Why Osteoarthritis Doesn't Always Explain Your Pain

Many people are surprised to learn that osteoarthritis and pain do not always go hand in hand.

Research has shown that many people have osteoarthritis on X-rays or MRIs and experience little to no pain. On the other hand, some people experience significant pain despite having only mild changes on imaging.

One way I like to explain this is by thinking about wrinkles.

As we age, many of us develop wrinkles on the outside. Osteoarthritis can be thought of as "wrinkles on the inside." They are a common part of aging and do not automatically mean you will have pain, limitations, or need to stop doing the activities you enjoy.

This raises an important question:

If osteoarthritis does not always explain pain, should we be afraid of every change we see on an X-ray or MRI?

The answer is no.

Another important question is: what is actually contributing to the pain? Sometimes the tissue itself plays a large role. Sometimes the nervous system plays a larger role. In many cases, both contribute in different ways.

Most people assume pain is always a direct reflection of damage, but the reality is often much more complex.

Imaging is one piece of the puzzle, but it does not tell the whole story. Factors such as strength, mobility, sleep, nutrition, stress, activity levels, overall health, how the nervous system communicates information from the body to the brain, and how the brain interprets and responds to that information can all influence how much pain a person experiences.

The goal is not to ignore imaging findings.

The goal is to understand them in the proper context.

Because imaging findings are only one piece of the puzzle. They can provide valuable information, but they do not automatically tell us how much of your pain is being explained by that finding, how much it is contributing to your current limitations, or what your future will look like.

If you have been told that your pain is simply "bone on bone" or that nothing can be done because of what an image shows, remember that there may be more to the story. Understanding the bigger picture is often the first step toward meaningful improvement.