Pain≠tissue damage

I’ve put the most important concept of the article as the title. If there’s one thing you can take away from here, that should be it.

Pain, technically, is an interpretation of one’s nervous system. Nothing but impulses conducted through a particular type of fibers, and translated in the brain as something that needs to be avoided.
It is a defense mechanism and ac extremely useful one that has kept us alive and safe, ever since life evolved.

This interpretation of the brain is the output from several different inputs. One of which, *may* be tissue damage.

Human thinking is accustomed to taking shortcuts, and therefore attributes all pain to “damage”.

Tissue damage itself can be of several kinds. Structural vs biochemical. Reversible vs irreversible, with permutations and combinations of the above in varying degrees. All we have, as humans, to interpret that, is intensity, type and location of the pain.

It is not always possible to accurately discern how much tissue damage is present or even whether there is tissue damage at all, with just pain. Of course, the accuracy of one’s own assessment can be improved by careful observation and mindfulness. Having a second opinion about a chronic pain is useful to eliminate/reduce bias towards one’s own pain. That is where doctors should come in.

Instead, I find that there is now a trend towards pathologising and exaggerating the significance of pain. We’re doing a disservice to our patients by adding to their (patient’s) fears by over investigating and trying to categorise these innumerable pains into a few broad boxes. We’re making things worse by attributing to anatomy, what could be explained by inflamatory biochemistry. Attributing to pathology, what should be just normal wear and tear.

Basically barking up the wrong tree, because of over diagnosis, and over sensitive testing.

Repeatedly, studies have shown no correlation between what appears to be structural damage on MRIs and severity (or even presence) of pain. That has not stopped people from emphatically requesting scans and doctors from enthusiastically obliging them. All the while corporates and scan centers laugh their way to the bank.

So, what is the solution?
1. Stop kickbacks for prescribing scans
2. Try and avoid hospitals and scan centers that are built on loans (easier said, than done, I know)
3. If the pain is not disabling or progressively worsening, try lifestyle, Postural modification and corrective exercise for as long as possible.
4. Please do not ask your doctor for scans, if required, they’ll do that for you. They already have a very low threshold for investigation, without you instigating them
5. If an ayurveda or homeo practitioner is requesting a “scan”, please rethink your choice of healthcare provider.
6. If you do actually end up getting a scan, make sure that you don’t get rushed into treatments that are irreversible. Especially if your pain hasn’t changed in character or intensity for a really long time
7. Any trauma causing structural damage will cause pain almost immediately. Pain that follows a few weeks after trauma is usually residual inflammation / hypersensitivity /or muscle spasms and might not need “scans”

These are just thoughts. I’d like to discuss this further, if you’ve got doubts. Please point out, if you think I’ve made mistakes, or if something needs elaboration.

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