The Modern Pain Podcast

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


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Part 2 goes from definitions to implications.

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

This episode is a recording 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 usually modulators, 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.


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Modern Pain Care is a company dedicated to spreading evidence-based and person-centered information about pain, prevention, and overall fitness and wellness

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The Modern Pain PodcastBy Modern Pain Care

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