When a patient comes in complaining of lower back pain they want answers. They may be scared and anxious. My patients often search online for their symptoms and what that ache or stabbing in their back can mean, they read horror stories and anecdotes which heighten their dread. When they ask me what could be causing their pain they often want an MRI to confirm a diagnosis.

A good doctor who takes a detailed history, listens to you, performs a competent exam, and gives reasonable advice and a treatment plan that aligns with your goals and expectations…this approach has been well studied and there is much evidence to demonstrate it’s superiority over expensive MRI scans and cookie cutter treatments.

The Need To Know

Yet, there is the human desire to KNOW what is going on inside our bodies. There are also costs to knowing that you have a disc protrusion, or osteoarthritis, or degenerative disc disease.

What that MRI won’t tell you is that the prevalence of disk degeneration in asymptomatic individuals increases from 37% of 20-year-old individuals to 96% of 80-year-old individuals¹.

An MRI is great at showing tissue structure such as discs, cartilage, and tendons. An MRI will not show you what hurts, not definitively.

Your story, experiences, and your doctor’s exam should do a much better job in most cases in identifying the culprit. Imaging for many cases can not determine the age of these findings, sometimes providers are not skilled in identifying old versus new injuries, sometimes it is just impossible to tell. The imaging findings may correlate with your symptoms, or they may not, or they may match up with what you are feeling AND still not be the pain generator.

Say you are a runner. You’ve been running for decades and have had various minor injuries, aches, and pains. Now you are in your 50’s and your back starts hurting after a run, like it has on occasion many times over the years, but this time it lasts a little longer and is more intense than before, so you seek care with your primary doctor and they prescribe you some Ibuprofen and tell you to take it easy for a couple weeks. Two weeks pass and your back doesn’t feel much better, you go back to your doctor and they order an MRI.5 Steps To Overcome Long COVIDPost-Acute Sequelae of SARS CoV-2 infection, or PASC, is increasingly reported. Here’s what you can do to combat these…medium.com

The MRI shows a disc protrusion at L5-S1 and mild osteoarthritis at multiple levels. What the MRI doesn’t tell you is if you take 100 people without back pain off the street, on average 36 of them are going to have a disc protrusion at your age. So is the disc protrusion causing your pain? The MRI can’t tell you that, but now you know you have a disc protrusion, maybe your doctor tells you to stop running so as to not make it worse, maybe you are referred to a surgeon for an injection. There is a whole cascade of possible outcomes, none of which have been shown to be all that helpful versus a gradual return to general exercise and a wait and see approach.

All that care is very expensive though, and healthcare is a business, and lower back pain is a $100 billion a year subset of that industry.

You Can’t Unsee Your MRI

With 36% of people in their 50’s out there running around with disc protrusions and not having any symptoms, it may be hard to believe a radiologist pointed it out on your scan and it might not be important as a source of your pain.

However, many normal changes that occur with aging are routinely noted as abnormal.

Try to remember that wrinkles do not hurt, greying hair is not painful, and that rotator cuff or labrum tear, disc bulge, or torn meniscus…could just be part of the bodies normal aging process.

Find a doctor, chiropractor, physical therapist, or other licensed health care provider who takes a detailed history, performs a thorough examination, and works with you on goal setting and an individualized treatment plan.

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Sources:

Brinjikji, W et al. “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR. American journal of neuroradiology vol. 36,4 (2015): 811–6. doi:10.3174/ajnr.A4173

The post When Your Back Hurts, Sometimes It’s Better Not Knowing Exactly Why appeared first on Medika Life.

While there is no miracle drug or solution that can take away your pain completely, there are some strategies that you can explore that may help you cope with chronic pain in your daily life.

Explore your strengths, abilities, and things you are grateful for

This can be very challenging to do, especially when your mind is absorbed with the pain you are feeling in your body. It can be useful though to keep in mind what you are able to do, what is going well, and what is in your life that makes you happy.

Shifting the focus to a positive outlook can possibly help you ever so slightly to redirect your attention to other things, even if they are fleeting moments throughout the day.

Pace yourself, prioritize your to-do list, and break tasks into smaller pieces

Keep in mind that you may have more energy at specific times of day, you may need to take frequent breaks, and you may have to prioritize some tasks over others because you only have so much energy and time in the day before your body and your pain levels force you to stop.

Carefully mapping out your day, and knowing that you understand yourself and your needs better than anyone else, can help you maximize your daily function.

Try out relaxation techniques

Try deep breathing, meditation, progressive muscle relaxation, mindfulness, yoga, or using your senses to relax you (sight – getting out in nature, making art, imagining scenes and memories that make you happy); smell – scented candles, essential oils, listening to music); touch/sensation – feeling a soft blanket or pillow, having a warm bath, using ice or heat pad, stretching); etc.

There are many other options out there. Test out ideas to find out what works well for you.

Get a massage

If you enjoy massages and feel comfortable with accessing these services, book a massage regularly as per your schedule and finances. Having a massage can help ease tight, painful muscles and give you some intermittent relief.

Exercise regularly based on what is physically possible for you

In a similar way, regular physical exercise – in whatever way you can and in whatever method you enjoy- can help you feel good and ease your stress at the same time.

If possible, consider booking an assessment or services with a personal trainer who is experienced with your type of needs. They can give you some strategies or develop an exercise program that works for you. You can pursue sessions with a trainer or take what you’ve learned and use it when you exercise on your own time.

Optimize your pain medication with support from your family doctor (if you are using pain medication)

It can be hard to find a way to balance using medication so that you can cope with the pain while also not feeling too sedated, or foggy. Let your doctor know if you are having any unusual symptoms and they will do their best to figure out the best dosage for you. Keeping the line of communication open with your doctor can help you find a good balance. Not everyone uses pain medication, but this may be helpful to consider if you are.

Reduce substance use (if you are using substances)

Sometimes, people use substances, such as alcohol, smoking, marijuana, or other drugs as an escape or a way to avoid the pain. However, using substances can significantly impact your daily function, sleep, and ability to navigate all of the important areas of your life. Substances mask the pain but don’t eliminate it.

Taking a harm reduction approach, speaking with your doctor, exploring addiction services (such as the Centre for Addiction and Mental Health), and replacing substance use with more adaptive coping strategies can help you as you strive toward optimizing your health.

Access support groups

Connect with others who are going through similar experiences for a sense of belonging, building meaningful relationships, sharing personal experiences, and learning from peers who may have gone through or are currently going through similar hurdles as you.

Distract yourself

If you can, try to focus on things other than your pain. In doing so, it will help you feel that there is more to life than your pain, keeps your mind and body occupied, and enables you to not be so consumed, absorbed, and overwhelmed by your pain.

This is easier said than done but is definitely worth trying even for a few minutes or an hour at a time.

Start to slowly adjust to your diagnosis while you work toward your goals

You may have heard this saying before: it’s a marathon- not a sprint.

Taking time to clearly understand your diagnosis that is causing your chronic pain and beginning to adjust to it doesn’t mean you are giving up or have no hope. It means you are discovering a way to deal with the challenges you are facing right now while also holding hope for the future as you continue trying different coping strategies, working with your health care team, and living your life in the best way you can based on your current circumstances.

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