The medical community has a problem: we dug way too deep a hole in the pain cave. Patients now, more than ever, associate pain with a specific structural issues that was shown on an MRI or similar film. At least once a day, and my caseload is not incredibly high right now, I hear from at least one patient or family member that they have pain “because of a disc”. Some individuals do experience discogenic pain, however, there is a growing body of evidence that many more individuals have disc dysfunction and yet have no pain at all.(1)
So why, then, do we perpetuate that whatever we see on film is the exact reason someone has pain?
Since as early as 2006, clinical guidelines have argued that films such as MRI’s should not be performed unless absolutely necessary. The biggest issue is not what the film shows, but what the patient interprets from the film. Fear of the unknown can be paralyzing, and the more we as clinical practitioners learn about the human body, the more we realize we don’t know. The more fear the patient has about a spine injury or diagnosis, the higher the risk that her low back pain will become chronic (2).
So what can we do as clinicians, and how can we educated the public? For one, clinicians (especially we physical therapists) need to do some research. Far too many of us still cling to the postural/structural model of pain, despite evidence that it is not near comprehensive enough to adequately cover a true description of pain and symptoms. Educating the patient that her body is more robust than it is brittle is a great way to start, for many of us. Studies are exploring the efficacy of cognitive functional methodology, with improvements in pain levels in case studies. (3).
The human body is remarkably resilient, in more ways than can be discussed in one simple musing. Isn’t it about time we start teaching the patient what she is capable of, rather than what damage she has done? This physical therapist thinks the community at large as a duty to do better. Education is one of the keys to pain management, and if the medical community (and even the fitness community) is going to discuss pain, we have to become better educated and stop spreading lies, whether knowingly or otherwise. “Do no harm to your patients” or clients, and help provide a better service than what is currently in place.
Dr Taylor Weglicki, PT
(3) Caniero, JP et al. “Cognitive functional therapy for the management of low back pain in an adolescent male rower: a case report.”