Why pain can persist long after an injury heals

If your pain has lasted for months and the scan came back clear, the pain is real, but it has become a different problem from the injury that started it.

Pain that has settled in behaves differently from pain that is days old, and treating the two as though they were the same is one of the most common reasons people spend years getting nowhere.

Understanding that difference is the first step toward treatment that actually works for the kind of pain you have.

In this post:

1. Why pain can outlast an injury
2. What a scan can and can’t tell you
3. How Chinese medicine describes it
4. What it means for treatment

Why pain can outlast an injury

Pain starts out as an alarm that protects you, but when it keeps sounding for months, the alarm itself can change.

#1: Fresh pain does a useful job

• When tissue is damaged, nerve endings report it and the body makes it hurt enough that you stop using the injured part while it mends.
• This kind of pain is roughly in proportion to the damage, and it fades as the damage repairs, so a strain settles within weeks and even a broken bone has knitted within a couple of months.

#2: Months of pain retune the nervous system

• When pain signals arrive over and over for months, the spinal cord and brain get better at passing them on, the way a path becomes easier to walk the more it is used.
• Researchers call this central sensitisation, and in plain terms it means the alarm has been turned up too high.

#3: The alarm starts going off on its own

• Signals that were once too faint to notice now get through, so ordinary pressure from a waistband or a light touch can register as pain.
• The pain can linger after whatever set it off has stopped and spread beyond where it started, all without any new damage to the tissue.

In long-standing pain, the pain has become the condition itself, rather than a reliable readout of what is happening in the tissue.

What a scan can and can’t tell you

A clear scan doesn’t mean the pain is imagined, and a scan full of findings doesn’t necessarily explain it either. A 2015 review pooled imaging from more than 3,000 people who had no back pain at all.

The words on a scan report that sound so alarming when read aloud are often just a record of a few decades of living in a body. They may explain your pain or they may be incidental, which is why an image has to be read alongside the person rather than instead of them.

How Chinese medicine describes it

Chinese medicine never had the language of sensitised nerves, but it has always separated pain that has just arrived from pain that has settled in, and it treats the second by restoring flow through the whole body rather than repairing a single part.

The classical line runs 不通则痛，通则不痛: where there is no free flow there is pain, and where there is free flow there is none. In that view, it is expected that long-standing pain also shows up in sleep, digestion and mood, because a body that has been guarding itself for years is not doing so in only one place, which is much the same picture a modern pain clinic would describe.

What this means for your treatment

• Treat the system, not just the spot. If long-standing pain is largely an oversensitive nervous system rather than an unhealed wound, treatment aimed only at the tissue misses the target, which is why the same injection can help one year and do nothing the next.
• Rest helps a sprain, not long-standing pain. The nervous system recalibrates through steady, repeated input, so gentle movement that stays within what you can manage, and slowly builds on it, works better than keeping still.
• Sleep is part of the treatment. A tired nervous system is a more sensitive one, so sleeping better tends to take the edge off pain as well.
• It takes a course. One session rarely does it, because you are asking your nervous system to unlearn a habit it spent years acquiring, and in trials most of the relief from acupuncture was still there a year later.

If that sounds like your pain, the question worth asking is no longer only what is damaged, but why your nervous system is still sounding the alarm and what will persuade it to stand down. Request a first visit and we’ll talk through how long your pain has lasted and what makes it better or worse, then plan a course of treatment around it.

References

• Woolf CJ. Central sensitization: implications for the diagnosis and treatment of pain. Pain 2011;152(3 Suppl):S2–S15.
• Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology 2015;36(4):811–816.
• Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for chronic pain: update of an individual patient data meta-analysis. The Journal of Pain 2018;19(5):455–474.

This article is general information, not medical advice, and results from treatment vary from person to person. Talk to your doctor or a licensed practitioner about your own situation.