Have You Been Told You Should Be in Pain?
Something I see in my clinic all the time: a person walks in already convinced their body is broken. Not because of how they feel, but because of what they've been told. A scan report full of alarming words. A practitioner who said their neck was "a mess," "full of knots," or "the worst I've seen this week." An x-ray described as "bone on bone," or a back that supposedly looks "like an 80-year-old's."
They often hurt more after being told these things, not less. And that isn't a coincidence. What your health care providers say, and the exact words they choose, can shape how much pain you feel. In a lot of cases, people have essentially been told they should be in pain, and their nervous system took the message to heart.
This is one of the most important and least discussed ideas in modern pain science, and it sits right at the centre of Dr. Howard Schubiner's book Unlearn Your Pain. Let me walk you through it, because once you understand it, you become a much harder person to accidentally harm with words.
Key Points:
Pain is an output produced by the brain as a danger signal. Anything that convinces the brain the body is fragile or damaged can turn that signal up.
Scary language from a trusted expert can act as a nocebo, the opposite of a placebo, and directly worsen pain and anxiety.
"Abnormal" scan findings are extremely common in people with no pain at all. They are usually normal age-related changes, not a diagnosis.
Most people living with chronic pain do not have tissue damage driving it.
The way a finding is framed matters enormously, which is why part of my job is to reframe your tissue quality in a way that calms your nervous system rather than frightening it.
First, why do words affect pain at all?
Because pain is not a damage meter. It is an alarm to a threat. Its purpose is to protect you, and the brain decides how loudly to sound that alarm based on how much danger it perceives you're in. Dr. Schubiner's central point in Unlearn Your Pain is that this danger assessment draws on everything: your past injuries, your stress levels, your emotions, and crucially, your beliefs about what is happening in your body.
So when an authority figure in a white coat or a treatment room tells you that your spine is degenerating, that you have a tear, or that your muscles are dangerously tight, the brain files that under "serious threat." A threatened brain produces more pain, which then seems to confirm the scary story, which raises the threat level again. It's a self-reinforcing loop, and it can be kicked off by a single sentence.
The nocebo effect: "I shall harm"
Most people have heard of the placebo effect, where a positive expectation improves how you feel. Fewer people know it has an evil twin. The nocebo effect (Latin for "I shall harm") is when negative expectations make symptoms worse. And in pain care, the words of a clinician are one of the most powerful triggers there is.
This has been tested directly. In a 2023 randomised controlled trial, researchers had people watch a short educational video about low back pain. One group heard the information delivered in negative language, the other heard neutral or positive language. The negative-language group came away with meaningfully higher anxiety and more unhelpful beliefs about their backs, from nothing more than word choice. A 2014 meta-analysis in the journal Pain similarly found that verbally induced nocebo effects can be substantial. Your expectations aren't just a mood. They are a genuine prognostic factor: people who expect to recover tend to recover better.
Your scan is probably "abnormal," and that's completely normal
Here is the part that surprises people most. If you took a large group of people who have zero pain, scanned their spines, knees, and shoulders, and read out the reports, they would sound terrifying. Yet these people feel fine.
The evidence for this is overwhelming:
Spines. A landmark 2015 review by Brinjikji and colleagues pooled imaging from over 3,000 people with no back pain. Disc degeneration showed up in 37% of pain-free 20-year-olds and in 96% of pain-free 80-year-olds. Disc bulges appeared in 30% of pain-free 20-year-olds, rising to 84% by age 80. In other words, "degeneration" and "bulging discs" are closer to the rule than the exception, and most of the people who have them feel nothing.
Knees. In a well-known study published in the New England Journal of Medicine, most of the meniscal tears found on knee MRI, about 6 in 10, were in people who had experienced no knee pain, aching, or stiffness at all in the previous month. A separate study that scanned the knees of pain-free adults found abnormalities in 97% of the knees they examined.
Shoulders. In a 1995 study, Sher and colleagues scanned the shoulders of 96 people who had no shoulder pain at all. They found rotator cuff tears in 34% of them overall, and in 54% of those over 60. Every one of these people was pain-free.
None of this means structural problems are never real or never need care. Sometimes they do, and ruling out serious issues matters. But it does mean that finding "wear and tear" on a scan tells you shockingly little about why you hurt. In fact, one 2013 study of people with chronic low back pain found that the amount of disc degeneration on their MRIs had no relationship to how much pain or disability they actually had.
But my report used such scary words
This is where the language problem really bites. Radiology reports and hands-on assessments are full of words that sound catastrophic but describe ordinary biology. "Degeneration" mostly means normal age-related change. Think of it as the inside-the-body equivalent of grey hair and wrinkles. Nobody panics about grey hair, yet we've been trained to panic about a "degenerative" disc, even though both are just signs of a body that has lived a life.
The same goes for what you're told by hand. I regularly meet people whose massage therapist, chiropractor, or physiotherapist told them their neck is "so tight," or that they have "a huge knot," or "the worst muscle tension I've ever felt." Even when that's said with kind intent, the person hears: my body is badly damaged and stuck this way, I will never be able to get better. That belief itself can ramp up guarding, tension, and the output of pain. The description becomes part of the problem.
If the tissue isn't the cause, what is?
This is the heart of Schubiner's work and, in my experience, the more accurate picture for most chronic pain. When pain has hung around long after any injury should have healed, and when the scans don't match how much someone is suffering, the pain is often being generated by learned neural pathways in the brain rather than by ongoing damage in the tissue (often referred to as neurogenic or neuroplastic pain). The brain has, in effect, learned the pain the way it learns any habit, and it keeps the danger alarm running.
The hopeful flip side, which Schubiner emphasises again and again, is that anything the brain can learn, it can also unlearn. But that process depends on lowering the brain's sense of threat, and that is exactly what a frightening diagnosis undermines. You can't easily calm a nervous system while it believes it's carrying a broken spine.
So this is why what your practitioner says matters
A clinician's explanation is never neutral. It either raises your sense of threat or lowers it. It can act as a nocebo that feeds the pain, or as a form of reassurance that helps quiet it. The same finding, "you have some age-related changes that are totally normal and that lots of pain-free people your age also have," lands in the nervous system completely differently than "your disc is degenerating and your spine is a mess." Same body. Different words. Different outcome.
How I try to reframe things
Part of my job, before I lay a hand on anyone, is to take the fear out of the story. If your neck feels tight to me, I'm not going to tell you it's a disaster. Tightness is usually your nervous system holding a protective pattern, not evidence that the tissue is rotting or ruined. A "knot" is not a permanent lump of damage. These things reflect how your brain is currently running your muscles, which is software, not broken hardware, and software can be updated.
That's the whole basis of the work I do with SensoriMotor Repatterning (SMR). Rather than treating you as a damaged structure, I look for the protective motor-control patterns your nervous system is still holding onto and help it recognise that the threat has passed and the body is safe. I've written more about that side of things in Neuroplastic Pain and the Body's Safety System and in Feeling Safe? Chronic Pain, Athletic Performance & Safety. Reframing the words and calming the nervous system are two sides of the same coin.
How to protect yourself from a scary story
If you ever get imaging results or a hands-on assessment that frightens you, these two questions are worth their weight in gold:
Is this finding normal for someone my age? More often than not, the honest answer is yes.
How many people with no pain at all have this same finding? As the research above shows, usually a lot.
Asking these does not mean ignoring genuine medical problems. It means refusing to let ordinary, age-related, or non-threatening findings get turned into a life sentence of pain by a poorly chosen sentence.
A note on my role
To be clear about what I do and don't do: SMR is not psychotherapy, and I don't treat trauma or stress directly. What I do is find and resolve the protective motor-control patterns your nervous system is holding onto, and help take the fear out of what's happening in your body. For the emotional and belief side of pain, I'm a strong believer in the right support. Unlearn Your Pain is an excellent self-guided resource, and I keep a list of skilled Registered Clinical Counsellors and psychologists I'm happy to recommend.
You were very likely never meant to be in this much pain, and in many cases you were, in a real sense, talked into some of it. The good news is that the reverse is also possible. With the right words, the right understanding, and a nervous system that learns it's safe again, a great deal of pain can be unlearned.
Curious whether this fits your situation? Read some client success stories, check out some video demo's of volunteers being treated with SMR, visit VanSMR.ca, or book a session here.
Resources / References
Unlearn Your Pain by Dr. Howard Schubiner https://unlearnyourpain.com/unlearn-your-pain-book/
Brinjikji W, Luetmer PH, Comstock B, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015;36(4):811-816. https://pubmed.ncbi.nlm.nih.gov/25430861/
Englund M, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008. https://www.nejm.org/doi/full/10.1056/NEJMoa0800777
Horga LM, Hirschmann AC, Henckel J, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiol. 2020. https://pubmed.ncbi.nlm.nih.gov/32060622/
Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77(1):10-15. https://pubmed.ncbi.nlm.nih.gov/7822341/
Linskens FG, van der Scheer ES, Stortenbeker I, Das E, Staal JB, van Lankveld W. Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: a randomised controlled trial in healthy respondents. Patient Educ Couns. 2023;110:107649. https://pubmed.ncbi.nlm.nih.gov/36764063/
Petersen GL, Finnerup NB, Colloca L, et al. The magnitude of nocebo effects in pain: a meta-analysis. Pain. 2014;155(8):1426-1434. https://pubmed.ncbi.nlm.nih.gov/24780622/
Do more MRI findings imply worse disability or more intense low back pain? A cross-sectional study of candidates for lumbar disc prosthesis. Skeletal Radiol. 2013. https://link.springer.com/article/10.1007/s00256-013-1700-x
My overview of the neuroplastic pain model https://www.vansmr.ca/post/the-mind-body-connection-to-chronic-pain-and-other-physical-symptoms
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