By Annalisa Brown, L.Ac.
AB Acupuncture, 118 West 72nd Street
I hear some version of this in my acupuncture practice all the time.
My answer is usually: Maybe. But let’s not stop there.
MRIs are extraordinarily useful. They can identify disc herniations, arthritis, stenosis, degeneration and other structural changes that absolutely can matter. But an MRI is a picture of your anatomy. It isn’t a pain meter.
One of the more surprising findings in pain research is just how common some scary-sounding MRI findings are in people who feel perfectly fine.
A large systematic review looked at spinal imaging from more than 3,000 people who had no back pain at all. By age 50, about 80% showed disc degeneration and 60% had at least one disc bulge. Those findings became even more common with age.
That doesn’t mean your MRI finding is irrelevant. Research also shows that some degenerative findings are more common in people with back pain than in people without it.
It means the picture needs context.
Two people can have remarkably similar-looking spines on an MRI while one is playing tennis and the other can barely put on a sock.
So when someone arrives in my office with an MRI report in hand, I’m interested in what it says. But I’m also interested in another question:
What is actually contributing to this person’s pain?
One Piece That Often Gets Overlooked: The Muscles
When we talk about back and joint pain, the conversation tends to focus heavily on bones, discs and joints.
But there’s an enormous piece in between: the muscles that have to make that structure work.
Your spine isn’t a stack of blocks sitting motionless on a shelf.
Every time you walk, bend over, reach, twist, carry groceries or sit at your desk, muscles have to continually coordinate to stabilize you and respond to changing loads. Our bodies are built to accommodate movement, compression and anatomy that is rarely textbook-perfect.
When muscles aren’t doing their jobs well, however, the equation can change.
One muscle may be chronically overworking because another isn’t contributing enough. Your body may have developed a compensation after an old injury and simply kept using it. A muscle may have difficulty activating or relaxing appropriately when the movement requires it.
That’s why I pay so much attention to muscle function, rather than assuming that the painful spot is necessarily where the problem begins.
It’s also one reason I use motor point acupuncture.
Motor points are specific areas where a motor nerve enters a muscle. I can use targeted needling, sometimes combined with gentle electrical stimulation, as part of treatment aimed at changing muscle tone and neuromuscular activation.
I’m not trying to make your MRI prettier.
I’m trying to see whether we can make you function better with the anatomy you have.
But Muscles Aren’t Always the Whole Story
There’s another piece of persistent pain that we understand much better today than we did even a couple of decades ago: sometimes the nervous system itself becomes part of the problem.
Pain is protective. If you put your hand on a hot stove, you want an alarm system capable of getting your hand away from it immediately.
But alarm systems can become overly sensitive.
In some people with persistent pain, the nervous system can become sensitized, producing a stronger protective response than the current state of the tissues alone would predict. Pain can persist after an injury has healed, fluctuate in ways that don’t correspond neatly to structural changes, or become associated with movements and sensations the brain has learned to interpret as threatening.
That does not mean the pain is imaginary.
The pain is real.
It means pain and tissue damage aren’t always the same thing.
For patients whose symptoms suggest that this may be part of the picture, I sometimes incorporate principles from Pain Reprocessing Therapy, or PRT.
PRT uses education and specific techniques to help appropriately selected patients change the way they interpret bodily sensations that have become associated with danger.
And the research is fascinating.
In the Boulder Back Pain Study, 151 adults with chronic back pain were randomized to PRT, a placebo treatment or usual care. After treatment, 66% of those receiving PRT were pain-free or nearly pain-free, compared with 20% in the placebo group and 10% receiving usual care.
Researchers recently went back to see how these patients were doing five years later. Among those who participated in the follow-up, 55% of the PRT group were still nearly or completely pain-free, compared with 26% of the placebo group and 36% of the usual-care group. The researchers also note important limitations, including that the original participants generally had low-to-moderate chronic back-pain severity.
That doesn’t mean 66% of everyone with back pain can think their pain away. It doesn’t mean a herniated disc can’t hurt. And it certainly doesn’t mean every pain problem is neuroplastic.
It means that for some people, nervous-system processing is an important part of the pain picture—and it’s worth considering alongside muscles, joints, discs and other structures.
So Is It the Disc, the Muscle or the Nervous System?
Sometimes the answer is: yes.
Real bodies don’t divide themselves neatly into specialties.
You can have a genuine disc bulge, muscles that aren’t adapting well to the demands being placed on them, and a nervous system that has become increasingly protective after months or years of pain.
My job isn’t to decide before I meet you that your pain is structural, muscular or neuroplastic.
It’s to work through the possibilities.
And that brings me to something else I tell patients fairly often.
Some people come to me specifically because they’re trying to avoid an injection, procedure or surgery. I’m happy to help them explore conservative options when that’s medically appropriate.
But avoiding surgery at all costs is not the goal.
If we’ve addressed the muscles that could reasonably be contributing to the problem, worked on function, considered and addressed a possible neuroplastic component, and you’re still significantly limited by pain, that’s useful information too.
It may be time to go back to the orthopedist, neurologist or spine specialist and have a more serious conversation about whether an injection, procedure or surgery is appropriate.
Sometimes conservative treatment solves the problem.
Sometimes it solves part of the problem.
And sometimes working through the things we can change helps clarify that a structural problem really does need a structural solution.
The goal isn’t to prove your MRI wrong. It’s to make sure we’ve asked enough questions before assuming the MRI tells us the whole story.
Annalisa Brown, L.Ac. is the owner of AB Acupuncture, located at 118 West 72nd Street on the Upper West Side. Her practice combines traditional acupuncture with motor point acupuncture, Pain Reprocessing Therapy principles and a neuroscience-informed approach to persistent pain.
