Why I Wrote a Book About the Difference Between “Hurt” and “Harm”

A reader wrote me a few months ago with the same story I have been hearing for years: the moment that broke something in her. Not the pain itself; she'd been living with that for two years. It was the appointment where her doctor slid the MRI across the desk, glanced at it for maybe four seconds, and said, "Well, this all looks normal," in a tone that made it clear the conversation was over.

Nothing was torn. Nothing was fractured. And somehow that got treated as proof that nothing was actually wrong with her.

That moment is the reason Making Sense of Chronic Pain exists. Not because I wanted to write a neuroscience book, but because I wanted to write the book that would have made that appointment go differently.

Here's the piece almost nobody explains to patients: an MRI or X-ray measures structure. It does not measure function, and it absolutely does not measure what your nervous system has learned to do with a signal. Structure turns out to be a remarkably bad predictor of pain. Elite athletes compete at the highest level with scoliosis, with leg-length discrepancies, with spines that would make a radiologist wince, and they're pain-free. Meanwhile, someone with a textbook-perfect spine can be unable to get out of bed. Pain isn't a readout of what your tissue looks like sitting still. It's a readout of whether your nervous system has decided that tissue is safe to load.

When it hasn't, the nervous system guards. It keeps guarding long after the original injury has healed, because it learned a threat response during the injury and never got the signal to stand down. That's maladaptive neuroplasticity, and it produces pain that is completely, physically real and is generated by a system that mislearned, not a body that's broken.

This is where I get, honestly, a little angry on behalf of the people who write to me. Telling a patient their pain is psychological because a scan is clean doesn't calm anything down. It adds a new threat: the threat of not being believed, which the nervous system processes through the exact same circuitry as physical danger. And going the other direction does damage too. Hand someone a scary-sounding label for normal wear and tear, and you've triggered the nocebo effect, measurably worsening the outcome.

Both directions get you the same result: more pain, less trust, further from an actual fix.

The way out starts with a distinction I spend a good chunk of the book building from the ground up: hurt versus harm. Hurt is the pain signal your brain is producing right now. Harm is structural damage to tissue. They are not the same thing, and the gap between them is where recovery actually becomes possible, because you cannot retrain a nervous system you're still busy being afraid of.

That's the whole argument of Making Sense of Chronic Pain, worked through in far more depth than a blog post allows: the neuroscience of why pain outlasts healing, why the medical system keeps getting this wrong in both directions, and the specific, evidence-based path back to trusting your body again.

Grab a copy here: https://a.co/d/06weR6OT