Pain, What is it?

By Andrew on 17 Oct 2014

Have you got Pain? And is it persistent? 


Persistent pain, is classified as Pain lasting longer than 3 months. 
But what is pain? 


Is it tissue damage? Is it emotional? Is it behavioural? Is it psychological? Is it a memory? Is it just one of these things or is it a complex combination of all of them? 


I'm sure you or a friend have been told "the MRI showed nothing, therefore there is nothing to explain your symptoms from the scan". You are left scratching your head, thinking, 'is it in my head' or and most commonly of all 'there must be a test out there somewhere that explains my pain'. This can lead to years of searching and hoping, which can ultimately become exhausting. 


First of all, I am always pleased to see a negative scan. However, what's worth pointing out is, scans only tell us a little bit of the story. I have worked alongside a number of different surgeons and specialists who all say the same thing, "history of the problem tells us approximately 90% of the diagnosis, physical assessment appoximayely 7%, and imaging & investigations 3 %,which should be done last to confirm what you think the problem is. This then allows the clinician to estimate appropriate recovery timeframes either using conservative treatments like physiotherapy, medications etc or in some cases, planning for surgery. 


Why sometimes imaging (scans, X-rays etc) can be unhelpful. 
Let's use a metaphor to explain it.  If you take your lovely new 6 month old car down to the garage and ask the mechanic to check it over, he/she could probably find something to replace or tighten. Now the car runs perfect and there is no signs of a problem, therefore do you pay £100 to have a service done? I'm guessing your shaking your head and saying of course not. Well due to advancements in technology, scans are very detailed and can show up a lot of things,which may have nothing to do with your actual pain. In fact there are a lot  of scientific studies highlighting that positive signs on imaging can often not correlate with pain. Therefore, if a surgeon was to decide to operate based  only on the findings of a scan, the patient could still end up with pain after the operation. A very common example of this is 'slipped discs' or 'herniated disc' in the lower back. We know from many research studies that this diagnosis is something that is very common in non symptomatic patients. Furthermore, in the majority of cases who have symptoms, they require only physiotherapy and nothing else. 
So, your probably asking, 'what the hell is causing the pain then if my tissues are not damaged'. This is a very good question with a relatively complex answer. Therefore I am going to direct you to a link to one of the worlds leading pain scientists, Lorimer Moseley.  He can give you a little taste about why things cause pain and it will probably be a lot more entertaining than me waffling on here. 


If this doesn't help or you have more questions than answers, please send me a message on FB and I will try and answer it. 
The last point I want to make is, I am not saying that when a scan is negative that your pain is "in your head", but how you interpret pain does take place in your brain. Pain is very real but it is very complex and my point is, looking for a scan or a 'magic' quick fix treatment to sort it out is something that can be more detrimental than helpful. Research is happening everyday on this topic and things will change in the future I'm sure.  I hope this link will help to open your thoughts about pain so that you can come back stronger. 


http://youtu.be/gwd-wLdIHjs

 

Posted in: Making Sense of Pain

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