The Worst Pain Is an Unexplained Pain

Musculoskeletal (MSK) pain, especially when the reason for the pain is unexplained, is often associated with distress, fear, reduced self-efficacy and cycles of medicalization. Pathoanatomical diagnoses, based on clinical tests and imaging, have a weak correlation between structural findings and pain, and fail to explain why something hurts. This viewpoint advocates for non-pathoanatomical functional diagnoses or classifications and practical, relatable explanations for patients with pain without a definitive pathoanatomical cause—what some might call a person-centered model of care. Using an example of low back pain, we explore how functional terminology and empathetic communication can foster better understanding of pain, reduce fear, and support people to engage with treatment. We encourage clinicians to integrate lifestyle factors in a shared decision-making framework. By supporting patients to understand their pain, we suggest an approach that improves both physical and psychological well-being.