What you need to know about pain: Part 2


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Pain is poorly related to damage

Why can stubbing your toe hurt more than a broken bone that’s comfortably sitting in a cast? Because pain is poorly related to actual tissue damage. Have you ever noticed a bruise on your arm yet, have no idea how it occurred? Similarly, lots of people show wear and tear on imaging (MRIs, ultrasound etc.), yet experience no pain. Zero. Zilch. Nada. Pain is weird and and is often not experienced in proportion to tissue damage.

"Pain and tissue damage are rarely perfectly correlated."

Did you know:

  • 96% of athletes under 22 years of age have “abnormal” findings on MRI (Rajaswaran et al., 2014). However, if nearly everyone has them, how abnormal can these findings be?
  • Over 1 in 3 20 year-olds with zero pain have disc degeneration in their spine (Brinjikji 2015). 

  • 80% of healthy, symptom-free 50 years-olds have disc degeneration and 60% have disc bulging (Brinjikji et al., 2015).
  • Almost 60% of those between the ages of 20-50 have cartilage and ligament tears in their hips, yet experience no hip pain (Tresch et al., 2016).

You are not your MRI 

See, if you’ve been to your doctor with pain, there’s a good chance that you’ve been told you have some tear, bulge, tendinopathy, bursitis or degeneration. But as we’ve seen, these findings on scans are often completely normal. You can think of it as “wrinkles on the inside”. They don’t always have to hurt, and occasionally they’re relevant - but not always. “Abnormal” findings are often actually “normal” changes and don’t fully explain pain. Now, I know you’re thinking: “But what about acute pain (stubbing your toe, paper cuts etc.)?” Great question, I’m glad you asked!  When it’s acute pain, it’s better related to damage. But even then it doesn’t tell us too much about the damage. People have been known to break bones, snap ligaments and tear muscles and have no pain whatsoever. Other times, you can have a very small injury or strain and feel seriously injured for weeks or months.



We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session.
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Pain and tissue damage are rarely perfectly correlated. Think of the athlete who rolls their ankle in competition. Oftentimes the pain is greatest in the days following the injury, but obviously the increase in pain isn’t due to more tissue damage. The pain has changed but the damage hasn’t. Pain is an unreliable indicator of the presence or extent of tissue damage – either can exist without the other.

Remember, pain is weird! If you’re struggling with pain and think you would benefit from seeing a physiotherapist for your pain management, talk to your GP. Sycamore Health has a speciality in pain management and non-medicated remedies, and would love to help you take control of your pain!

References:
Brinjikji, W., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36(4), 811-816.
Rajeswaran, G., Turner, M., Gissane, C., Healy, J. (2014). MRI findings in the lumbar spines of asymptomatic elite junior tennis players. Skeletal Radiology, 43(7), 925-32.
Tresch, F., et al. (2016). Hip MRI: Prevalence of articular cartilage defects and labral tears in asymptomatic volunteers. A comparison with a matched population of patients with femoroacetabular impingement. Journal of Magnetic Resonance Imaging, 46, 440-451.

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Are you ready to break free of your pain?

What you need to know about pain: Part 1


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What on Earth is pain!?

What’s the purpose of an alarm? In its most basic sense, an alarm prompts you to do something. When your alarm goes off in the morning it’s a prompt  to wake up. If your car alarm goes off it’s a prompt to get there quick and see what’s going on! Pain put simply is an alarm or a “danger sensor”; it's our body’s special way of telling us to take some action. Let's not think in terms of pain pathways or pain endings – rather “danger sensors”.

"...our pain experience is based on perceived danger."

Consider these examples:

  • Firmly squeeze your ear lobe - it hurt right? Although no damage was done to the tissue, the pain is telling you to stop squeezing your ear.
  • When your hand gets too close to a fire you’ll feel pain – a prompt to move your hand away!
  • When you roll your ankle you experience pain when you try to move it as normal. The pain is telling you to minimise walking or heavy loading on the ankle while it heals.
  • If you injure your shoulder, you may feel pain when you raise your arm up too high - the pain is telling you avoid aggravating positions while the tissue heals.  

These alarms come on to protect us.

Pain warns us of potential danger and compels us to act to relieve or avoid that danger. Therefore, our pain experience is based on a perception of danger. It doesn’t tell us how much danger we’re actually in. Even if there are no problems in your muscles, nerves, bones and ligaments, you can still feel pain if your brain concludes you’re in danger! (Butler & Moseley 2003)

Why does any of this matter?

When you view pain as an alarm or “danger sensor”, it helps make sense of some of the strange things about pain. Consider the following questions from Greg Lehman’s pain workbook, ‘Recovery Strategies’:

  • Does a smoke alarm tell you if there’s a fire?
  • Does a smoke alarm tell you how much smoke there is?
  • Do smoke alarms tell you precisely where the fire is?
  • If an alarm goes off, does it tell you exactly what the problem is?
  • Can alarms go off for no apparent reason?

Are you starting to see that there's more to pain than meets the eye?


Are you ready to break free of your pain?

We're serious about helping you live life without pain. Right now, you can book in for a FREE initial assessment. No hidden funnies, weird pyramid schemes, or quackery. Just a great chance for you to see how physiotherapy can help you move again. In fact, we're so serious, we even offer half-price treatment should you chose to pursue your tailored therapy, right in the very same session.
Press the button below to quickly make an online booking. It's no fuss and super-simple, we promise.


In the following blog posts we’ll discover how pain is an alarm, how alarms can become sensitised or desensitised, what pain doesn’t tell us about the body and why pain can persist. There will be some overlap of key concepts and not every concept will be relevant to you, but all of the content is useful for developing a better understanding of pain.

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Finally, most pain is not life threatening. But, in very rare cases pain may be a sign of something serious. If you’re struggling with pain and think you would benefit from seeing a physiotherapist for your pain management, talk to your GP. Sycamore Health has a speciality in pain management and non-medicated remedies, and would love to help you take control of your pain! Book Now with our easy online bookings, or call the clinic between 9am-5pm, Mon to Fri on (07) 3046 1700

References:
Butler, D. S., & Moseley, G. L. (2003). Explain pain. Adelaide: Noigroup Publications.
Lehman, G. (2017). Recovery Strategies. Retrieved from http://www.greglehman.ca/pain-science-workbooks/

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