To the intense frustration of everyone, doctors and patients alike, levels of pain can’t be picked up on a blood test, a urine screen, or any of the other tests the medical profession relies on to diagnose other medical conditions. There is no test that can measure pain.
Even worse, research has shown that oftentimes signs that SHOULD be associated with pain aren’t, and signs of causes of pain are completely missing in people with severe pain. What on earth?
What does the research say?
Check this out. In 1994, a group of researchers published a brilliant study in the New England Journal of Medicine. They took 94 people without back pain and performed a test that is commonly used to evaluate complaints of lower back pain called an MRI (magnetic resonance imagery) scan. They took those scans, mixed in 24 scans of people with back pain, and gave the lot to two highly experienced MRI readers. They asked each of these experts, separately, to evaluate the scans and look for signs (physical indications that are observable, like a bulging disc) of low back pain.
Sixty-four percent of people without low back pain had at least one sign on MRI that is usually associated with back pain.
Let me repeat that. Sixty-four percent of people without back pain had abnormal signs on their MRI scans. Let that sink in for a moment. In that study, only 36% of people without pain had normal spines on MRI scan results. That means there are a group of people with spine problems walking around without pain, a group of people with no normal spines and no pain, and some people with normal spines and chronic low back pain.
This is the conclusion those researchers drew, in their own words, “Given the high prevalence of back pain in the population, the discovery of a bulge or protrusion on an MRI scan in a patient with low back pain may frequently be coincidental.” [emphasis mine] So when someone with ongoing low back pain goes to the doctor, the doctor does what doctors do, and orders a scan. They see a disc bulge or herniation, order procedures like injections, or even sometimes surgery. And what happens for many people? A whole lot of nothing. Except that now a person also has to deal with the pain and cost of medical procedures on top of pain.
The lack of correlation between chronic pain and physical signs is not just related to low back pain either. There is research showing the same thing for knee pain, headaches, migraines, and a whole host of other chronic pain conditions. Pain sometimes, but by no means always, comes with signs that can be observed. This is a big part of what makes pain tough to treat.
What does this mean for us?
The takehome message from this study is that sometimes MRI scans do indicate a reason for low back pain, but not always.
Just because a scan or test is "normal" does not mean that your pain is not real.
Many people have had the experience of being in severe pain and being dismissed by a doctor. It happens often and one (of many) reasons is that a medical doctor is used to having observable signs of medical conditions easily available to them. In their experience, no signs of a medical condition usually means no medical condition. End of story, for them. Beginning of story for you and me.
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