A few days ago, I underwent a total hip replacement.

Over the last several years, the cartilage in my hip gradually wore away, leading to increasing pain and a significant loss of mobility. Walking long distances became difficult. Simple movements I once took for granted became frustrating and painful. Eventually, it became clear that surgery was the right choice.

As I recover, I’ve been reading Back in Control by Dr. David Hanscom, a spine surgeon who has spent decades helping patients better understand chronic pain.

One of the most important ideas in the book is this: pain is real, but it is not always a direct measure of tissue damage.

That may sound surprising. In my case, there truly was a structural problem. My hip joint had severe arthritis, and replacing it was necessary. But Dr. Hanscom’s work highlights something equally important: the nervous system plays a major role in how we experience pain.

Two people can have similar MRI findings and experience very different levels of suffering. Some individuals have severe degeneration with very little pain. Others have relatively minor findings but debilitating symptoms. Why? Because pain is not produced by tissues alone. It is created by the brain as it interprets signals from the body, the nervous system, and the environment.

Stress, unresolved emotions, poor sleep, fear, anxiety, isolation, and past experiences can all increase the sensitivity of the nervous system. When the body remains stuck in a protective state, pain can become amplified, sometimes long after tissues have healed.

Why this matters for chronic pain

This has profound implications not only for back pain, but also for migraines, fibromyalgia, chronic fatigue, irritable bowel syndrome, pelvic pain, sciatica, and many other chronic conditions.

As a functional medicine physician, I often talk about the importance of addressing root causes. Sometimes those root causes are structural or biochemical: inflammation, hormones, nutrition, infections, injuries, or degeneration. But sometimes the nervous system itself has become overwhelmed, sensitized, and hypervigilant.

Healing often requires attention to both.

What this experience reinforced for me

My hip replacement reminded me that structural problems are real and deserve appropriate treatment. At the same time, reading Back in Control reinforced something I see often in practice: helping the nervous system feel safe can be one of the most powerful interventions we have.

If you have struggled with chronic pain, migraines, sciatica, chronic fatigue, or other persistent symptoms, this perspective may change the way you think about pain — and what may be possible for recovery.

Wishing you health and healing,
Dr. Julia Ward
Balanced Body Functional Medicine