Looking for Pain in All the Wrong Places


Imagine with me for a second an all-too-familiar movie scene: It’s the middle of the night and an inmate has escaped from prison. The prison guards on duty fire up the spotlights and begin their search as the prisoner escapes into the darkness. The spotlight scans back and forth, illuminating only what’s within the diameter of the light beam making it very easy for the guards to miss what they’re looking for. After all, they’re searching for something that is, most likely, located far outside the realm of where they’re looking. They’re only seeing a small part of a much-larger picture.

The same is true with chronic pain. The tools we typically use when someone hurts–MRIs, x-rays, CT scans, bone scans–are basically nothing more than prison spotlights. Those diagnostic scans are illuminating an area that, typically, doesn’t show what we are really looking for. You’re wanting to find the reason why you have a herniated disc, a torn meniscus, plantar fasciitis, or degenerative disc disease (side note–can we PLEASE stop calling it a disease? It’s a condition, not cancer.), yet those tools are simply illuminating a very limited area. Similar to the inmate who is hiding somewhere in the darkness away from the light, the cause of your pain is typically located away from where the focus is. Your back pain could be caused by your misaligned pelvic position. That foot pain could be from a femur that isn’t positioned quite right. And your knee pain might just be from a shoulder joint that isn’t functioning properly. Things like MRIs and x-rays are done in an attempt to find the problem, but they’re often missing the bigger picture, just like the prison spotlight is only showing you that the escaped inmate most likely isn’t in your illuminated circle.

Unfortunately, in the medical world, more and more patients are realizing just how flawed our system is at addressing their root issue. Just this week a client emailed me an article from NPR that claims physicians are getting worse at treating back pain. According to the article, “researchers at Beth Israel Deaconess Medical Center in Boston looked at records of 23,918 doctor visits for simple back pain between 1999 and 2010, they found that doctors have actually been getting worse at prescribing scientifically based treatments.”

I believe they’re “getting worse” because they’re focusing only on what they see in the spotlight. They aren’t looking at the rest of the picture, the “darkness outside of the spotlight,” if you will.

In addition to missing the bigger picture, along the way, doctors have run into some very significant health issues with their pain clients.

Doctors were recommending NSAID pain relievers and acetaminophen less often. Instead, they were increasingly prescribing prescription opioids like OxyContin, with use rising from 19 percent of cases to 29 percent. Over-the-counter painkiller use declined from 37 percent to 25 percent. Other studies have found that opioids help only slightly with acute back pain and are worthless for treating chronic back pain.

About 43 percent of patients taking opioids for chronic back pain also had other substance abuse disorders, the researchers found. In 2008, almost 15,000 people died from overdoses of prescription opioids, and abuse has surged among women.

Doctors were also quick to whip out the prescription pad and call for CT and MRI scans for people with lower back pain, the study found. The number of people getting scans rose from 7 to 11 percent. Though those scans won’t hurt the patient, in most cases they don’t find anything wrong. (emphasis added) And they are expensive, costing $1,000 or more.

Anyone else have a problem with those facts? Because I sure do. Let’s review:

*Nearly one-third of patients are given opioids.

*Opioids are considered “worthless” for treating chronic back pain.

*They are widely abused.

*15,000 people have died from overdosing.

*The vast majority of MRIs are expensive and don’t find anything wrong (in other words, the escaped inmate isn’t in the spotlight).

When will society wake up and realize that our medical system is a broken one? We’re looking in the wrong location, for the wrong thing.

While the MRI might show that you have a herniated disc, bulging disc, or spinal stenosis, for example, it won’t show why the condition happened. Similarly, the prison guard might get lucky and find the prisoner smack dab in the middle of his spotlight, but when it’s all said and done, don’t you think what the prison guard really wants to know is how the prisoner escaped? He knows there’s a bigger problem at hand.

Ultimately, the guard wants to know what caused the disturbance…JUST LIKE YOU DO WITH YOUR BODY!

All of us in the health and wellness world can get better at what we do if we stop treating your symptom and instead, start focusing on why you have it. It’s imperative that we broaden the scope of the search, because there’s a lot that we’re missing outside of the spotlight. 

QUESTION: If you’re struggling with chronic pain, what has been the most- and least-effective things you’ve done in an attempt to eliminate your pain?