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Discovering the Truth about Pain

Debunking some low back pain myths

Thanks to Pain Revolution rider Edel O'Hagan for this post

People like to think that they know their bodies. We think that we know about our back, and what it likes and dislikes. We think we know our limits and our strengths.

But what if everything you thought you knew about your back and low back pain was wrong? Wrong is not quite the right word, perhaps inaccurate is a better way to understand the way we often perceive our body and the signals it sends.

Some of the ways we understand our body are related to threat and danger. Others tell us about our capability and strength. Many of the ways that we think we’re certain about how our back feels and functions, are myths more than they are truths.

There’s three commonly held myths about your back that we’re going to bust, and find new ways to explain them.

It is not surprising that there are many misunderstandings around low back pain. If you “Google” low back pain, you will find hundreds of supposed causes and equally as many treatments for low back pain. Despite all this information, in 95% of cases low back cannot be attributed to any specific cause and is termed “non-specific low back pain”.

Causes of Low Back Pain are unknown

Here is our first myth. You may think you know what “caused” your low back pain but in fact it is still not clear what causes low back pain in anyone! Therefore, whatever term you apply to it; slipped disc, disc protrusion, osteophyte formation, degenerative changes, osteoarthritis, is inaccurate. These terms describe normal age-related changes, rather than pathological processes requiring further investigation or treatment. These are normal changes, and there is no evidence that any of these changes cause low back pain. In some cases they are not even present in people with low back pain or conversely they are present in people without low back pain. These terms seem to provide a convenient explanation for low back pain, and an image that can give a cause to the pain and make it tangible. It doesn’t make it the truth. These explanations are over simplistic and untrue, adding to a sea of confusion that already surrounds low back pain for the general public.

Keep away from scans (mostly!)

Our second myth is that medical imaging is necessary to diagnose the cause of low back pain. We have learned so far that changes we can see on scans don’t accurately explain the source of the pain, and changes are normal. I hope you’re already wondering what the point of these images is if they’re only going to show some normal age-related changes? That’s good thinking, because whatever imaging you choose, an x-ray, MRI or CT scan, it will likely show some changes in your back structure but it does not tell us anything about your pain. It can’t tell us what you are feeling or why you are feeling it. It’s most likely to cause you to worry about things which are essentially normal.

Pain doesn't equal damage

This information leads us to our third myth. Many people believe that pain is a reflection of damage, and that the more pain you experience, the worse the damage must be to your body, such as your muscles, bones, ligaments or nerves. This is a big myth. Pain exists as a sign of protection, not as an indicator of the severity of the damage to our body. In an early stages of injury or trauma, just after a fall or an accident, pain can accompany tissue damage but, pain is not an accurate reflection of what is happening in the body tissues.

Think of a paper cut, usually there is considerable pain, but minor tissue damage.

For pain to be present, our our brain and our nervous system has to assess information from multiple sources, including our tissues, but also our environment, our emotions, our thoughts and beliefs, our memories, among others.

Pain is not what it seems

Things aren’t always what they seem with pain, it’s a complex (and sometimes weird) experience. The official definition of pain by the International Association for the Study of Pain, says that “pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage”.

When pain persists, like chronic low back pain lasting longer than 3 months, we are confident that if there were any tissue damage involved when pain started, healing will have occurred by 3 months. The ability for tissues to heal is amazing. When pain continues, we know that pain is telling us about more than what’s happening in the structures of your back.

Myths are everywhere

If you didn’t know about any of these myths before, you are in good company. There have been many studies that have looked at the level of agreement of ordinary people with statements that researchers consider “myths” about low back pain. These studies found that myths about low back pain exist widely among the general public, and not many people know much about pain. Some of the myths were things like “If your back hurts, you should take it easy until the pain goes away’ or “Everyone with back pain should have a spine x-ray”’. What do you think about these statements? Do you think they’re true?

This misinformation is a problem since holding on to these myths about low back pain influences people’s path to recovery. When we believe these kinds of false statements about low back pain recovery takes longer, and requires some clever myth busting that is individual to each person.

Learning about pain helps pain

There is good news to all these myths. An intervention as simple as delivering accurate, evidence-based education to those who are experiencing an episode of low back pain will reduce fears, worries and disability associated with low back pain.

This is the basis of the educational approach that we’ll be taking on the road during the Pain Revolution ride, and what our Local Pain Educators will be teaching in their rural communities. We’ll be debunking some of these myths and helping people to find a starting point on the challenging but achievable road to recovery.

At the Brain Bus, and in our evening events, we'll be sharing some better messages (and the science that shows us why we can say them with confidence) such as:

"Backs are strong and resilient"

"Pain is not a reliable indicator of damage"

"Imaging is rarely needed for low back pain"

Join the Pain Revolution

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Wollongong 11/4

Nowra 12/4

Canberra 14/4

Cooma 15/4

Albury-Wodonga 16/4

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