Top 3 Myths about pain
- I have to live in pain for the rest of my life
Pain is a complicated, multifactorial experience which is a decision by your brain to a perceived threat (Louw & Puentedura, 2013). Pain is not a result of a specific injury to your knee, foot, back, but a joint effort between your past, present, and future. Here is an example, if you twisted your ankle right now, would it hurt? (nearly everyone would say yes). Many will say ankle injury = pain. Now, same scenario, but you are crossing a busy road. You twist your ankle, but as you twist it, you look up and see a speeding 18 wheeler coming right at you that shows no sign of slowing down. Does your ankle still hurt? I would argue, of course your ankle doesn’t hurt because you need to get out of the way of the speeding 18 wheeler (Louw & Puentedura, 2013). This is a prime example of how your body ranks threats to control your pain experience. I have even met a few people that told me they have been shot in the leg without knowing, had a nail go straight through their foot without knowing, and even broken their toe without knowing.
So you may be saying, “yea, thanks for telling me about pain, but how do I get rid of it?”
Here are a few keys to decreasing your pain:
- pain education
- aerobic exercise
- and sleep to name a few
Honestly, my best advice for anyone in chronic pain is to go and see a practitioner with a background in pain science to help you put all the pieces together for your tailored pain solution.
- Rest is good for my pain
Many therapists and medical professionals now know and preach that rest can be one of the worst things someone can do when they are in pain. From our current understanding, pain is a protective response (an alarm) from your brain in the threat of danger. Meaning, pain is there to protect us from hurting ourselves. Because of this, our body is at a heightened sensitivity level. The simple things we used to do are now harder. For example, you used to be able to stand for 2 hours without any ache in your back, now you can only stand for 10 minutes before your back starts aching or you used to be able to walk from your room to the mailbox without any trouble, now you can barely make it to the door without having to sit down and rest.
Due to this heightened sensitivity, the goal of decreasing pain is by focusing on decreasing your sensitivity (resetting your alarm) and allowing the body to no longer feel a threat.
So, you may be asking, wouldn’t rest help decrease my sensitivity (reset my alarm)?
Unfortunately, in many instances rest is counterproductive to resetting our alarm. Rest actually tells our body something is still wrong.
- I have pain because of what is on my MRI (“I have a slipped disk”, “torn rotary cup”, “bone on bone knee”)
Many people believe that the pain in their low back is linked to their slipped disk, or pain in their shoulder is linked to their torn rotator cuff, or even pain in their hip is linked to the dreaded “bone on bone.” From our current understanding of pain, these connections may be far from the truth. In a study completed in 2006, the authors found that 89% of their participants had “abnormal MRIs” (disc degeneration and disk bulges) and even though 89% had “abnormal MRIs” nearly 50% had little to no pain (Kleinstuck, Dvorak, & Mannion, 2006). Boos et. al (2000) reported 73% of their participants showed a disc bulge on their MRIs, but had no pain, while Minagawa et al. (2013) found that 65% of the people with a rotator cuff tears had no pain. Ironically, the American College of Physicians and the American Pain Society have suggested guidelines to discontinue imaging of low back pain unless patients have severe or progressive neurological deficits (“can’t feel your legs”) or to help guide epidural steroid injections (Chou et al. 2007). Now, this is not to say that your images (X-ray, MRIs, CTs) can’t be linked to your pain, but you should know that there is typically a weak link. Think of these changes, disc bulges, rotator cuff tears, etc. as wrinkles on the inside of your body. Do the wrinkles on your face hurt?
So you might be wondering, “if my MRI or X-ray can’t explain my pain, then what can?”
Sorry, but this is a question that doesn’t have a simple answer and varies from person to person. All these quick fixes you see on television, billboards, and infomercials are just like shooting dice, sometimes you will hit, but more often you will crap out. But my advice again, would be and see a practitioner with a background in pain science to create your personalized plan to help you put all the pieces together to get you out of pain.
Boos, N., Seemer, N., Elfering, A., Schade, V., Gal, I., et. al. (2000). Natural history of individuals with asymptomatic disc abdnormalities in magenetic resonance imaging: predictors of low back pain-related medical consultation and work incapacity. Spine. 25 (15), 1484-1492.
Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, T. et al. (2007). Diagnosis and treatment of low back pain: a joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annuals of Internal Medicine. 147 (7), 478-491.
Kleinstruck, F., Dvorak, J., & Mannion, A. (2006). Are “structural abnormalities” on magnetic resonance imaging a contraindication to the successful conservative treatment of chronic nonspecific low back pain? Spine. 31 (19), 2250-2257.
Louw, A. & Puentedura, E. (2013). Therapeutic neuroscience education teaching patients about pain.
Minagawa, H., Yamamoto, N., Abe, H., Fukuda, M., Seki, N. et. al. (2013). Prevalance of symptomatic and asymptomatic rotator cuff tears in the general population: from mass-screening in one village. Journal of Orthopedics. 10(1), 8-12.
-LD Woods, PT, DPT, CSCS-