chronic back, neck, shoulder, hip, knee, or foot pain and feel like you've tried everything, the next step may be figuring out what is actually contributing to your pain.
At Thrive Chiropractic & Functional Health, that's where we start.
Schedule a Complimentary Pain Relief Consultation to talk with us about what's going on, what you've already tried, and whether our approach may be right for you.
Frequently Asked Questions
Q. Is chronic pain always caused by inflammation?
A. No. Inflammation can contribute to pain, but chronic pain can involve several factors, including tissue health, previous injuries, strength and movement, nerve function, sleep, stress, and changes in pain processing.
Q. What is considered chronic pain?
A. Pain is generally considered chronic when it lasts or repeatedly returns for more than three months. [1]
Q. Can I have pain even if my MRI doesn't show major damage?
A. Yes. Imaging findings and pain don't always match perfectly. Research has found degenerative changes, including disc degeneration and bulging discs, in many people who have no back pain at all. [4] An MRI is one piece of information and should be interpreted along with your symptoms and physical examination.
Q. Does chronic pain mean the pain is "in my head"?
A. No. Pain is a real experience involving the brain, nerves, and body. Psychological and social factors can influence pain, just as sleep, inflammation, injury, movement, and physical health can. Recognizing that pain has multiple influences does not mean the pain is imaginary.
Q. What is central sensitization?
A. Central sensitization is a scientific term describing increased responsiveness of pain-related neurons within the central nervous system. [2] However, it cannot currently be directly diagnosed in people during a routine clinical examination, and researchers caution against assuming that all chronic pain is caused by central sensitization. [3]
Q. Can exercise help chronic pain?
A. For many musculoskeletal conditions, appropriate exercise can be an important part of treatment. Exercise can help improve strength, mobility, confidence in movement, and tolerance to activity. The type and amount of exercise should be appropriate for the person's condition and abilities.
Q. Can chiropractic care help chronic back pain?
A. Spinal manipulation is included by the World Health Organization as one of several nonsurgical physical treatments that may be offered as part of care for adults with chronic primary low back pain. [5] It should be considered as part of an individualized treatment plan rather than viewed as the answer for every patient.
Q. What is the best treatment for chronic pain?
A. There isn't one treatment that works for every person. The best approach depends on what is contributing to the pain. Treatment may involve education, exercise, rehabilitation, manual or physical therapies, medication when appropriate, lifestyle changes, or a combination of approaches.
References
1. International Association for the Study of Pain (IASP). Definitions of Chronic Pain Syndromes. IASP. Chronic pain is defined as pain that persists or recurs for longer than three months.
2. International Association for the Study of Pain (IASP). Pain Terminology. Definitions of sensitization, central sensitization, and nociplastic pain.
3. Velasco E, Flores-Cortés M, Guerra-Armas J, et al. Is chronic pain caused by central sensitization? A review and critical point of view. Neuroscience & Biobehavioral Reviews. 2024;165:105886. doi:10.1016/j.neubiorev.2024.105886.
4. Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR American Journal of Neuroradiology. 2015;36(4):811-816. doi:10.3174/ajnr.A4173.
5. World Health Organization. WHO Guideline for Non-Surgical Management of Chronic Primary Low Back Pain in Adults in Primary and Community Care Settings. Geneva: World Health Organization; 2023.
This article was written by Dr. Tim St. Onge, DC a board certified Chiropractor and instructor for the Academy of Shockwave Excellence.
This article is for educational purposes and is not intended to diagnose or treat a specific medical condition.
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