Why does something hurt?
Until about 40 years ago, pain was seen in scientific and medical circles as a quite simple phenomenon.
Back then, it was thought that the cause of pain was always structural in nature.
It was thought that there must be anatomical damage to some tissue (muscle, nerve, cartilage, etc.) if there is pain.
This (outdated) way of understanding pain is called “pathoanatomical model of pain”.
Today we know that this way of observing and understanding the pain system is not correct.
Pain is a very complex phenomenon, the origin and survival of which is influenced by many factors, and it can exist without any structural damage.
This (better) way of understanding pain is called the “biopsychosocial model of pain”
(Cholewicki et al. 2019; Hartvigsen et al. 2018).
Pain is more an indicator of the sensitivity of the nervous system than an indicator of tissue damage (O’Sullivan et al. 2019).
Imagine two very common occurrences of pain in everyday life: headaches and painful menstruations.
Almost no one ever thinks that it is necessary to do an emergency X-ray or MRI in these situations.
The pain is often very intense, but there is no damage to blame for it.
We simply accept that the head can sometimes hurt for various (more or less clear) reasons.
Also, often in these situations (headaches) we think:
“What could I have done that made this pain worse?”
Because we know and it is socially accepted that things like alcohol, dehydration, stress and lack of sleep can affect headaches.
This is how we should observe and analyse other pains of the musculoskeletal system, such as back pain.
Due to inadequate education and slow transfer and acceptance of new knowledge from the
scientific literature to educational institutions, pain is still viewed too mechanically, too anatomically and too structurally.
However, due to the large number of studies published in the field of pain pain science,
today we know that pain is an extremely complex multifactorial phenomenon.
For example, if we take 1000 people aged 60 who DO NOT have any back pain and do an
MRI on them, we will see that 60-70% of these people have various degenerative changes in
the spine such as disc herniation, disc protrusion, disc degeneration, etc. (Brinjiki et al. 2015)
Horga et al. (2020) showed on a sample of 230 asymptomatic (painless) knees that
degenerative changes were present in 97% of cases.
Other similar studies have reached the same conclusions for other joints.
Such evidence tells us that the anatomical structure is not the only factor that affects pain,
and that anatomical structure cannot always be fully blamed when something hurts.
This is especially the case with chronic, long-term pain.
If our back or knees hurt, it does not necessarily mean that there is tissue damage.
And if there is tissue damage, it does not mean that this damage is the (only) cause of the pain.
In other words, if your back hurts and the MRI shows that you have degenerative disc
changes or a protrusion, this does not automatically mean that the pain was caused by
these changes, nor that the pain will disappear if these changes are removed or modified in any way.
What are the factors that can affect the occurrence and intensity of pain?
Every day we come to new knowledge, but from what we know so far, these are some of
the most important factors that influence the occurrence and intensity of pain:
1. Insufficient physical activity
2. Too much physical activity (“too much too soon”)
3. Poor quality of sleep
4. Insufficient hours of sleep
5. High subjective perception of stress
6. Smoking cigarettes
7. Dissatisfaction with work
8. Bad social life
9. Kinesiophobia (fear of movement and fear that exercise will worsen pain)
12. Catastrophizing (negative expectations)
14. Spending large amounts of time in the same position
15. Other diseases
16. Inadequate training plan
17. The list goes on…
Likewise, all the opposite is true. Well-structured training, quality sleep, low stress level,
regular physical activity, high quality interpersonal relationships, etc. reduces the frequency and intensity of pain.
The more factors we have under our control, the less chance there is of pain.
Also, the healthier we are (that is, the less threatened the nervous system), the less likely we are to have any type of pain.
Sounds crazy right?
Sounded crazy to me as well a lot of years ago.
As for low back pain (but also for pain in other joints), research estimates that a huge
number of surgeries are performed unnecessarily, and that often the outcomes are the same in people who do not undergo surgery (Harris et al. 2020).
Which makes sense, because with surgery we can only affect the anatomical structure, and
we know that the structure is often not the primary/only cause of pain.
So, what can we do and how can we help you if you are in pain?
We can primarily help you by helping you understand what YOUR pain is, what factors can
affect YOUR pain based on your history and clinical picture, and by guiding you through a complex process of understanding and rehabilitating pain.
All this with a true individual and “evidence-based” approach based on the highest quality scientific literature in the field of pain and injury rehabilitation.
While working with us, you can expect maximum attention and empathy towards your
problem, unlimited support and communication, the best possible education and help in getting rid of pain and returning to the activities you like to do.
- Harris et al. (2020) „Surgery for chronic musculoskeletal pain: the question of evidence“ Pain
- Cholewicki et al. (2019) „Can Biomechanics Research Lead to More Effective Treatment of Low Back Pain? A Point Counterpoint Debate“ JOSPT
- Brinjikji et al. (2015) „Systematic Literature Review of Imaging Features of Spinal Degeneration in Asymptomatic Populations“ AJNR
- Caneiro et al. (2019) „There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport.“ BJSM
- O’Sullivan et al. (2019) „Back to basics: 10 facts every person should know about back pain.“ BJSM
- Hartvigsen et al. (2018) „What low back pain is and why we need to pay attention“ The Lancet series
- Horga et al. (2020) Prevalence of abnormal findings in 230 knees of asymptomatic adults using 3.0 T MRI