Why Imaging Misses Chronic Pain: Structural vs Physiologic Thinking (Part 2)

Part 2 goes from definitions to implications.

Bottom-up pain does not mean “it’s in the tissues.”

This episode is arecording of a live interview with pain researcher and clinician Asaf Weissman. If you haven’t watched Part 1, start there—we laid the foundation: why pain semantics matter, how mixed messages harm patients, and why “nothing is wrong with your body” is an overreach.

In Part 2, we dig into:

• What “always bottom up” actually means (and what it doesn’t)
• Structural paradigm vs pathophysiology: why imaging often fails us
• Why stress, fear, and emotions are usuallymodulators, not causes
• Threshold models: when trajectories may (and may not) be changeable
• The case for neuroimmune mechanisms in chronic pain states
• Where diagnostics and biologics may take chronic pain care next
• What role physios may play as case managers and guides

This is the second half of a two-part series. Part 1 builds the framework. Part 2 challenges how we interpret evidence, scope, and clinical uncertainty—while staying anchored to what helps the patient in front of you.