Why Chronic Pain Persists Even After Imaging, Physical Therapy, and Medication

If you’ve had X-rays, MRIs, physical therapy, injections, or medications—and you’re still in pain—you’re not alone. This is one of the most common stories we hear from people dealing with chronic pain in Central New Jersey.

What’s frustrating isn’t just the pain itself. It’s being told “everything looks normal” while your daily experience says otherwise.

The truth is uncomfortable but important: chronic pain is not the same problem as acute pain, and treating it with acute-pain tools often misses what’s really going on.

This article explains why chronic pain persists, even when conventional approaches appear thorough—and where other approaches, like acupuncture, fit into the picture.

Acute Pain vs. Chronic Pain: A Critical Distinction

Acute pain is the body’s alarm system.
Chronic pain is the alarm system malfunctioning.

Acute pain:

• Starts with tissue damage or injury
• Has a clear cause
• Resolves as tissues heal

Chronic pain:

• Persists for months or years
• Often continues after tissues have healed
• Becomes driven by the nervous system itself

This distinction matters because most medical imaging and treatments are designed for acute pain, not pain that has rewired how the nervous system processes signals.

Why Imaging Often Comes Back “Normal”

MRIs and X-rays are excellent at showing:

• Fractures
• Disc herniations
• Severe structural changes
• Advanced arthritis

They are not good at showing:

• Nervous system hypersensitivity
• Pain signal amplification
• Subtle inflammation or micro-dysfunction
• How the brain is interpreting sensory input

By the time pain becomes chronic, the original injury may no longer be the primary driver. The nervous system has learned the pain pattern—and keeps running it, even when the tissue damage is minimal or resolved.

This phenomenon is often referred to as central sensitization, a well-documented process in pain science where the brain and spinal cord become overly responsive to stimuli.

For a clinical overview of this mechanism, the National Institute of Neurological Disorders and Stroke provides a helpful explanation of how chronic pain differs from injury-based pain:
https://www.ninds.nih.gov/health-information/disorders/chronic-pain

Why Physical Therapy Helps—But Sometimes Isn’t Enough

Physical therapy is valuable. It improves strength, mobility, circulation, and biomechanics. For many people, it’s an essential part of recovery.

But when pain persists despite good PT, the limitation usually isn’t effort—it’s scope.

Physical therapy primarily addresses:

• Muscles and joints
• Movement patterns
• Structural loading

Chronic pain often involves:

• Autonomic nervous system imbalance
• Heightened pain signal gain
• Poor communication between nerves and tissues

When the nervous system remains stuck in a heightened “protective” state, even well-performed exercises can trigger pain rather than resolve it.

This is why some people feel temporarily better after PT sessions, only to regress again shortly afterward.

Why Medications and Injections Can Lose Effectiveness

Medications and injections are designed to reduce symptoms, not retrain the nervous system.

Over time:

• Pain receptors can become less responsive to medications
• Higher doses are needed for the same relief
• Side effects accumulate
• Relief becomes shorter-lived

Steroid injections may calm inflammation temporarily, but they don’t change how the nervous system processes pain signals. Once the medication wears off, the underlying pattern often resumes.

This doesn’t mean these tools are “bad.” It means they are incomplete for chronic pain.

When Pain Becomes a Nervous System Problem

In long-standing pain, the nervous system adapts—often in unhelpful ways.

Common changes include:

• Increased sensitivity to normal sensations
• Pain spreading beyond the original injury site
• Pain triggered by stress, poor sleep, or emotional strain
• Symptoms fluctuating without a clear mechanical cause

At this stage, pain is no longer just a message from injured tissue. It’s a learned pattern maintained by the brain, spinal cord, and peripheral nerves.

This is why people often say:

“Some days it hurts more for no obvious reason.”

They’re right. The driver isn’t always structural anymore.

You can read more about how this transition happens in our article
Understanding Chronic Pain Syndrome and Its Causes.

Where Acupuncture Fits into Chronic Pain Care

Acupuncture does not “fix” pain by masking it. Its role is different.

From a physiological standpoint, acupuncture is known to influence:

• Nervous system regulation
• Local and central pain signaling
• Blood flow and tissue oxygenation
• Endogenous pain-modulating chemicals

Research published in The Journal of Pain has shown acupuncture to be effective for several chronic pain conditions by modulating central pain pathways rather than simply acting locally:
https://www.jpain.org/article/S1526-5900(17)30780-0/fulltext

In clinical practice, this means acupuncture is often used to:

• Calm an overactive nervous system
• Reduce pain amplification
• Help the body “relearn” non-painful signaling
• Support longer-term resolution rather than short-term relief

At PA-OM, treatments are individualized and often incorporate electro-acupuncture, which provides controlled stimulation shown to be especially helpful in long-standing pain patterns. You can learn more about our approach on our
How It Works page.

Why Chronic Pain Requires a Different Timeline

One of the hardest truths for people in pain to hear is this:
chronic pain usually doesn’t resolve in one or two treatments.

That’s not because it’s untreatable—it’s because it took time for the nervous system to adapt into the pain pattern, and it takes time to reverse it.

Effective chronic pain care focuses on:

• Gradual nervous system recalibration
• Consistency rather than intensity
• Measuring progress over weeks, not days

This is also why expectations matter. Chronic pain recovery is a process, not a quick fix.

If you’re curious about what treatment frequency and timelines often look like, our
FAQ page answers many common questions.

The Takeaway

If your pain has persisted despite imaging, physical therapy, or medication, it does not mean:

• The pain is “in your head”
• You’ve failed treatment
• Nothing else can help

It means the problem has shifted from a tissue issue to a nervous system regulation issue.

Understanding that shift is often the turning point—because it opens the door to treatments designed specifically for chronic pain, not just acute injuries.

For many people in Central New Jersey, acupuncture becomes part of that next step—not as a last resort, but as a more appropriate tool for the problem they’re actually facing.

If you’d like to explore whether this approach makes sense for your specific situation, you can learn more about the conditions we treat on our
Complete List of Conditions.

Written and reviewed by Steve Hoffman, L.Ac., Dipl. OM
Princeton Acupuncture & Oriental Medicine