A picture paints a thousand words but pain isn’t one of them: Why getting that scan may not be so helpful

Pain leads to Panic,

Panic leads to Fear,

Fear leads to Suffering,

Suffering leads to Pain.

…and so the pain-cycle goes on and on!

Years ago, I experienced what it was like to ride this pain-cycle while I battled through my own bout of persistent lower back pain. I remember what it was like, trawling through the internet, trying to find answers as to why I’m in pain. I also had friends, family, colleagues and the occasional random blow-in that would suggest everything under the sun to help manage it. Awash with conflicting opinions as to what is the best treatment for my lower back pain, I was able to notice one consistent message. “You should get a scan to see what’s causing your pain?”

Fast forward to now and I’m a physio hearing about how my clients are stuck on this not-so-fun ride. I’ve reflected on the barrage of poor advice I was given surrounding my previous condition. I’ve realised most of it was not helpful and some of it was actually harmful. My past lived experience and now clinical interest treating pain has led me to understand it deeply. Pain is a complex blend of petrophysics, biology and psychology which are embedded in our environment and context. Read on and see why getting that scan may not be so helpful…

Over the last few decades, our hunger to consume digital information has spread into the medical world. We now have greater access to a range of services including medical imaging (X-Ray, CT, MRI, ultrasound etc). Unfortunately, contrary to common belief, pain cannot be seen in these images. Yet, each year Australia records 27 million of these images racking up a hefty $4 billion in Medicare spending. What’s worrying is that a huge number of these scans are not even needed and often lead to other unnecessary and potentially harmful medical procedures such as cortisone injections or even surgeries. I read a recent study that showed a shocking 100% of CT scans and 60% of MRI scans in degenerative spinal disorders were deemed unnecessary (Busse et al., 2014).

Let’s look at a typical scenario:

You might have been referred for a scan on your lower back, shoulder, knee or hip because we need to see what’s causing the pain (by the way, this is by no means a valid reason to send for a scan). The report may have said something like a complex, degenerative meniscal tear or a severely arthritic joint or multilevel bulging discs. It really doesn’t matter. Being non-fluent in medical jargon, you now have an increased level of anxiety and fear surrounding these findings. Sadly, you now don’t just have an image. You’ve also now pinned this mumbo-jumbo to the cause of your pain.

There has been a stack of high-level studies that have shown that people have been getting around with tears, bulges and degenerative conditions such as the ones in that scenario without any pain at all! (Brinjikji et al. 2015). When looking at persistent lower back pain, about 90-99% of back pain is considered to be non-specific (Maher et al. 2017). This means there is a very low chance that a scan will find something responsible for a person’s pain. This results in most radiology findings, highlighting various age-related structural changes. Although, they tend to be described in a gloomy report filled with medico jargon. Note that these words are like toothpaste, and they are the catalyst for fear. Generally, it’s human instinct to fix a problem – so you can see how this leads to poor management and even unnecessary procedures like surgery.

What to do if you’re in pain.

Avoid unnecessary diagnostic images. They have the power to create an emotional attachment to an incidental finding which is not the driver of your pain. Go and see your local physiotherapist at Sportscare Caloundra. We are highly trained to assess a range of conditions and will only send for an image if absolutely necessary. Our team are also experts in pain management and will help put you back in the driver’s seat so that you can steer yourself out of pain.

Remember an image is just that.
An image.
A snapshot in time that can provoke emotions – sometimes stress, panic and fear…
Cue the pain cycle!

Sam Taylor
Physiotherapist | Caloundra Sportscare