PART 2: THE REAL CAUSE OF PAIN
In Part 1 of the Pain Series, titled "Pain is More Than Meets the Eye" we covered the complexity of pain, phantom pain (pain that occurs in limbs that aren't there) and watched a 5-minute video that explained what pain REALLY is, in a way that's easy to understand.
By the end of the article we had established that pain was formulated in the brain, it is NOT a normal symptom of ageing and that each one of us could be, and should be, pain-free.
In this part, we'll uncover more about pain, why medical imaging findings (e. g., osteoarthritis) are not the cause of chronic pain and I'll then explain why we get pain in certain areas of our body.
MEDICAL IMAGING FINDINGS DO NOT EQUAL PAIN
When we are in chronic pain (longer than 6-12 weeks), medical imaging (X-rays, MRI, ultrasound, etc.) is what's most commonly used by Doctors to identify what the cause is.
Medical imaging can identify many physical 'abnormalities' and the majority of the time these ''abnormalities'' are then identified as the cause of pain.
It's a common belief that a scan is going to uncover the cause of chronic pain.
Unfortunately, although this belief is common, holding this belief is where many issues towards overcoming pain start and become a detriment to any progress.
Thinking your pain comes from a physical 'abnormality' (such as degeneration/arthritis) shown on a scan, can lead people to believe that their pain cannot be overcome if this physical 'abnormality' is always going to be there.
But to begin overcoming chronic pain, medical imaging findings need to be taken with a grain of salt.
Medical imaging is great to find any ''red flags" (i.e., something serious) but imaging does very little in explaining the cause of chronic pain.
In some cases, the images can pick up all types of physical ''abnormalities'', we can be riddled with joint degeneration (osteoarthritis) and yet have NO pain.
And in other cases, images can show we have no ''abnormal'' findings or minor degeneration (osteoarthritis), and yet have excruciating pain.
There is a large amount of evidence that suggests that the “abnormalities” found with medical imaging are not causing pain.
Let's look at some of this evidence: (Click the links to see the study)
Study 1: On Spine Degeneration in Populations With No Symptoms:
In this study, imaging findings of degeneration in the spine are present in high proportions of individuals WITHOUT any pain (or other symptoms), increasing with age.
This study concluded that many imaging-based degenerative features are likely a part of normal ageing and unassociated with pain.
Study 2: On The Discordance Between Clinical and Radiographic Knee Osteoarthritis
In this study, up to 85% of adults with no knee pain, had x-rays showing arthritis.
This study concluded that radiographic knee osteoarthritis is an imprecise guide to the likelihood that knee pain or disability will be present.
Study 3: On The Association of Hip Pain with Radiographic Evidence of Hip Osteoarthritis
This study showed that hip pain was NOT present in many hips with radiographic osteoarthritis.
This study concluded that hip pain is discordant with radiographic hip osteoarthritis
Study 4: On The Pattern and Prevalence of Lumbar Spine MRI Changes
In this study of 1043 random volunteers, forty percent of individuals under 30 years of age had lumbar spine degeneration (arthritis), with the prevalence of lumbar spine degeneration increasing progressively to over 90% by 50 to 55 years of age.
This study demonstrates how common lumbar spine degeneration is, without pain.
This study showed that it is just as common to have NO PAIN in the presence of these “abnormalities” seen on medical imaging.
Here is a graph that summarises the findings.
Percentages of pain versus no pain were similar for all. Including osteoarthritis (cartilage damage).
These are just five studies I picked from a large amount. There are plenty more studies out there proving this.
It's clear that medical imaging is never going to show your pain.
It can't!
So you may be thinking, “if physical 'abnormalities' seen on medical imaging are not what causes pain, then what causes it?”
THE REAL CAUSE OF PAIN (& ARTHRITIS)
Pain is..... A feeling.
A feeling that presents in areas of physical weakness in our body caused and intensified by certain stressors/factors (cultural, biological, environmental, psychological and social factors).
As we age, we have been exposed to and can take on, more stress over the years, explaining the higher incidence of pain in seniors.
Arthritis is often used to refer to any physical disorder that affects the joints.
The most common type of arthritis is osteoarthritis (OA), where the softer cartilage in our joints can wear, leading to the bones moving closer together.
Arthritis is usually associated with pain, but can also cause stiffness and may limit your ability to move around freely.
Osteoarthritis increases in prevalence as we age. It is common in the knees, hips, spine, shoulders, elbows and fingers, and is usually the areas of weakness for most seniors.
When pain shows up in areas of weakness, it's usually going to be the areas of arthritis. (It is not uncommon for pain to move around in people if a new, weaker area is to present).
Arthritis is not the cause of pain; it's a weak area where pain MAY show up.
By knowing this, we can begin to make progress.
YOU DO NOT NEED TO BE FREE OF ARTHRITIS TO HAVE NO PAIN.
If you could be pain-free, move the best you have in years, yet still have arthritis identified on scans, would your arthritis still be an issue?
YOU CAN BE PAIN-FREE WITH ARTHRITIS
The first step is to shift your focus away from pain and the associated 'abnormalities' and towards wellness & health.
Healthy body, healthy muscles, healthy joints and a healthy mind.
We'll cover more in PART 3, where we look at managing pain and in PART 4: overcoming pain.