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Pain! It's not what you think it is!

September 9, 2017

I am going to be very direct and to-the-point with this blog posting as its really all about the stats. So, do you have an MRI that says you have a "bulging disc", a "herniated disc", bone on bone osteoarthritis, a nerve getting squashed or something similar that sounds like you are broken and that your clinician says you need treatment for in order to not feel pain? The following info is for you.

 

 

 

Shoulder Surgery

 

Type 2 SLAP lesion randomised controlled trial of three interventions - sham surgery (no actual repair done), biceps tenodesis (tendon release) or labral repair surgery. They compared the patients in intervals post surgery and found at 6 and 24 months of follow-up, there were no significant differences between labral repair, biceps tenodesis and sham surgery for patients with a type II SLAP lesion in the population studied.

 

Why does this study matter? Well, it shows us that surgery in this case was no better than the placebo sham surgery. Why waste your money and potential harm from the surgery? See the graph below for a comparison. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Lower Back

 

A game changing review called "Systematic literature review of imaging features of spinal degeneration in asymptomatic populations" has shown truly amazing findings. These numbers are for people who have no pain or any other symptoms.

30% of 20 year olds have a disc bulge (don't forget these people do not have pain)
29% of 20 year olds have a disc protrusion (don't forget these people do not have pain)

19% of 20 year olds have an annular fissure or tear (don't forget these people do not have pain)

 

The study also showed that as we age that percentage goes up and, again, does not correlate with any onset of pain. The point of mentioning this study is to show that when you get a scan to see "why" you have lower back pain, its likely that you will have one of these findings regardless of pain. The main reason MRI or CT should be used is to rule out "true" pathology such as cancer, benign tumours, fractures etc. A bulge, protrusion or fissure cannot be classified as a pathological finding. 

 

 

Knee

 

The follow review 710 people (30% had knee pain, the rest had no pain) and their mean age was 62.3 years.

 

Prevalence of “any abnormality” was 89% (631/710) overall.

Osteophytes were the most common abnormality among all participants (74%, 524/710)

Cartilage damage (69%, 492/710) 

Bone marrow lesions (52%, 371/710)

 

The higher the age, the higher the prevalence of all types of abnormalities detectable by MRI. There were no significant differences in the prevalence of any of the features between BMI groups. The prevalence of at least one type of pathology (“any abnormality”) was high in both painful (90-97%, depending on pain definition) and painless (86-88%) knees.

 

Again, the point of this discussion is to demonstrate that much of the MRI findings that are classified as a reason to get surgery according to many healthcare professionals, but the evidence that they "cause" the pain is very much lacking.

 

 

Cervical spine

 

This is another study that looks at the prevalence of "abnormalities" on MRI in 1211 healthy pain-free people. The findings will shock you. Age range was 20 to 70 years of age. With all findings being more prevalent as age increased.

 

87% had cervical disc bulging. Even most subjects in their 20s had bulging discs, with 73.3% and 78.0% of males and females. 5% of pain free people had spinal cord compression.

 

 

Pain is complicated, its true! The most important consideration when dealing with acute pain is understanding what the body needs in order to repair any damaged tissues and do our best to give it what it needs to achieve this. For chronic pain, other issues such as depression, anxiety, sleep issues, gastrointestinal problems, diabetes, insulin resistance, obesity and many others need to be addressed as these increase the risk of developing chronic pain and may be maintaining past the normal tissue healing time. This is why Athletica Physical Health approaches treating pain from a holistic mindset, considering the brain to gut and gut to brain axes, pain processing in the brain and how nutrition and lifestyle alter these processes and how other therapies such as transcutaneous vagus nerve stimulation and transcranial photobiomodulation can alter the neurochemistry and neurocircuitry of the brain in order to relieve chronic pain. 

 

 

References

https://www.ncbi.nlm.nih.gov/pubmed/25584950 

http://www.bmj.com/content/345/bmj.e5339

https://www.ncbi.nlm.nih.gov/pubmed/25430861

http://bjsm.bmj.com/content/early/2017/05/12/bjsports-2016-097098

 

 

 

 

 

 

 

 

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