Understanding Pain – Don’t Base Your Treatment Decision Just on A Scan

MRI’s often show tissue damage to spinal discs, muscles, cartilage and tendons when no pain is felt.


Now at first glance the above statement might seem woefully wrong or at the very least illogical and confusing.  However, it’s true. Understanding your pain more now will improve your quality life both now and into your old age.

Pain can be due to a recent injury or it can be a consequence of aging. Tissues wear with use and time. Thus a footballer is likely to put a lot of wear on his or her knees and is much more likely to suffer arthritic pain, due to heavy loss of the smooth cartilage on the bone ends. But not always.

We have seen scans of knee joints where there is full bone on bone contact with little pain. Yes, a bit of stiffness first thing in the morning or after being stationary for a while, but little pain.  In fact, 50% of MRI scans show moderate cartilage loss and yet with zero pain. On the other hand we have witnessed extreme suffering where there was quite a lot of cartilage still intact and functioning.

However, having a scan can help indicate the most appropriate treatment protocol. For example, we had a patient with a destroyed knee joint, but only felt mild discomfort. This indicated that a gentle rehab prescription, plus a change of lifestyle were needed for longevity of the joint.

This modern ability to provide a detailed internal scan can be a cause of pain, as it depends on what is said to the patient to explain the results, as well as how that patient interprets what has been said. The mind is very powerful and can act to ignore pain signals or magnify them.

These scans can also act to promote the need for replacement surgery because an individual may interpret moderate arthritis as a need for replacement, even though the level of pain is low. Further to surgery, research has shown in certain individuals, the brain magnifies the pain post operatively.

Is it the same for all parts of the body?

The simple answer is yes. It doesn’t matter where the problem is, whether it’s in the neck, shoulder, back or hips, there is little correlation between the injury and the level of pain being felt.

  • Only 10% of people found having a neck disc bulge suffered pain. 90% had no pain
  • The majority of those with disc changes in the lower back suffer no pain
  • More than 33% of people over 30 and more than 67% of people over 70 have abnormal MRI findings in the shoulder and suffer no pain
  • More than 73% of those found to have abnormalities in the hip had no pain

What is pain & why do we feel it?

Pain is an important signal that warns us something is wrong. For example, lumbar pain might occur because of a trapped nerve, and movement in a certain way causes pain. Thus, we are getting a warning that there is a problem and that certain postures or movements should be avoided so as to give the injury a chance to heal.

Pain signals are sent from the body and then up the spine into the brain. The brain decides how much pain will be felt based on this signal plus many other factors:

  • Emotion
  • Diet
  • Lifestyle
  • Fitness
  • Health
  • Genetic inheritance

Brain chemistry and thus how signals are fired in the brain are dependent on what you eat.

An MRI scan can’t see any of these factors and this is why it is so important to get a multi disciplinary approach to how you should be treated.


Ref:   ‘Wrinkles On The Inside’ Flynn, T; Heafner, J; Hall J.  Amazon UK