Your Protective Pain System
Did you know you have a Protective Pain System?
I feel I owe it to you to talk just briefly about a prevalent problem within medicine. Much of this thought is responsible for perpetuating the biomedical model, verses a more informed bio-psycho-social model that we have discussed in this episode.
As doctors and healthcare practitioners, we are all legitimately focused on finding the source of our patients' pain so that we can provide them with a solid diagnosis and a solution to their problem. The goal is to locate the place where the pain is being generated. In my experience, in many cases it is often difficult to identify. It is almost universal that we believe our search will be successful and we will identify the “pain or symptom generator,” the anatomical abnormality that is the source of our patients’ pain and symptoms. On the surface this seems plausible. It is not unlike how we think about car repair. If part of your car is broken, you go and get it fixed, right? If something in your body is broken you also go and get it fixed, right? Wrong! There is a major fallacy within this approach. Automobiles are not living creatures and therefore do not have protective pain systems.
Did you know that degenerative disc disease is not a disease?
For example, a condition called degenerative disc disease is often cited as a structural source of chronic low back pain (LBP). Multiple research studies, however, have shown this to be inaccurate, regardless of the severity of the degeneration. In truth, physicians can identify the source of LBP only about 15% of the time. When asked by patients if a degenerative disc is a legitimate source of back pain, I use to answer in the affirmative, but current research and studies have changed that. This thinking is so prevalent throughout medicine, chiropractic, and physical therapy that it may appear that we have lost our minds. But current neuroscience and physical medicine research confirms that there is little correlation between the presence of degenerative disc, spinal arthritis and low back pain. This has been shown with X-rays, CT scans, MRI scans. There is a lot that we don’t know about the cause of low back pain and other spinal conditions, but the lack of correlation between degeneration and pain is one fact that has been consistently documented.
If you take volunteers who have never experienced low back pain and obtain MRI scans, about half will have some disc degeneration by the age of fifty. By the time an asymptomatic person is sixty-five years old, the incidence of disc degeneration is around 100 percent. This also applies to bulging discs, herniated or ruptured discs, bone spurs, facet arthritis and arthritis. You may have seen an x-ray, CT scan or MRI of your spine that shows severe disc degeneration. The implication is that with this degeneration, the disc must be the source of your pain. There are many fusions performed for this problem each year. However, there are some orthopedic surgeons and neurosurgeons, who are more informed about the newest neuroscience research that believe that the collapsed disc is the least likely source of pain because there is essentially no motion. Only unstable disc can generate pain. If there is so little movement, how can they be a source of pain. Many professionals feel the term, “disease” should be discarded anyway. A better term might be “progressive disc degeneration” or “normally aging spine” or “wrinkles on the inside.” Degenerative disc disease is not a disease.
Similarly, studies on back pain reveal that there is little to no correlation between back scan “abnormalities” and pain. In one study disc degeneration and bulges were found in 80% of elderly patients who had no symptoms or pain. In another MRI Study “abnormalities” were found to be completely unrelated to the degree of disability or pain intensity reported by patients. Some people with extensive spinal degeneration had pain, and others with similar MRI scans had none. Scientists have therefore concluded that, like the wrinkles on our faces, “wrinkles” on our spines are likely a normal part of aging, However, these MRI and CT scan results are often incorrectly blamed as the sole cause of pain. This often leads to unnecessary surgeries and medical interventions, often without long term relief. This has given rise to a new diagnosis in the medical literature called “Failed Back Surgery Syndrome.” The research states that up to 40% of back surgeries are unsuccessful suggesting that surgery may not be the cure for back pain. Like every other type of pain, the cause of, and most effective treatment for back pain and other pain syndromes is biopsychosocial.
What if you have caught a “thought viruses”?
Many of my patients suffer from thought monsters that are blinding them to the truth of their situation. Health and wellness providers have come to know these thought monsters as “thought viruses.” A thought virus is a negative or limiting belief that originates from messages we receive, information we take in, and experiences we have. A common example is disc herniation or disc degeneration based on MRI findings. If the patient hears negative stories, sees online images of disc tearing, they may become afraid, fearing the worst. If they turn to their friends, the internet, or other unreliable sources for information they may ruminate on the “dangers “of such a diagnosis. Furthermore, the thought virus can easily get intensified when the idea is planted by an individual in a place of authority or perceived expertise.
What I want to leave you with in this article is that through time, the thought virus can become completely inaccurate due to changes in science, information, and circumstances. “Thought viruses” are often irrational and unfounded and aren’t backed up by the research. Pain, while unpleasant, is an essential part of life. It’s a personalized experience that’s heavily influenced by an individual’s environment, context, and beliefs. Don’t be afraid of “thought viruses,” they are just thoughts!
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