Pain is poorly related to damage
Written by Mitchell Robinson
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.
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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!
Next post in this series: What You Need To Know About Pain: Part 3
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.
