Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Two people can be diagnosed with the same spinal condition yet have very different experiences. One may continue working with only occasional discomfort, while the other struggles with persistent pain that affects sleep, exercise or everyday activities. This difference can be confusing, particularly when MRI scans or diagnoses appear similar.
The severity of back or neck pain is influenced by more than the structural changes seen on a scan. Factors such as nerve involvement, inflammation, muscle strength, overall health and daily activities can all affect how symptoms are experienced. Understanding these differences helps explain why treatment should be based on the individual rather than the diagnosis alone.
Why Pain Is About More Than the Spine
Although a spinal condition may be the source of your symptoms, the amount of pain you experience is influenced by more than the structural changes affecting your spine. Factors such as nerve irritation, inflammation and the body’s response to injury all contribute to how pain is experienced, which is why two people with the same diagnosis may feel very differently.
Factors that can influence pain include:
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Nerve involvement
A slipped disc or spinal stenosis may cause significant pain if a nearby nerve is irritated or compressed. If the nerve is unaffected, the same condition may cause only mild symptoms.
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Inflammation
Inflamed tissues around the spine or nerve roots can make movements feel much more painful, even when the underlying spinal condition has not changed.
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Muscle strength and support
Weakness or fatigue in the muscles supporting the spine may increase strain on the affected area and make symptoms more noticeable during everyday activities.
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Overall health and activity levels
Factors such as physical conditioning, existing medical conditions and daily activity levels can all influence how the body responds to a spinal condition.
Because of this, the severity of pain does not always reflect the severity of the underlying spinal condition. Understanding these factors helps explain why similar diagnoses can result in very different experiences.
Why MRI Scans Don't Always Tell the Whole Story
Many patients expect an MRI scan to provide a straightforward explanation for their back or neck pain. While MRI is an important diagnostic tool, the findings do not always match the symptoms a person experiences. Some people have noticeable changes on their scans but very little pain, while others experience significant discomfort despite relatively minor imaging findings.
This is why spine specialists interpret MRI results alongside your symptoms, medical history and physical examination rather than relying on the scan alone.
MRI Finding | What It Doesn’t Necessarily Tell You |
Disc bulge or herniation | Whether it is responsible for your symptoms or simply an incidental finding. |
Disc degeneration | How much pain you will experience or whether treatment is needed. |
Spinal narrowing (stenosis) | How much it affects your daily activities or quality of life. |
Arthritic or age-related changes | Whether these changes are the true source of your symptoms. |
Research has shown that many healthy adults have age-related changes visible on MRI despite having no back pain at all. Equally, someone with significant pain may have relatively subtle imaging findings. Treating MRI images instead of treating the patient can therefore lead to unnecessary concern or inappropriate treatment recommendations.
What Else Can Influence How Back or Neck Pain Is Experienced?
Even when two people have the same spinal condition, differences in their overall health, lifestyle and physical condition can influence how symptoms develop and how much they affect everyday life. These factors do not necessarily cause a spinal condition, but they can influence how the body responds to it.
Factor | How It May Influence Symptoms |
Age | Natural age-related changes occur in the spine over time, but they do not always cause pain. Many people remain active despite visible wear and tear on imaging. |
Muscle strength and physical conditioning | Strong muscles help support the spine. Weakness, reduced flexibility or poor conditioning may make symptoms more noticeable during everyday activities. |
Lifestyle and occupation | Prolonged sitting, repetitive lifting or physically demanding work may place additional stress on the spine and contribute to symptom flare-ups. |
Previous spine injuries | Earlier injuries or surgery may alter how the spine moves or functions, which can influence future symptoms in some individuals. |
Stress and sleep quality | Poor sleep and prolonged stress can increase muscle tension and make existing pain feel more noticeable, even when the spinal condition itself has not changed. |
Understanding these influences helps explain why two people with the same diagnosis may experience different levels of pain or recover at different rates. This is one reason why treatment plans are tailored to the individual rather than based on the diagnosis alone.
Why Personalised Assessment Matters
Because no two people experience back or neck pain in exactly the same way, treatment should never be based on imaging findings alone. A personalised assessment allows your spine specialist to understand how your symptoms, physical examination and overall health fit together before recommending the most appropriate management plan.
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During your assessment, your spine specialist will consider factors such as:
- Your symptoms and how they affect your daily activities
- Your medical history and previous treatments
- Findings from your physical and neurological examination
- Imaging results, where appropriate
- Your lifestyle, occupation and treatment goals
By considering the complete clinical picture, your spine specialist can determine whether your symptoms are best managed with conservative treatment, further investigation or, where appropriate, surgery.
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You may benefit from a personalised spine assessment if you:
- Have back or neck pain that does not improve despite rest or conservative treatment.
- Experience pain that radiates into your arms or legs, or develop numbness, tingling or weakness.
- Notice that your symptoms are affecting your work, sleep, exercise or everyday activities.
- Have recurring symptoms that continue to return without a clear explanation.
- Have undergone previous treatment but your symptoms have not improved as expected.
Seeking a specialist assessment does not necessarily mean surgery will be recommended. Instead, it helps ensure that any treatment recommendations are based on a clear understanding of your symptoms, examination findings and individual circumstances.
Understand Your Symptoms with Dr Colum Nolan
No two people experience back or neck pain in exactly the same way. If your symptoms persist, continue to return or do not seem to match what your scans suggest, Oxford Spine & Neurosurgery Centre provides comprehensive spine assessments to identify the factors contributing to your symptoms and recommend the most appropriate treatment for your individual needs.
Dr Colum Nolan, Senior Consultant Spine & Neurosurgeon, takes a thorough, evidence-based approach to assessing spinal conditions, considering your symptoms, physical examination, medical history and imaging findings to develop a treatment plan tailored to you rather than your diagnosis alone. Schedule an appointment with us for a personalised spine assessment and advice on the most appropriate next steps for your condition.
FAQs About Persistent Neck and Back Pain
How long should back or neck pain last before I see a spine specialist?
Many episodes of back or neck pain improve within a few days or weeks. If your symptoms persist despite rest or conservative treatment, continue to return or begin affecting your daily activities, it may be appropriate to arrange a specialist assessment.
Can I continue exercising if my back or neck pain persists?
Light physical activity may be appropriate for some people, but the most suitable type and intensity of exercise depend on the underlying cause of your symptoms. If exercise consistently worsens your pain or you are unsure which activities are safe, seek advice from your spine specialist.
Can persistent back or neck pain improve without surgery?
Yes. Many spinal conditions can be managed without surgery through approaches such as physiotherapy, medication, lifestyle modifications or spinal injections, depending on the diagnosis. Surgery is generally considered only when it is likely to provide meaningful benefit or when conservative treatment has not been effective.
Meet Our Spine Specialist in Singapore
Dr Colum Nolan
Senior Consultant Spine & Neurosurgeon
MB, BCh, BAO, LRCPSI, MRCSI, FRCSI (Neurosurgery)
Dr Colum Nolan is a senior consultant spine and neurosurgeon, as well as the Medical Director of Oxford Spine & Neurosurgery Centre. He undertook specialist neurosurgery training in Ireland and Australia, and later on completed a complex spine surgery fellowship at Addenbrooke’s Hospital in Cambridge, UK.
Dr Colum held key leadership roles including Director of the Spine and Spinal Disorders Programme at the National Neuroscience Institute (NNI), as well as the Head of Neurosurgery Service at Sengkang General Hospital.
With his depth of experience, Dr Colum is committed to guiding each patient towards the safest and most effective treatment for their needs.
