What should now be obvious about chronic pain is that it does not always equate to tissue damage. So we need to know how to manage this pain to enable us to move on in life. If you feel that all this makes sense to you but you still feel that there is tissue damage causing pain, because you believe in the biomedical model consider the following.
A classic study by Jensen at el (1994) took MRI scans of 98 subject’s lumbar spine. Their results demonstrated that 52% of subjects had a disk bulge at at least one intervertebral disc, 27% had a disc protrusion and 1% had an extrusion. Thus 64% of subjects had an intervertebral disc abnormality, and 38 % had an abnormality of more than one intervertebral disk (including schmorl’s nodes and annular tears). Furthermore 8% had facet joint arthropathy, 7% had spondylolysis, 7% had spondylolisthesis, 7% had stenosis of the central canal and 7% had stenosis of the neural foramina. This adds up to a lot of spinal pathology. This study was conducted on people that had NO PAIN! The is not an isolated study and there are many other papers that have results indicating that pathology does not equal pain.
I hope that the title of this article now makes some sense. Pain being “all in your head” doesn’t mean you are imagining it, it means that it is the brain that decides if something is painful or not. Pain and nociception are not the same thing. Nociception can come from tissue damage, but can also be maintained after an injury had healed. Even if is there is nociception reaching the CNS the brain can choose to ignore it. Pain is a multi system output that is dependent on what the pain really means. Managing chronic pain does not need to be a nightmare for patient or therapist if people are educated about the neurophysiology of pain, the meaning of pain and how to take an active role in managing pain. It may be a slow process, but we all have the capacity to lead a normal life.