Your MRI shows degeneration. Your back “goes out.” Someone tells you that you have a “bad knee,” a “bad back,” or a condition you'll have to manage forever.
But what if the scan is telling you what your body looks like—while your brain and nervous system are helping determine how much it actually hurts?
That question is at the center of our conversation with Nicole Sachs, LCSW, psychotherapist, author of Mind Your Body, creator of JournalSpeak, and host of The Cure for Chronic Pain podcast.
And Nicole doesn't approach this as an outsider.
She lived it.
At 19, her back went out so severely she couldn't stand. Imaging revealed spondylolisthesis, and she was given a frightening picture of her future: possible spinal fusion, limited exercise, restricted lifting, and concerns about what her body might—or might not—be capable of.
Today, more than 25 years later, Nicole says something remarkable:
The structural abnormality is still there. The chronic back pain isn't.
Same spine.
Different experience.
So what changed?
That's where this conversation gets interesting.
Chronic Pain Is Real—But Pain Isn't Always the Same as Damage
Nicole is emphatic about one point:
“Your pain is real.”
Mind-body medicine does not mean pain is imaginary, exaggerated, or “all in your head.”
But modern pain science has complicated the old assumption that pain intensity always equals the amount of tissue damage.
The brain and nervous system interpret information coming from the body. They also use past experiences, expectations, emotions, fear and perceived threat to decide how protective they need to be.
Think about someone who has experienced back pain every time they bend forward.
Eventually the brain may begin expecting danger before the movement even occurs.
The body braces.
Muscles tighten.
Movement becomes guarded.
Fear increases.
And suddenly you're not just dealing with pain.
You're dealing with the fear of pain.
That can become a powerful loop.
Nicole describes chronic pain, in part, as an epidemic of “fear and meaning.”
And that raises an uncomfortable question:
What if the story you tell yourself about your body is keeping the alarm system turned up?
“My back is out.”
“My spine is degenerating.”
“I'm bone-on-bone.”
“My knee is bad.”
“I'll never be able to do that again.”
Those words may seem harmless, but they carry meaning.
And meaning can influence how safe—or unsafe—the nervous system believes movement to be.
That doesn't mean you ignore an injury, MRI, neurological problem, infection, fracture, or other serious condition. New, severe, unexplained, or changing symptoms still deserve proper medical evaluation.
The question comes after that evaluation:
Does the diagnosis completely explain why you're still hurting?
Sometimes it does.
Sometimes the answer may be more complicated.
5 Key Insights From This Episode
1. Your MRI Is Information—Not Your Identity
An imaging abnormality can be completely real without necessarily explaining every symptom you're experiencing.
Nicole is a striking example: her structural finding remains, yet she says her chronic back pain disappeared decades ago.
That doesn't make imaging useless. It means imaging needs context.
2. Fear Can Feed the Chronic Pain Cycle
Pain makes us cautious.
Caution can become avoidance.
Avoidance can increase fear.
And increased fear can make the nervous system even more protective.
One of the goals in chronic pain recovery may therefore be helping the brain rediscover something it has forgotten:
This movement can be safe.
3. Your Emotional Life May Matter More Than You Think
Nicole describes an internal “reservoir” filled with stress, anger, grief, resentment, childhood experiences, relationship pressure and emotions we may never openly acknowledge.
Her argument isn't that anger magically causes back pain.
It's that continually suppressing emotional stress may help keep the nervous system in a defensive state.
This is where her work becomes more controversial—and where you'll want to hear her explanation directly.
4. Perfectionists and People-Pleasers Should Pay Attention
Nicole repeatedly sees patterns including:
Perfectionism
People pleasing
Difficulty setting boundaries
Constantly worrying whether other people are okay
Feeling responsible for everyone
Being relentlessly hard on yourself
Consider one simple question:
How often do you say “I'm fine” when you're actually angry, exhausted, resentful, scared or overwhelmed?
That may be worth exploring.
5. Recovery May Require More Than “Fixing” the Body
Nicole's approach revolves around three principles:
Believe. Do the work. Practice patience and self-compassion.
Learn how pain and the nervous system interact.
Explore the emotions and stress you normally push aside.
Then stop treating yourself like you're failing every time symptoms appear.
That last step may be the hardest one.
Try These 4 Things Today
You don't need to accept every part of the mind-body model to start asking better questions.
1. Change the language.Instead of “my bad back,” try: “My back is sensitive today.” It sounds subtle, but it removes the implication that your body is permanently broken.
2. Notice your fear around movement.Before avoiding an activity, ask: Am I stopping because something is medically unsafe—or because I'm afraid it will hurt?
Those aren't always the same thing.
3. Write what you normally don't say.Spend five minutes privately writing what you're frustrated, angry, scared, resentful or exhausted about. Don't edit it. Don't make it appropriate. Just notice what's actually there.
Nicole's JournalSpeak process goes much deeper than this—but this can start the conversation.
4. Replace certainty with curiosity.Instead of saying, “This is how my body is now,” ask:
“What if there's another explanation?”
That simple question can create room for possibility.
Why This Conversation Matters Now
Millions of people live with persistent back pain, migraines, fibromyalgia, fatigue, joint pain and other chronic symptoms.
Many have already tried everything.
And when nothing works, one of the most damaging beliefs can creep in:
“My body is broken.”
Nicole Sachs challenges that conclusion.
Not by telling people their suffering isn't real.
But by asking whether we're looking at only one piece of a much larger puzzle involving the brain, nervous system, emotions, movement, stress, fear and the meaning we attach to symptoms.
And the deeper you get into this conversation, the bigger the questions become.
Can the brain actually learn chronic pain?
Why can two people have similar MRIs but completely different symptoms?
Can fear about your diagnosis unintentionally keep pain alive?
Why do perfectionism and people pleasing show up so often?
Can changing how the nervous system interprets a sensation actually change what you feel?
And perhaps the biggest one:
What if your body isn't broken at all?
Reading this gives you the framework.
Hearing Nicole explain how she went from a frightened 19-year-old facing a lifetime of limitations to more than 25 years without chronic back pain is where the story takes on an entirely different meaning.
And she doesn't stop with back pain.
The full conversation moves into migraines, fibromyalgia, chronic illness, emotional repression, nervous system regulation, JournalSpeak, diagnoses, long COVID, people pleasing—and some ideas that will challenge how you think about the relationship between your brain and your body.
For the full story and unfiltered conversation, listen or watch the Crackin' Backs Podcast.
▶ Watch on our YouTube Channel