The Illusion of Injury: Understanding Pain That Feels Real but Isn’t

When Pain Feels Like Something It's Not

We all understand the following scenario.

A young man in his 20s rushes into the emergency room, clutching his chest. "I'm having a heart attack! Please help! I can't breathe. My chest is in agony! I feel like I’m suffocating and about to pass out!"

The medical team springs into action. An EKG is ordered, along with blood tests to check for cardiac enzymes—markers that appear when heart cells die due to a heart attack. Minutes stretch into eternity as the patient waits.

Then, the results come back: completely normal.

With time, fluids, and deep breaths, his body begins to calm. His breathing returns to normal. His chest pain fades. He wipes the sweat from his forehead, relieved but confused.

"How could I feel like I was having a heart attack… but not actually have one?"

The doctor explains: it was an anxiety attack. The symptoms mimicked a heart attack, but there was no real heart damage. Relieved, but now diagnosed with an anxiety disorder, the patient at least has an explanation.

This is a common scenario where one condition (anxiety) resembles another (a heart attack), requiring a full medical workup to rule out the worst-case scenario.

But what happens when pain does the same thing?

The Case of Back Pain That Won’t Go Away

Now, imagine a different situation.

A person takes a fall, landing hard on their lower back. Or maybe they lift something heavy and feel a sharp pain shoot down their spine. The pain is severe—they can barely move.

An ambulance is called because no one knows how bad the injury is. Maybe there’s a broken bone. Maybe something in the spine is damaged. And when it comes to the spine, no one takes risks.

I experienced this firsthand. While on vacation in Hawaii with my two kids and my son’s friends, one of the boys slipped and landed hard on his back while getting onto a boat. He screamed in pain.

When we got to the dock, he could barely walk. I had him lie down, checked his legs—everything seemed fine, but he said the pain was unbearable. I was fairly certain—but only fairly—that he had no broken bones and no serious spinal damage. But “pretty sure” is a long way from absolutely sure, and in situations like this, that gap matters.

I could have been cocksure, but confidence without certainty is a dangerous thing. After all, there’s a reason we call overconfident people cocky—because they’re often wrong. I wasn’t about to make that mistake.

So, I did what any cautious person would do: I erred on the side of safety—just in case.

We spent hours in the ER, waiting for a CT scan. Finally, the results came back: normal. No broken bones. No damage to the spine. Nothing concerning.

The good news? By the next morning, my son’s friend was completely fine. The pain vanished as quickly as it had appeared.

But what if it hadn’t?

What if, despite normal scans, the pain had persisted for weeks? Months? Years?

When Negative Test Results Don’t Reassure

For the anxiety patient, once he knows it was an anxiety attack, he no longer worries about his heart. He learns to recognize the symptoms and understands that he’s not dying.

But for the chronic back pain patient, the story doesn’t end with normal MRI and CT results.

Even when tests show no structural damage, patients are often told:

It must be your facet joints.

Maybe it’s your SI joint.

Your piriformis muscle is tight.

Your spine is slightly misaligned.

Your leg length is uneven.

And slowly, a new fear takes root.

"There must be something wrong with my back."

Even though science tells us that most chronic low back pain resembles structural damage without actually being caused by it, patients continue to believe that their spine is broken.

And this belief makes the pain worse.

The Medical Trap: When Labels Make Pain Worse

For decades, doctors have used terms like "back sprain" or "strain" to describe back pain when MRIs and X-rays showed nothing serious. The assumption was that a muscle pull or tear was causing the pain.

But modern science has thoroughly debunked this idea.

MRIs are extremely sensitive and would show muscle damage if it were there.

Actual muscle tears are rare and heal relatively quickly.

Yet, despite all this knowledge, patients are still being told:

"Your back must be weak."

"Be careful with twisting, bending, lifting."

"You need to protect your spine."

The result? Fear.

And fear of movement leads to even more pain.

We Need a New Word for Chronic Pain

Just as "anxiety disorder" gives a name to heart palpitations and breathlessness without a heart condition, we need a new term for chronic pain that resembles tissue damage but isn’t caused by it.

Right now, patients without structural injuries are left in limbo—trapped in uncertainty, believing their spine is broken because they don’t have the language to understand what’s really happening.

Two potential terms already exist in medical literature:

Neuroplastic pain

Nociplastic pain

Both terms describe pain that is real, but not caused by tissue damage.

The challenge? These words are still unfamiliar to most people. But if they become widely recognized, they could change lives.

The First Step Toward Healing

If you are struggling with chronic pain, your journey to recovery begins with understanding.

Your pain is real.

Your spine is not broken.

You are not fragile.

Science tells us that pain does not always mean damage. Just like an anxiety attack mimics a heart attack without harming the heart, chronic pain can mimic an injury—without actual injury.

The key to breaking free? Relearning to trust your body.

And it all starts with the right words.