When pain has no clear cause: a rheumatologist’s perspective

Over my years working as a consultant rheumatologist, one moment in clinic has stayed with me more than almost any other. A patient who has lived with pain for months, sometimes years, hears that their blood tests and scans are normal, and their face shows relief and confusion at the same time.

They are relieved that nothing serious has been found, yet confused, because the pain is still very much there. If you recognise yourself in this, I want you to know that your pain is real.

Pain is always real

The International Association for the Study of Pain defines pain as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”

The word 'emotional' in that definition is important. It does not mean pain is imagined. It reflects what neuroscience now shows clearly: pain is produced by the brain and nervous system as a protective signal, and it is shaped by our biology, our emotions, our experiences and our environment.

How the nervous system can turn up the volume

I often explain this using the image of a smoke alarm. A well-tuned alarm sounds when there is smoke, while an overly sensitive one may sound every time you make toast, and it is no less loud because there is no fire. When the nervous system has been under strain for a long time, it can become more sensitive in a similar way.

Doctors describe this as central sensitisation. Signals that would once have registered as mild discomfort can be felt as pain, and pain can spread or persist long after an injury has healed. Poor sleep, prolonged stress and fear of further pain can all keep that alarm system on high alert.

In rheumatology, this understanding has changed how we think about conditions such as fibromyalgia, where altered pain processing in the nervous system plays a central role.

What our earlier experiences have to do with pain

Researchers have also looked closely at the link between difficult experiences in childhood and pain later in life.

A large systematic review and meta-analysis published in 2023, drawing on 85 studies involving more than 826,000 adults, found that people who experienced adversity in childhood, such as abuse or neglect, were around 45% more likely to report chronic pain as adults. The risk rose with the number of adverse experiences, and people who had experienced four or more had nearly double the odds of chronic pain.

These findings show an association rather than a direct cause, and many people with chronic pain have had no such experiences, yet they support what many clinicians observe: the body can carry the imprint of emotional pain for decades.

What the evidence says about hypnosis for chronic pain

As a doctor, I think it is important to be honest about what the research does and does not show.

A 2022 systematic review of nine randomised controlled trials, involving 530 people with chronic musculoskeletal or nerve pain, found that hypnosis led to a moderate reduction in pain intensity compared with control treatments, with stronger effects when people had eight or more sessions.

A 2025 review of trials from the past decade was more cautious, finding clear benefits of hypnosis for acute pain, such as during medical procedures, but no significant reduction in chronic pain overall. 

The picture is therefore mixed. NICE guidance on chronic primary pain recommends exercise programmes, psychological therapies such as CBT and acceptance and commitment therapy, and in some cases acupuncture, and hypnotherapy is not currently among its recommendations. For this reason I see hypnotherapy as a complementary approach that can sit alongside good medical care, rather than a replacement for it.

Where subconscious work fits

What follows reflects my own professional experience and perspective rather than established evidence.

In my work as a Rapid Transformational Therapy (RTT®) practitioner, I have come to see a pattern that echoes the research above. For many of the people I work with, chronic pain appears to be connected with emotional pain from earlier in life that never had a safe way to be expressed or processed.

Feelings such as grief, fear or a sense of not mattering are often pushed down, sometimes because a child had no one to turn to, and sometimes simply because they had to keep going. Over time, the subconscious mind holds on to these feelings so we can keep functioning. My understanding is that this held emotion does not simply disappear. Years later, often during stress, loss, or change, it seems to seek a way to be felt, and one way the body may express it is through physical pain.

A case study

I think of one woman in her fifties, whose details I have changed to protect her privacy, who came to me after living with widespread pain for around five years. Her symptoms had first appeared during the COVID pandemic, and she had always assumed that this difficult period was the cause.

In her first RTT session, as she was guided back to the memories her subconscious mind felt were most significant, a deeper story emerged. As a young girl, she had lost her grandparent, and soon afterwards an older sibling. Her mother, raising her alone and grieving herself, had to keep going in survival mode, and there was little space for a child’s feelings.

Without anyone to help her understand or talk about what had happened, she buried her grief and quietly concluded, “My feelings aren’t important” and “I don’t matter.” She had felt almost invisible, and those beliefs had shaped how she lived her life ever since, always coping and rarely putting herself first.

Together, we gave the child she once was the understanding, compassion and permission to grieve that she had never been offered. She released a great deal of emotion during the session, and we created powerful new beliefs in place of the old ones: that she is worthy, that her needs matter, that she deserves to be heard and that she is lovable.

She worked with me over a programme of three sessions. After the second, she told me her pain levels had reduced significantly, and by the end of our work together she had been able to reduce her pain medication. Her experience is her own, and I share it not as a promise but as an illustration of how deeply our emotional history and our physical health can be connected.

Not everyone’s pain has an emotional root, and physical causes always need to be properly assessed first. Results differ from person to person, and this work is always best alongside, not instead of, appropriate medical care, with any change to medication discussed with your prescriber.

Gentle steps you can take today

Have new or changing pain properly assessed

Please see your GP about any unexplained or persistent pain, particularly if accompanied by unexplained weight loss, fever, night pain, new weakness or numbness.

Calm the alarm system

Slow breathing with a longer out-breath, gentle regular movement and a consistent sleep routine all help the nervous system feel safer.

Speak to yourself with kindness

Pain is not a personal failing, and self-criticism tends to keep the stress response switched on.

Your body is not working against you. In many cases, it is trying to protect you with the only language it has, and sometimes it is asking you to finally hear feelings that were never given a voice. Understanding that language, and giving yourself the safety you may not have had before, can be a powerful part of moving forward.

References

International Association for the Study of Pain (2020). IASP terminology: Pain. https://www.iasp-pain.org/resources/terminology/

Bussières A, et al. (2023). Adverse childhood experience is associated with an increased risk of reporting chronic pain in adulthood: a systematic review and meta-analysis. European Journal of Psychotraumatology.https://doi.org/10.1080/20008066.2023.2284025

Langlois P, et al. (2022). Hypnosis to manage musculoskeletal and neuropathic chronic pain: a systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews. https://doi.org/10.1016/j.neubiorev.2022.104591

Yerzhan A, et al. (2025). The use of medical hypnosis to prevent and treat acute and chronic pain: a systematic review and meta-analysis. Journal of Clinical Medicine. https://doi.org/10.3390/jcm14134661

National Institute for Health and Care Excellence (2021). Chronic pain (primary and secondary) in over 16s (NG193). https://www.nice.org.uk/guidance/ng193