The Pain Series: Part 2 - The Real Cause of Pain

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.

Study 5: Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study

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.

Click here for Part 3 - Managing Pain

The Pain Series: Part 1 - Pain Is More Than Meets The Eye

PART 1: PAIN IS MORE THAN MEETS THE EYE

When I meet new people and they find out I'm a Physiotherapist, it's almost as if I've said: "tell me all about your different aches and pains!"

Wherever I am, when people know what I do, they'll usually start talking about their pain and ask for advice on it.

It comes with the territory of being a Physio.

I do, however, have a fascination with pain. Obviously not being in it, but studying it further in my spare time. So I don't mind hearing people's stories of pain.

I usually hear many similar stories, or pain patterns, between people. But specific stories, especially ones I heard at the beginning of my career, really intrigued me.

A story that stands out is one told by a pain researcher in my early university days. This story was about a man with excruciating hand pain.

Doctors could not find a cause of this man's pain, but it was clear to them this pain was real.

He tried everything to stop the pain in his hand, and everything he tried came to no avail.

Eventually he couldn't handle the pain any longer and desperately wanted it gone. He was so desperate that he went on the hunt to find a surgeon who would amputate his hand.

After going to many surgeons who declined, finally, he found one who agreed to the surgery.

Not long later, the surgery was complete, and his hand was now gone.

Some time post-surgery and after all healing had taken place, you'd think the pain would now be gone, right?…………. Wrong! 

The same pain, at the same intensity, still existed in this man's hand….. A hand that now wasn't there.

This is not a one-off story, this type of pain is not uncommon in people who have had limbs amputated and it is a type of pain known as Phantom Pain. 

This was one story of many that piqued my interest. I heard many more stories and saw many pain-patterns in patients, which demonstrated to me there was something more to pain than meets the eye. Pain wasn't just something physical.

This is what lead me to study pain in greater depth.

When most other Physiotherapists were studying different massage techniques or something similar, I took courses and read books on pain and the brain.

So when people now ask for advice on their pain, you could say that I'm the right person to answer this question for them.

However, giving an answer is never straightforward.

Most of the time, it's not the acute pain people are wanting advice for. Acute pain is pain after an injury or a health ailment that lasts only a short amount of time.

It's usually pain of the chronic type they are asking about. Pain that lasts longer than 6-12 weeks.

And chronic pain is complex.

I mean, everyone has their remedies that help MANAGE chronic pain, which do have their place, and I will go through them in Part 3 of this series. However, to OVERCOME pain, a different approach is needed.

This 4 part series of articles is my answer to the pain questions I get and the different approach that is needed.

I'll put everything I know about pain into these articles to not only help you manage pain but also help to overcome it.

To get started, here is a short video by the New South Wales Government.

This video explains pain a lot better than I could in 5 minutes.

Click to watch and learn below.

UNDERSTANDING PAIN

This is an excellent video educating on what pain really is and how to deal with it.

It is targeted toward younger people in chronic pain; however, do NOT be deterred by this.

Everything mentioned in this video still applies to those of all ages.

Now that’s it for Part 1 of The Pain Series. In finishing this part, I want you to remember this:

PAIN IS NOT A NORMAL SYMPTOM OF AGING.

IT IS POSSIBLE TO BE PAIN-FREE.

UP NEXT:

In PART 2, we’ll see how this new model of pain relates to seniors, with reference to a specific common pain-related condition (arthritis). 

In PART 3, we’ll cover ways to manage pain. And….

In PART 4, we'll cover ways to overcome pain, for good.

CONTINUE TO - PART 2 - THE REAL CAUSE OF PAIN.