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Low back pain myths – Part Five: MRIs, stabbings and the biology of pain

These two myths really get to the guts of it and are best dealt with together, and the answer is rooted in the biology of pain.  

These are probably the two biggest ‘hangovers’ from the previous era of thinking by most health professionals. Both are now outdated thinking, but are still out there. Hopefully in time, everyone from general public through to health practitioners will understand these ideas and really ‘get it’.

If you missed the start of this series with clips of the talk up to this point, click here to go back to the start and see the first one.

If you have any thoughts or comments about this series, feel free to post a comment on our Facebook page at Facebook.com/AdelaideWestPhysio

[If you would like to cut to the chase and get the top 10 myths in a free printable guide, just click here]


Myth #10 – If no specific back problem is found on scans, your pain must be psychological.

Fact: You don’t have to find any ‘issues’ on scans to have back pain.

It can be hard to fathom, but most cases of back pain will not follow the typical ‘biomedical’ approach.

And what is a biomedical approach?

An example of a biomedical approach would be this. With infection, you can identify the bacteria and treat it with the appropriate antibiotic. Or you break your leg, you see the XRay with the fracture, you get it fixed. Simple.  

Not so simple with low back pain. It has traditionally been thought of purely in a biomedical way.  However, most of the time it is impossible to give a solid, specific structural diagnosis.  This flies in the face of our intuition (and the intuition of a lot of health professionals), especially with the kind of technology at our disposal these days, like brilliant scans with amazing resolution.

Non-specific back pain – correct but crappy diagnosis

The diagnosis of ‘non-specific low back pain’ is a fluffy kind of diagnosis, and not surprisingly not really popular amongst back pain sufferers.

However, it is usually the most accurate diagnosis because it isn’t possible to identify without doubt that there is one structure ‘at fault’. Often any scans won’t shed a lot of light on the situation because of the usual age-related changes and incidental findings.  And for all their amazing resolution, one thing that a scan can’t tell you is what actually hurts.

But the pain is still 100% real, even if there is nothing to find on scans. So is it purely psychological?  No.  Well, rarely.

While psychological factors, such as depression, anxiety, sleep deprivation, stressors at work or at home – they can all be a big influence on the amount pain experienced and the degree of distress it creates, it still doesn’t mean that the pain is ‘psychological’. 

However, pain is 100% of the time an experience that the brain constructs, regardless of whether it is acute, chronic, a stubbed toe or an amputated limb.  That is just the biology of pain.

Although that might seem contradictory to what I have just said about psychology, it’s not.  The biology of pain means that it is a brain construction, which is quite different to saying that it is purely psychological.

 

Myth #11: The amount of back pain correlates to the amount of back damage

Fact: The amount of pain does not simply indicate the amount of tissue damage.

I know that this statement is counter intuitive.

There are many situations where the amount of pain does not match the amount of tissue damage at all.  There are frequent reports in the news and in history of gunshot wounds, shark attacks, stabbings that don’t have a significant amount of pain associated with them. At the other end of the scale, paper cuts can really hurt, even though the number of sensors that are affected is so much less.

See the example in the video below for one story of a stabbing in Perth with no pain.

The longer the symptoms have been going on, the weaker the match between tissue damage and pain is.

Pain is a measure not of tissue injury.

Pain is a measure of the amount of protection that your CNS has calculated that you need.

You can have excruciating low back pain and have minimal changes on a scan, and you can have horrible looking scans with no pain.

This is a well-researched, indisputable fact about the biology of pain that is worth remembering.

The video has a good discussion about this principle that is worth watching to help get a handle on this concept.

 

YouTube video

If you missed the start of this series with clips of the talk up to this point, click here to go back to the start and see the first one.

If you have any thoughts or comments about this series, feel free to post a comment on our Facebook page at Facebook.com/AdelaideWestPhysio

[If you would like to cut to the chase and get the top 10 myths in a free printable guide, just click here]

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About the author

Russell Mackenzie
Russell Mackenzie
Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
Russell Mackenzie

Russell Mackenzie

Russell is a physiotherapist and clinic owner in Adelaide, South Australia. He received his physiotherapy degree from UniSA in 1994, and has since also become a Credentialed McKenzie Therapist. Russell is the co-owner of Adelaide West Physio + Pilates and more recently, Adelaide West Headache Clinic, which was formed after becoming a Watson Headache Certified Practitioner to show his dedication and passion for headache and migraine treatment. Russell also aims to spread the word about the role of physiotherapy and non-surgical methods of helping persistent pain, low back pain and other conditions. Learn more about Russell on our About Us page.
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