“What is the cause of my pain?”
The most common question I get asked as a healthcare practitioner is what is the cause of my pain? A perfectly valid question, no doubt, but one that is really not that straightforward. Indeed, it is my contention that providing patients with a single answer (you have injured this structure in your back) might actually be slightly misleading. Let’s use back pain as an example.
Occasionally back pain is caused by something sinister (about 1% of cases) and this is why any well-reasoned healthcare practitioner will take time exploring aspects of an individual’s general health.
So called ‘trapped nerves’ are also a cause of back pain. I use the term lightly here, because trapped nerves, associated with true objective neurological deficits in the legs are also relatively uncommon (5% of cases) despite their common usage.
This means that the majority of back pain actually has an unknown cause, hence the emergence and common use of the term ‘non-specific low back pain’.
What does this mean?
This means that lots of structures in the low back (discs, joints, muscles etc) can cause pain, either in isolation and or more commonly together. However, research has shown that the magnitude of pain an individual experiences, is rarely a reflection of the degree of ‘damage’/ injury (lots of pan does not mean lots of injury). This is because lots of things can contribute to an individual’s perception of pain, outside of tissue insult.
These factors include:
- our genetics (some people are more likely to get aches and pains than others),
- our environment,
- our general health,
- our thoughts, feelings and behaviours, lifestyle factors such as how much sleep we get, and even the food we eat.
Thus ascribing pain to a single structure in the low back, my actually be a deterrent from exploring and addressing other aspects of an individual’s case history which may be more revealing. In fact, as pain persists, the relationship between pain and injury (and the assortment of factors that might be contributing) become even less clear.
This is not to suggest that we ignore a patient’s tissue health, and or their physical examination, rather it is a reflection of modern science, and how management should be as broad and unique as the individuals we see, and their unique story.
If you would like to learn more, or have any questions, about how this information relates to your own pain experience, please feel free to contact me on firstname.lastname@example.org
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