Is this article saying my pain is caused by stress or emotions?

No. This article describes how emotional state amplifies or dampens pain signals that originate from a real physical source. The pain generator, whether it is a joint, a nerve, or inflamed tissue, is still there. Emotional state acts on the volume control for that signal through specific circuits like the periaqueductal gray and RVM. Addressing the emotional and inflammatory layer does not mean the physical layer is being dismissed.

Why does my pain feel worse on some days even when nothing physically changed?

Two mechanisms drive this. Increased connectivity between the default mode network and salience network can pull pain-related threat signals into your ongoing self-focused thinking, and glucocorticoid receptor resistance can leave cortisol circulating without effectively shutting down inflammation. Both of these fluctuate with your stress load, which is why identical days on paper can feel physically different.

Does this mean medication won't work for me if my pain has an emotional component?

Medication still works on the target it was designed for. Anti-inflammatories still reduce inflammation in tissue, and nerve-targeting medications still reduce nerve signal transmission. What they were not designed to do is reach brainstem circuitry, glial activation in the central nervous system, or brain network connectivity. That is why addressing the emotional and inflammatory layer alongside your current medication, rather than instead of it, tends to produce a more complete result.

What can I actually do to influence this brainstem pain circuit?

Structured mindfulness training, consistent breathwork, cognitive behavioral therapy, and consistent sleep have measurable effects on amygdala reactivity, prefrontal regulation, cortisol output, and glucocorticoid receptor sensitivity. These are not generic wellness suggestions. Each one targets a specific mechanism described above, and each requires consistency rather than a single session to produce a measurable shift.

How do positive emotions actually reduce pain, not just distract from it?

Genuine positive emotion activates the ventral tegmental area and increases dopamine signaling, which triggers release of your body's own opioid molecules, beta-endorphins and enkephalins. Those molecules bind to the same mu and delta opioid receptors that prescription opioids target, in the same PAG and RVM circuit described earlier in this article. This is a direct neurochemical effect, not a psychological distraction from the sensation of pain.

Why Does My MRI Look Normal When My SI Joint Hurts So Much?

Jason Winkelmann

2 minutes ago

3 min read

A normal MRI does not rule out SI joint pain, because mechanical SI problems are mostly about how the joint is loaded and controlled, not about visible damage. Many lumbar scans stop above the joint, and even scans focused on it can look normal in people whose joint is proven painful by a numbing injection.

If your scan came back normal and someone implied the pain must be mild or stress-related, that is a deeply frustrating thing to hear while you are still hurting. A normal image and real pain can both be true.

The Mechanism

Think of an MRI as a photograph. It shows structure at one moment, lying still. SI joint pain is often a problem of the joint in motion, and of the muscles that control it, which a photograph cannot capture. The joint's stability depends on force closure, the active compression supplied by muscles and ligaments during movement. A joint can be strained by poor muscle timing while its bones, cartilage, and ligaments look perfectly ordinary.

The research backs this up directly. A review in the International Journal of Spine Surgery states that specific imaging of the SI joint has not been shown to correlate accurately with SI joint pain. Degenerative changes can often be seen in people with no symptoms, and joints that are proven inflamed and painful by anesthetic block often appear normal on imaging. There is a second, simpler reason as well. Routine X-rays and most MRI scans of the low back look at the lumbar spine and often stop above the SI joint, so the joint may never have been closely examined.

None of this means MRI is useless. It is highly sensitive for one specific thing, sacroiliitis from inflammatory conditions like spondyloarthritis, and CT and MRI are valuable for excluding fracture, infection, and tumor. What it is not good at is detecting the mechanical dysfunction that accounts for most SI joint pain.

When It's Something More Serious

Numbness in the groin or inner thighs, changes in bladder or bowel control, progressive leg weakness, fever with back pain, or pain after significant trauma needs urgent evaluation. Back and buttock pain with morning stiffness lasting more than 30 minutes that improves with movement, especially before age 45, warrants rheumatology assessment, and a normal scan does not close that question when symptoms persist.

How This Gets Addressed

Because imaging rarely settles it, the work begins with a hands-on exam that tests the joint's response to loading and provocation, then treats what the exam finds.

Chiropractic care addresses the SI joint directly, with techniques directed at the joint rather than the lumbar spine in general.

Massage Therapy and Dry Needling release the guarded muscles around it.

Physical Therapy completes the picture by retraining the muscles that control the joint, which is what prevents the pain from returning

Naturopathic Medicine addresses the inflammatory and metabolic factors that contribute to recurrent joint irritation.

You can learn more about our full approach to sacroiliac joint pain here.

Most people find that once the true source is examined and treated, their symptoms begin to follow a logic they can finally understand, though a joint that has been irritated for years may always respond to overload.

Written By:

Dr. Jason Winkelmann

Naturopathic doctor, Chiropractor, Chronic Pain Specialist, and Educator

Frequently Asked Questions

Should I get a diagnostic SI joint injection?

That is a decision to make with your physician. The injection uses imaging guidance to place numbing medication into the joint, and a large drop in pain, commonly more than 75 percent for a short window, is taken as confirmation. It carries a meaningful false-positive rate, so many clinicians use it only after conservative care and a thorough exam point toward the joint.

My MRI showed a disc bulge. Can the SI joint still be the cause?

Yes. A disc finding on a scan does not prove that the disc is the source of your pain, and both can contribute at once. The question is whether your symptoms and exam match the disc, the joint, or both.

Does a normal MRI mean my pain is not real or not serious?

No. A normal scan means no structural damage visible on that scan. It says nothing about how well the joint is controlled when you move, which is where many SI problems originate.