If you are like most people, you’ve likely experienced pain at some point in your life. Maybe that pain lasted only for a day or two, or perhaps you have pain now and it has been lasting for a while.
The International Association for the Study of Pain (IASP) recently revised their definition of pain by adding new elements that are important for understanding why we hurt. Two of the key elements described are:
- Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
- Pain and nociception (i.e. signaling from the tissues) are different. Pain cannot be solely attributed to issues in our tissues.
How do our bodies understand pain?
As a physical therapist who works with individuals challenged by pain, these key points really resonate and reflect what I have come to learn about pain from the thousands of patients I have been privileged to work with.
Both points reflect a shift in our understanding of pain: a shift away from a strictly tissue injury-based understanding of pain to a more complete understanding including the tissues as well as the unique person living with those tissues.
If pain was completely and accurately explained solely by issues in the tissues—like arthritis, tears, degeneration, and disc herniation—then everyone with those issues would have pain. Interestingly, that is not the case at all. Over the past 20 years, multiple studies have resulted in a significant shift in our understanding of pain. Here are some highlights:
- 40% of people with no back pain have bulging discs
- One in three pain-free people over the age of 30 have abnormal findings on scans of their rotator cuff
- Only half of people with arthritis in their knee experience pain
I first realized the inconsistencies in pain and imaging findings early in my professional career. I would often have patients tell me that they had an x-ray of their knee or shoulder and the doctor told them the other side looked worse than the side they were having the pain! I wasn’t sure how to make sense of this until I began learning more and more about pain.
Misconceptions around pain
Pain–whether it’s chronic or acute–is always a personal experience and reflects an individual’s perception of threat. Words like rip, torn, ruptured, misaligned, degenerated, and arthritic are provocative and contribute to uncertainty regarding our health and wellbeing. When uncertainty exists, pain often follows.
Don’t get me wrong, I’m not advocating that we disregard x-ray and MRI findings; I am advocating, however, that we consider them as a single piece of the whole person challenged by pain. Pain can have a significant influence on our lives, and it is important to have an accurate and complete understanding of why you hurt so you can make the most informed decisions on how you treat and resolve your pain.
The physical therapists at Des Moines University Physical Therapy Clinic have extensive training in understanding pain and can help you discover how you are more than just your imaging. Visit the DMU Clinic website or call 515-271-1717 to schedule an appointment.
- X-Rays. Medlineplus.gov. https://medlineplus.gov/xrays.html. Published 2021. Accessed May 6, 2021.
- Magnetic Resonance Imaging (MRI). Nibib.nih.gov. https://www.nibib.nih.gov/science-education/science-topics/magnetic-resonance-imaging-mri. Published 2021. Accessed May 6, 2021.
- Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJH. Dead men and radiologists don’t lie: A review of cadaveric and radiological studies of rotator cuff tear prevalence. Annals of the Royal College of Surgeons of England. 88(2):116-121. doi:10.1308/003588406X94968
- Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. The Journal of bone and joint surgery American volume. 1995;77(1):10-15. doi:10.2106/00004623-199501000-00002
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- Gill TK, Shanahan EM, Allison D, Alcorn D, Hill CL. Prevalence of abnormalities on shoulder MRI in symptomatic and asymptomatic older adults. International journal of rheumatic diseases. 2014;17(8):863-871. doi:10.1111/1756-185X.12476
- Lindsey T, Dydyk AM. Spinal Osteoarthritis. [Updated 2021 Mar 16]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553190/
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- Wasserman MS( 1 ), Guermazi A( 1 ), Abdelkader M( 1 ), et al. Evaluation of spine MRIs in athletes participating in the Rio de Janeiro 2016 Summer Olympic Games. BMJ Open Sport and Exercise Medicine. 4(1). doi:10.1136/bmjsem-2017-000335
- Register B, Pennock AT, Ho CP, Strickland CD, Lawand A, Philippon MJ. Prevalence of abnormal hip findings in asymptomatic participants: a prospective, blinded study. The American Journal of Sports Medicine. 2012;40(12):2720. Accessed May 6, 2021. http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,uid&db=edsgao&AN=edsgcl.334511330&site=eds-live
- Chu Miow Lin D, Reichmann WM, Gossec L, Losina E, Conaghan PG, Maillefert JF. Validity and responsiveness of radiographic joint space width metric measurement in hip osteoarthritis: a systematic review. Osteoarthritis & Cartilage. 2011;19(5):543-549. Accessed May 6, 2021. http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,uid&db=edo&AN=60654447&site=eds-live
- Bedson J, Croft PR. The discordance between clinical and radiographic knee osteoarthritis: A systematic search and summary of the literature. BMC Musculoskeletal Disorders. 2008;9. Accessed May 6, 2021. http://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,url,uid&db=edsgao&AN=edsgcl.185266381&site=eds-live
- Horga LM, Hirschmann AC, Henckel J, et al. Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI. Skeletal Radiology. 2020;49(7):1099. doi:10.1007/s00256-020-03394-z
- Culvenor AG( 1,2 ), Hart HF( 2 ), Crossley KM( 2 ), Øiestad BE( 3 ), Stefanik JJ( 4 ), Guermazi A( 5 ). Prevalence of knee osteoarthritis features on magnetic resonance imaging in asymptomatic uninjured adults: a systematic review and meta-analysis. British journal of sports medicine. 53(20):1268-1278. doi:10.1136/bjsports-2018-099257
- Silvis ML, Mosher TJ, Smetana BS, et al. High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. The American journal of sports medicine. 2011;39(4):715-721. doi:10.1177/0363546510388931
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- Bezuglov E, Khaitin V, Lazarev A, et al. Asymptomatic Foot and Ankle Abnormalities in Elite Professional Soccer Players. Orthopaedic Journal of Sports Medicine. 2021;9(1):1-7. doi:10.1177/2325967120979994