Outdated concepts of pain

Find that scapegoat!

Pain warns us something is going wrong. It is very important to find the cause of problem, sometime it may mean life or death.

Experience tells us that pain will subside after the damage is correctly dealt with. So we look for any localized, abnormal structural change in the body using x-ray, MRI and other advanced procedures. We trust what we see, and we confide in technology. We just want to find it and get rid of it once and for all.

When the report comes back with impressions of imperfection of some anatomical structures like bulged (herniated) disk, degenerative disk, etc, we are much eager to take treatment to correct these unrelated conditions. Negative findings may not comfort us. Some of us are still puzzled with the unanswered question. All these lead to mounting medical insurance payout and promoting a much dreadful condition—chronic pain syndrome.

To overcome this socio-economic-medical problem, before the turn of the 21st century, a simple and practical clinical approach has been recommended. It helps to rule out nerve root pain and serious spinal pathology from the vast majority of what is called the "nonspecific back pain" of mechanical in nature. The use of advance diagnostic procedures on what seemingly benign ordinary back pain is not suggested.

Let us see why the following are not considered as the cause of pain. At the matter of facts, pain may occur without these conditions.

Herniated disk

Protrusion of intervertebral disk

Herniated Disk: Blausen.com, Wikimedia Commons

Intervertebral disk protrusion or so-called herniated disk is the early stage of normal aging process. It is the weakening of the wall of the disk. Many people have it without being aware of it.

Commonly it appears as a bulge spreading slightly outward like an under-inflated tire to a protrusion where the inside jelly seeps into a crack in the wall of the disk and balloons it outward at that spot.

The pain is a result of stretching and swelling of sensitive tissues on the outside of disk. It almost always resorbs on its own, and even when it doesn’t, pain still subsides, usually in about 6 weeks.

Degenerated disk

Degeneration is actually a natural phenomenon of aging, and over time our disk will exhibit various degrees of degeneration.

A disk acts as shock absorber between two vertebrae. With aging and increased use, the wall is weakened with cracks. The protein of the fluid inside is able to seep through this barrier that has kept it isolated from the rest of the body. The immune system treats it as foreign protein. Pain arises due to the inflammatory reaction caused by this protein and the instability of the disk.

With continued disc degeneration, the inflammatory protein will eventually be depleted, and the disc will become stiffer and more stable. Because of this, even though disc degeneration is likely to advance, the pain usually does not get worse and in fact usually gets better with time.

MRI of cervical vertebral degeneration

Cervical Spine MRI showing degenerative changes: Stillwaterising, Wikimedia Commons

Poor posture

Poor sitting posture in front of desk

Bad posture: Skoivuma, Wikimedia Commons

Poor posture is commonly thought to put stress on the body and cause pain. But it cannot explain why so many of us have bad posture and yet to complain of pain, and others who have good posture may always have pain.

We can find that toddler's posture is very fine. Posture is just a natural response of human body to fight gravity.

Having poor posture with pain does not mean posture is the cause of pain—slouching in front of the computer and looking down on a mobile phone may aggravate pain.

On the contrary, it is pain that affects our posture. We are keeping poor posture to avoid pain. In this situation, it is very uncomfortable to maintain “good posture.”

In the past, more attention is placed on searching for superficial cause.

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