Therapy for Chronic Back Pain: When Medical Tests Don’t Explain Your Pain

Your back has been hurting for months. Maybe years.

You've had the imaging—MRIs, X-rays, maybe a CT scan. The results show some normal age-related changes, perhaps a bulging disc that "shouldn't cause this much pain," or nothing remarkable at all.

Your doctor says your spine looks fine. Physical therapy helped a little, but the pain keeps coming back. Medications barely touch it. You're starting to wonder if you'll ever feel normal again.

Here's what no one may have told you: When medical tests don't explain your level of back pain, it's often a sign that your pain has a significant neuroplastic component. This doesn't mean it's imaginary. It means your brain's alarm system has learned to create pain even when there's no longer structural damage that requires that alarm.

And that's actually hopeful news because it means therapy can help.

At Aspire Counseling, we offer Counseling for Chronic Pain that addresses the nervous system patterns keeping back pain stuck. Back pain is one of many types of chronic pain where understanding the brain-pain connection makes all the difference.

Why Does My Back Still Hurt When Imaging Shows Nothing Wrong?

This is the question that brings most people to therapy for back pain. If your spine looks fine on imaging, why are you in so much pain?

Here's what's happening:

Your brain creates pain based on what it perceives as dangerous—not based on actual tissue damage. When you first injured your back (or when pain first started), your brain learned to create pain to protect that area. That was helpful at the time.

But even after tissues heal, your brain can keep creating pain. It's learned that certain movements, positions, or activities are dangerous. So whenever you do those things, your brain sounds the alarm—pain.

This is neuroplastic pain. It's real pain. You're actually feeling it in your back. But the source isn't structural damage. It's your brain's learned response.

Several things reinforce this pattern:

Fear of movement. You're afraid certain activities will hurt or cause damage, so you avoid them. This teaches your brain that those activities ARE dangerous, which makes it create even more pain when you attempt them.

Protective guarding. You unconsciously tense muscles around the painful area to protect it. But this constant tension actually creates more pain over time.

Stress amplification. When you're stressed, your back pain gets worse. This isn't coincidence—stress puts your nervous system on high alert, which makes your brain more likely to interpret signals as dangerous.

The imaging being normal is actually good news. It means your spine is structurally sound. The pain isn't coming from something broken that needs surgery or procedures. It's coming from learned patterns—and those can change.

How Does Fear of Movement Keep Back Pain Stuck?

Fear of movement (kinesiophobia) is one of the biggest factors keeping chronic back pain persistent.

Here's how it works:

Your back hurt when you bent over to tie your shoes. So your brain learned: bending = danger. Now, every time you need to bend, you feel a spike of fear. Your muscles tense protectively. And that tension often creates the very pain you were afraid of.

You start avoiding bending. You avoid lifting things. You stop exercising. You move very carefully, always bracing yourself.

This avoidance has two major effects:

It sensitizes your nervous system. The less you move, the more sensitive you become. Activities that should be fine start triggering pain because your brain hasn't had evidence that they're safe.

It weakens your body. When you move less, your muscles get weaker. Your range of motion decreases. This makes movement genuinely harder, which reinforces your fear.

The cycle feeds on itself: Fear → Avoidance → Increased sensitivity → More pain → More fear.

Breaking this cycle doesn't mean ignoring pain or pushing through. It means gradually teaching your brain that movement is safe. This happens through:

Reframing what pain means. Pain during movement doesn't always mean damage. Sometimes it's just your brain being overprotective. Learning to distinguish between "pain as alarm" and "pain as sensitivity" is key.

Gradual exposure. You start with movements that feel safer and gradually work up to things you've been avoiding. Each time you move without catastrophe, you give your brain new information: "This is actually okay."

Paying attention differently. Instead of moving with fear and tension, you practice moving with curiosity. What does this actually feel like? Can you notice sensation without immediately interpreting it as danger?

Working with the part of you that's scared. That fear is trying to protect you. We don't ask it to go away—we help it understand that you don't need that level of protection anymore.

What Is the Protection Pattern That Makes Back Pain Worse?

When something hurts, your body naturally tries to protect that area. This is helpful for acute injuries. But with chronic back pain, these protective patterns often become the problem.

Here's what protection looks like:

Muscle guarding. You unconsciously hold tension in muscles around the painful area. Your back stays tight, your shoulders hunch, your core braces. This is supposed to protect you, but constant tension creates its own pain.

Altered movement patterns. You start moving differently to avoid pain. Maybe you twist from your hips instead of your spine. Or you favor one side. These compensations put stress on other areas and often create new pain.

Shallow breathing. When you're bracing against pain, you often breathe shallowly. This keeps your nervous system activated and makes everything more tense.

Hypervigilance. You constantly monitor your back—checking for pain, worried about doing something wrong. This vigilance keeps your nervous system on high alert, which amplifies pain signals.

The protection pattern made sense at first. Your brain was trying to keep you safe. But now it's stuck, and it's actually making things worse.

Therapy helps you:

Notice when you're guarding. Most people don't realize how much tension they're holding. Learning to notice it is the first step to releasing it.

Practice letting go gradually. You can't just force yourself to relax. But you can practice small moments of releasing tension and breathing fully. As your nervous system learns it's safe to let go, the pattern naturally changes.

Understand that protection isn't always helpful. Your brain means well, but overprotection keeps you stuck. When you can acknowledge the protective part while also helping it understand you don't need that much protection anymore, things shift.

How Do You Retrain Your Brain's Response to Back Pain?

Retraining your brain isn't about positive thinking or pretending pain doesn't exist. It's about giving your brain new information so it can learn different responses.

Here are the main approaches we use:

Pain Reprocessing Therapy (PRT). This specifically addresses neuroplastic pain. You learn to pay attention to sensations in your back with curiosity instead of fear. You actively remind your brain that these sensations are safe, not dangerous. Over time, your brain learns to turn down the alarm.

Internal Family Systems (IFS). We work with the parts of you that relate to back pain—the part that's scared of reinjury, the part that's angry this is happening, the part that's trying to push through. When these parts work together instead of fighting, your nervous system settles and pain often decreases.

Somatic tracking. You practice noticing actual sensations without immediately labeling them as "pain" or "danger." There's pressure. There's tightness. There's warmth or coolness. When you can observe sensations without catastrophizing, they often change or decrease.

Gradual movement exposure. You slowly reintroduce movements you've been avoiding, paying attention to what's actually happening rather than what you fear will happen. Each successful movement teaches your brain: "This is safe."

Understanding isn't enough—practice is essential. Your brain learned these pain patterns through experience. It needs new experiences to learn something different. That's why practice between sessions is so important.

Most people start to see changes within a few weeks to a few months. Some notice shifts quickly—less fear, more confidence moving. Others take longer to see significant pain reduction. Progress is rarely linear, but it is possible.

Can I Get Back Pain Therapy in Lee's Summit or Online?

Yes. Therapy for chronic back pain is available both in-person and online throughout Missouri.

In-person sessions at our Lee's Summit office work well for people who prefer face-to-face therapy and live in or near the Kansas City metro area.

Online therapy is equally effective for back pain. The work is about changing how your brain interprets signals and how you respond to pain—which translates perfectly to video sessions. Plus, when your back is hurting, not having to drive to an office can be a real advantage.

Your first step is a free consultation. You'll talk about your back pain history, what you've already tried, and whether our approach makes sense for your situation. No pressure, no commitment—just a conversation about possibilities.

Your back pain doesn't have to be permanent. When medical tests don't explain your pain, that often means your brain's alarm system is stuck—and that can change.

Schedule your free consultation by contacting us online or calling 573-328-2288.

This article was written by the clinical team at Aspire Counseling, a therapy practice in Lee's Summit and Columbia, Missouri, specializing in chronic pain, anxiety, and trauma. We use evidence-based approaches including Pain Reprocessing Therapy (PRT) and Internal Family Systems (IFS) to help clients with chronic back pain. Available in person in Lee's Summit and online throughout Missouri.