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A picture paints a thousand words but pain isn’t one of them  

Pain leads to panic, 

Panic leads to fear,

Fear leads to suffering,

Suffering leads to pain.

…and so the cycle goes on and on!


7 years ago, I experienced this sequence while battling through my own bout of persistent lower back pain. Fast forward to now and I’m a physio hearing my clients sing the same tune. Pain is a complex blend of neurophysics, biology, psychology and contextual factors. 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 on 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 medical procedures such as cortisone injections (see my article on cortisone injections) or even surgeries (see my article on degenerative meniscus 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.


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 severe arthritic joint or multiple 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 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! A lot of the time, findings from images are actually not the source of pain people are wanting to investigate. They can be normal age-related or accidental findings where you didn’t have any symptoms. Because we now have a big scary word on the report our human instinct is to fix the problem – which was never a problem before we knew about it! Like I mentioned earlier, you can see how this leads to poor management and even unnecessary procedures like surgery.


So, let’s get it straight. An image is just that. An image. A snapshot in time which can provoke emotions – mainly panic and fear. And so, the never-ending pain cycle begins!


“So, what the hell do I do then?”

You should 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 physio first! They are highly trained to assess a range of conditions and will only send for an image if absolutely necessary. Physios are experts in the management of pain and they will put you back in the driver’s seat so that you can steer yourself out of pain. 

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