What is the evidence behind pain? - [The Fundamentals of Pain] -
According to science, the cause of pain is not clearly identified. In the past, structural damage to body tissues was considered to be the cause of pain, but now factors such as previous experiences of pain, stress levels in daily life and social position are also considered.
However, these concepts are so broad and vague. Thus, we will try to find out the cause of pain based on what is already known. First, let's look at the scientific evidence on whether or not structural damage is the cause of pain.
1. About 70% of the 3,110 participants who have never experienced lower back pain had abnormalities on their MRI results, such as disc bulging and/or disc protrusion (Even annular fissure = about 30%).
2. As a result of hip imaging tests (MRI, X-ray) in about 5,300 people, the probability that a person with inflammation in the hip joint had pain was only 6-7%.
3. Although pain and functional aspects improved after 24 weeks of eccentric exercise in patients with chronic Achilles tendon pain, the appearance of their Achilles tendon did not change on their MRI (Abnormal MRI findings are still there even if they no longer experience pain).
Aside from the above, a significant body of evidence suggests that the correlation between structural abnormalities and pain is minimal. However, these results are a bit different to what we already know because we all have experiences where pain occurs when there is structural damage or inflammation (e.g. ankle sprain). Why are the scientific results different then? I believe that there are three reasons.
1. The level of inflammation is different
Research shows that when tissue was damaged, the inflammatory substance 'Cytokine' increased 1,000-10000 times, but in tendinopathy(chronic tendon problem), the level increased about 1-1.5 times only. Thus, it can be seen that when the tissue is acutely damaged by an external force, a strong inflammatory reaction occurs, but the inflammatory reaction does not occur significantly in situations where the problem is gradually built up without major episodes, such as chronic pain.
2. The level of tension is different
Similarly, tissue damage occurs when there is more tension applied to the tissue than what it can handle. Therefore, if the tissue is torn due to high tension, a strong inflammatory reaction and damage can be accompanied. However, if not enough to tear the tissue, the tissue exposed to higher tension than normal can become painful without actual damage and inflammatory reactions.
3. The timing is different
According to the three scientific results above, most of the MRI or X-ray abnormalities in people with no pain were seen as degenerative changes. Degenerative changes are basically 'Scar tissues' formed after the recovery process in the past. Therefore, it can be interpreted that the participants might have had some episodes in the past which they did not notice (no pain experienced) because those episodes did not cause strong inflammatory reactions and only had minimal (if any) structural damages. However, it is reasonable to think that any acute injury can cause inflammation and tissue damage followed by pain.
In summary, according to science, structural damage and inflammatory reactions are unlikely to be the main source of pain especially if the symptoms are chronic. However, as our experience shows, acute injuries can make exceptional situations. Now that you know all this, you do not need to be too scared by your abnormal imaging test results. Rather, it is better to think that inflammation, MRI, or degenerative X-ray changes have little to do with pain if you have not had an acute accident or injury.
*Take-home message
- Pain after an acute injury: likely to be the result of inflammation and tissue damage
- Chronic pain: not so much to do with the above (something else -> see the next posting)
Mr.Physio
What is the evidence behind pain? - [The Fundamentals of Pain] -
According to science, the cause of pain is not clearly identified. In the past, structural damage to body tissues was considered to be the cause of pain, but now factors such as previous experiences of pain, stress levels in daily life and social position are also considered.
However, these concepts are so broad and vague. Thus, we will try to find out the cause of pain based on what is already known. First, let's look at the scientific evidence on whether or not structural damage is the cause of pain.
1. About 70% of the 3,110 participants who have never experienced lower back pain had abnormalities on their MRI results, such as disc bulging and/or disc protrusion (Even annular fissure = about 30%).
2. As a result of hip imaging tests (MRI, X-ray) in about 5,300 people, the probability that a person with inflammation in the hip joint had pain was only 6-7%.
3. Although pain and functional aspects improved after 24 weeks of eccentric exercise in patients with chronic Achilles tendon pain, the appearance of their Achilles tendon did not change on their MRI (Abnormal MRI findings are still there even if they no longer experience pain).
Aside from the above, a significant body of evidence suggests that the correlation between structural abnormalities and pain is minimal. However, these results are a bit different to what we already know because we all have experiences where pain occurs when there is structural damage or inflammation (e.g. ankle sprain). Why are the scientific results different then? I believe that there are three reasons.
1. The level of inflammation is different
Research shows that when tissue was damaged, the inflammatory substance 'Cytokine' increased 1,000-10000 times, but in tendinopathy(chronic tendon problem), the level increased about 1-1.5 times only. Thus, it can be seen that when the tissue is acutely damaged by an external force, a strong inflammatory reaction occurs, but the inflammatory reaction does not occur significantly in situations where the problem is gradually built up without major episodes, such as chronic pain.
2. The level of tension is different
Similarly, tissue damage occurs when there is more tension applied to the tissue than what it can handle. Therefore, if the tissue is torn due to high tension, a strong inflammatory reaction and damage can be accompanied. However, if not enough to tear the tissue, the tissue exposed to higher tension than normal can become painful without actual damage and inflammatory reactions.
3. The timing is different
According to the three scientific results above, most of the MRI or X-ray abnormalities in people with no pain were seen as degenerative changes. Degenerative changes are basically 'Scar tissues' formed after the recovery process in the past. Therefore, it can be interpreted that the participants might have had some episodes in the past which they did not notice (no pain experienced) because those episodes did not cause strong inflammatory reactions and only had minimal (if any) structural damages. However, it is reasonable to think that any acute injury can cause inflammation and tissue damage followed by pain.
In summary, according to science, structural damage and inflammatory reactions are unlikely to be the main source of pain especially if the symptoms are chronic. However, as our experience shows, acute injuries can make exceptional situations. Now that you know all this, you do not need to be too scared by your abnormal imaging test results. Rather, it is better to think that inflammation, MRI, or degenerative X-ray changes have little to do with pain if you have not had an acute accident or injury.
*Take-home message
- Pain after an acute injury: likely to be the result of inflammation and tissue damage
- Chronic pain: not so much to do with the above (something else -> see the next posting)
For more information, click the link below (Free program)
‘[HEALTH 101] The Secret To Living A Healthy, Fit & Pain-Free Life’
www.mrphysio.net/p/health-breathing-and-core-basic…
8 months ago (edited) | [YT] | 33