Pain ≠ Damage
Updated: Dec 14, 2018
Lots of people come to see me because they’re injured in some way. Sometimes it’s a clear event, they remember the exact moment that changed how they feel, other times there’s no clear event but a gradual change over time. Most injured people follow some familiar pitfalls in their thoughts regarding the injury or pain, so I thought we would take a moment to dispel a common myth about pain.
MYTH #1 - Pain ≠ damage. Read that again. Pain DOES NOT mean damage!! Pain is a very basic necessity for life-- we’ve villainized this experience, it's certainly unpleasant, but that’s the point and that doesn’t make it bad! We often think if it hurts, something wrong with it but that’s a faulty line of thinking. Let's look a little deeper.
Pain is a highly studied experience, because science has only scratched the surface of how it works. Pain is a experience in the brain, not in the tissue. The things that affect pain are so complex that it makes the study of pain science diverse and incredibly expansive. Pain science is moving foward so quickly that most physicians can't keep up with emerging science. (Most doctors get only 9-11 hours of education in pain management, that merely .3% of their total curriculum.)
Often the experience of pain is a misleading sensation that becomes worse than whatever started the experience. If pain being “in your head” sounds too new age for you, don’t let that old idea scare you from reading farther. Just because the pain is a construct of your brain, doesn’t mean you can just imagine it gone, or that it isn’t real or serious.
Pain is, generally, a response sesensation produced by your brain. This sensation is usually over exaggerated, as it's the nervous system first line of defense to keep you protected. This response often becomes more severe than the originating cause.
How do we know that pain doesnt equal damage? There’s a growing body of evidence that suggests many diagnoses that are commonly associated with pain occur just as frequently in the “non-injured”. Take for example this study where healthy participants received an MRI of their spine. 52% were diagnosed with a herniated disc, in at least one level of their spine, though they were asymptomatic. (Disc herniations are worthy of their own post, we’ll cover that another day) Disc herniations, like the ones sited in this study, which are confirmed by MRI, are often prescribed surgery to correct. Here we can see these patients had no symptoms, so why would we “correct” it? It leads to the question, when you get that MRI and it shows a herniation, who’s to argue how long that herniation existed before pain began, or that it’s the cause of your current experience?
Not enough to make you question the origin of your pain experience? Here’s another study done on shoulders which found that pain was not an indicator of tear severity. For many orthopedic disorders, pain is used as an indicator of damage severity or the need for surgical repair but pain is a complex experience that has more effects than just tissue damage. Even the combination of pain AND tear doesn’t always indicate that surgery is the best treatment method - surgery doesn’t correlate to a decrease pain, it just that something has been “fixed”. (There are many placebo factors that make a surgery successful, check out this article where similar results were achieved between a control and placebo group, despite one group receiving no surgery at all!) Many doctors recognize the number of “failed surgeries”, those surgeries which repair a ligament or tendon but the patient still presents with movement limitations and pain post surgical intervention, and now recommend a more conservative approach.
If we image healthy individuals without pain and they present with the same diagnosis, as you who feel crippled with unimaginable pain levels, what’s the difference? If you have so much pain that you’re having a hard time moving, how do we treat it? That’s what pain scientists are working on.
To start treating pain, we have to think about the purpose of pain: to alert you of damage OR the potential of damage. Ever touch a hot stove? It hurts! Most times, you pull your hand away before you receive a full burn from it. Paper cuts and stubbed toes can bring tears to a grown mans eyes, but usually don't cause damage. Pain can be just the alert of a threat. Think about it, how long could you live if your body didn’t alert you of potential harm? Not long.
In absolutely no way am I saying that you’re some kind of hypochondriac whose suffering a mental disorder, I AM saying that pain is complex and multifactorial. Often, pain is out of proportion to the problem. Imaging can’t analyze how threatening an injury is to your wellbeing and isn’t a good indicator of your experience. So relax, I know it hurts but running and getting it imaged isn't always your best move.
In my next post I'll cover some quick things to do when you're suddenly facing pain. Until
If you have more questions, please reach out. I can send your articles, refer you to other healthcare practitioners or even introduce you to support groups.
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Because almost no one over the age of 40 is going to have a normal knee or shoulder MRI.
"For back pain, MRI and X-ray are medical machines that make false alarms."
Pain Recovery Strategies by Dr. Greg Lehman <if you're dealing with pain, download this FREE workbook!!!!>