Chronic pain is often described as an “invisible illness.” It’s one of the most common reasons adults seek medical help, but it doesn’t always come with obvious signs. Just because someone is in pain doesn’t mean it can be seen from the outside, which makes finding the root cause just as challenging as the pain itself.
According to the CDC, about 20.9% of U.S. adults (more than 51 million people) live with chronic pain. Around 17 million of those adults have pain so severe that it frequently limits their daily activities.[1]
Radiology is a crucial tool used in diagnosing and investigating pain. Pain specialists use imaging techniques such as X-rays, MRIs, and ultrasounds to obtain a clearer picture of what’s happening beneath the surface. From bones and joints to muscles and nerves, these technologies can pinpoint hard-to-find causes of pain, making treatment more targeted and effective.
What Imaging Tests Are Commonly Used in Pain Management?
Different imaging methods provide various kinds of insight. Your doctor chooses the right one based on your symptoms and their suspected diagnosis. It may take more than one type to reveal the sneaky, hidden cause of your pain.
Some of the most common imaging include:
X-rays Radiography
Quick and inexpensive, X-rays are often the first step. They clearly show bones and can detect fractures, bone spurs, or arthritis, but not issues that affect your muscles, nerves, spinal cord, or discs. [2]
MRI Magnetic Resonance Imaging
MRIs provide highly detailed pictures of soft tissues, including discs, ligaments, and nerves. This makes them especially useful for spotting herniated discs, nerve compression, or inflammation.[3]
CT Scans Computed Tomography
A CT scan combines X-rays with computer technology to create cross-sectional images. It’s often used for complex spine problems or when more detail is needed than a standard X-ray provides.[4]
Ultrasound
Ultrasound uses sound waves, not radiation, to produce real-time images of muscles, tendons, and ligaments. It’s also commonly used to guide injections with precision, improving both safety and results.[5]
Bone Density Scans
Bone mineral density tests (BMD), also known as DEXA, DXA or Dual energy x-ray absorptiometry, help detect decreases in your bone mass (bone thinning).[6] While women face a higher risk of bone loss with age, men should also be tested for osteopenia or osteoporosis, which raises fracture risk.[6]
Nuclear Scans
Less common but sometimes used in pain management, nuclear scans involve a small amount of radioactive material to highlight areas of inflammation, infection, or unusual bone activity.[7]
What Hidden Causes Can Medical Imaging Reveal?
Do you have chronic pain, but the reason has eluded your doctors? One of the biggest frustrations with chronic pain is finding the elusive “WHY” when it’s not obvious.
Imaging can help your medical team uncover conditions like:
- Herniated or bulging discs pressing on nerves
- Neurodegenerative disorders [8]
- Vascular issues [8]
- Autoimmune conditions [8]
- Pinched nerves (radiculopathy)
- Arthritis or degenerative joint disease
- Stress fractures or microfractures
- Tendon or ligament inflammation
- Fibromyalgia
By shining a light on what can’t be seen from the outside, imaging allows your pain doctor to create a treatment plan that addresses the actual cause rather than just the symptoms.
Do All Patients with Pain Need Radiology?
Not necessarily. Imaging is powerful, but it’s not always the first step. Research shows that many people with low back pain improve without scans, and imaging is most helpful when specific “red flag” symptoms suggest something more serious may be going on.[9]
That’s why pain doctors don’t rely on imaging alone. They combine test results with a detailed history, physical exam, and your description of symptoms. This holistic approach avoids unnecessary tests while still ensuring the correct problems are identified.
The Future of Brain Imaging and Predicting Chronic Pain
Imaging today is used to identify physical causes of pain, such as herniated discs or arthritis. But researchers are also exploring how brain imaging could one day help predict and measure chronic pain itself. Advanced tools, such as functional MRI (fMRI) and PET scans, can reveal changes in brain activity and connectivity associated with long-term pain.[10]
Experts caution that brain imaging is not yet ready for everyday use, but it may one day provide objective pain markers to guide treatment alongside patients’ own symptom reports.[10]
Why Diagnostic Imaging Matters for Pain Management
Radiology plays a vital role in a multidisciplinary approach to pain management. Imaging allows your pain doctor to collaborate with other medical professionals to make an accurate diagnosis, create a personalized treatment plan, and monitor your progress.
Imaging can be life-changing and provide clarity when symptoms are vague. Findings can validate that your pain is real (and not just “in your head,” as some might suggest). Sometimes, the radiologist’s efforts bring a huge sigh of relief when more serious conditions are ruled out.
Fluoroscopy and other image-guided techniques also provide real-time accuracy for minimally invasive procedures, such as nerve blocks and steroid injections.
Your chronic pain may be invisible, but with modern imaging techniques, it doesn’t have to remain a mystery. Your pain doctor can help identify underlying issues and develop a personalized treatment plan tailored to your symptoms and goals.
Resources:
- Rikard M, Strahan AE, Schmit KM, et al. Chronic Pain Among Adults — United States, 2019–2021. MMWR Morbidity and Mortality Weekly Report – CDC [Internet]. 2023;72(15). doi:https://doi.org/10.15585/mmwr.mm7215a1. Accessed August 22, 2025. Available from: https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm
- Back pain – Diagnosis and treatment – Mayo Clinic. Mayo Clinic [Internet]. Published 2018. Accessed August 22, 2025. Available from: https://www.mayoclinic.org/diseases-conditions/back-pain/diagnosis-treatment/drc-20369911
- Medical Scans Explained – A Look Inside the Body. NIH News in Health [Internet]. Published October 28, 2019. Accessed August 22, 2025. Available from: https://newsinhealth.nih.gov/2019/11/medical-scans-explained
- Fayad LM. CT Scan Versus MRI Versus X-Ray: What Type of Imaging Do I Need? Johns Hopkins Medicine [Internet]. Accessed August 22, 2025. Available from: https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ct-vs-mri-vs-xray
- Gofeld M. Ultrasonography in pain medicine: a critical review. Pain Pract [Internet]. 2008 Jul-Aug;8(4):226-40. doi: 10.1111/j.1533-2500.2008.00215.x. Epub 2008 Jun 28. PMID: 18513228. Accessed August 22, 2025. Available from: https://pubmed.ncbi.nlm.nih.gov/18513228/
- Bone Density Scan – What is a bone density scan? MedlinePlus [Internet]. Accessed August 22, 2025. Available from: https://medlineplus.gov/lab-tests/bone-density-scan/
- Sukerkar PA. Imaging Modalities for Back Pain. Virtual Mentor [Internet]. 2007;9(2):119-122. doi:https://doi.org/10.1001/virtualmentor.2007.9.2.cprl1-0702. Accessed August 22, 2025. Available from: https://journalofethics.ama-assn.org/article/imaging-modalities-back-pain/2007-02
- How Radiology Is Uncovering Rare and Hidden Diseases. Midtown Medical Imaging [Internet]. Published June 13, 2015. Accessed August 22, 2025. Available from: https://www.midtownmedicalimagingfortworth.com/how-radiology-is-uncovering-rare-and-hidden-diseases/
- Rao D, Scuderi G, Scuderi C, Grewal R, Sandhu SJ. The Use of Imaging in Management of Patients with Low Back Pain. J Clin Imaging Sci [Internet]. 2018;8:30. Published 2018 Aug 24. doi:10.4103/jcis.JCIS_16_18. Accessed August 22, 2025. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC6118107
- Davis KD, Flor H, Greely HT, et al. Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations. Nature Reviews Neurology [Internet]. 2017;13(10):624-638. doi:https://doi.org/10.1038/nrneurol.2017.122 Accessed August 22, 2025. Available from: https://www.nature.com/articles/nrneurol.2017.122
