Think Your Pain Symptoms are Caused by a Structural Problem?

painting of a woman with shoulder painYou might want to think again.

Have you or a loved one ever been in that uncomfortable position of asking a health provider:

“What is the cause of my back pain?
“…shoulder pain?”
“…neck pain?”

or some other painful condition? And your well-meaning nurse, doctor, or physical therapist was kind enough to do a “diagnosis” with an MRI or X-Ray, solemnly telling you afterward that the cause was:

a torn rotator cuff
degenerative disc disease
disc protrusion
or some other scary and official-sounding “cause”? And those explanations sound convincing, do they not? If a person has intense and recurring back pain and someone shows them an x-ray with a “herniated disk” that disk must be the cause, right? After all, SOMETHING must be causing the pain. It is difficult to not associate pain with some type of structural abnormality…especially when someone who is supposed to be an authority on pain tells you so.

But do structural anomalies cause pain?

Is it true that disk protrusions, torn rotator cuffs, herniated disks, and the like actually cause pain? It’s not a trivial question. If a surgeon believes a spinal problem is causing a pain symptom, he or she may want to conduct an expensive and invasive surgery to “fix” the structural “problem.” The “cure” could cost tens of thousands of dollars and require months of recuperation. It might be nice to know if structural abnormalities are a necessary and sufficient cause of pain.

I’m not going to directly answer the question of whether so-called structural problems cause pain symptoms. You will have to be the judge. I will give you some information from several studies that demonstrate how many people with structural issues are, in fact, pain-free. In other words, the research shows that some people have pain “causes” and yet do not report pain symptoms. Let’s begin.

Pain and the Lower (Lumbar) Spine

The first research I will cite was conducted in 1991 and reported in the Journal of Neuroimaging (cited in PubMed). The researchers used magnetic resonance imaging (MRI) to examine the lumbar spine (the lower part of the spine) of 66 asymptomatic people. Asymptomatic means they had no back pain.

Given that they had no back pain, they had structurally perfect lower backs, right?

Not so fast.

Twelve of the people in the study (18%) had either a disc protrusion or a herniated disk of some kind. Twenty-six of the people in the study (39%) had a bulge that could associated with degenerative disc disease. In addition, there were many other structural issues found, including spinal stenosis, and narrowed nerve root canals. The researcher’s conclusion? “Degenerative disc disease is a common finding in asymptomatic [pain-free] adults…”

Pain and the Cervical Spine (Neck Region)

Next up, a more recent study, reported in 2005 in the European Journal of Radiology (PubMed). This study examined the cervical spine of 30 pain-free individuals. The cervical spine is the seven vertabrae at the top of your spine, beginning at the base of the skull and ending near the top of your shoulders. Again, 30 people who have no reports or history of pain near the cervical spine likely have no structural problems in that area, right?

Au contraire.

An astounding 73% of the sample (22 of 30) had a “bulging disk”! Fifty percent of the sample had a “disk protrusion”. The thought occurs to me that if the majority of the sample had a bulging disk perhaps having a bulging disk is normal. In that particular sample, it certainly was not out of the ordinary.

Let’s do one more.

Shoulder Pain and the Rotator Cuff

This one is from the Annals of The Royal College of Surgeons of England and was published in 2006 (Full-text online: Dead Men, and Radiologists Don’t Lie). This study is a review study, meaning they did a review of many different studies that had already been conducted. They reviewed the prevalence of rotator cuff tears in people who had reported pain and people who had not. Interestingly, they reported on studies of living people as well as cadaver studies of people who had died. In the cadaver studies, on average, people who had pain symptoms in the shoulder area had rotator cuff tears at a rate of 42%. Meaning that only 42% of those who were in pain had a rotator cuff injury. And for those without any pain? About the same: 39% of them had injuries.

The study of living people was a bit different. According to the studies, 26% of pain-free people had rotator cuff injuries and 49% of those in pain had injuries. The researchers concluded that “rotator cuff tears demonstrated radiologically during the investigation of the shoulder may well not be responsible for the presenting symptoms.” In plain English, rotator cuff injuries might not be the cause of pain symptoms.

You’ve got the take-home message by now?

According to the research, pain and structural problems are not necessarily related. Be wary when someone tells you that they are, even if they have an X-Ray or MRI scan to “prove” it. Get a second opinion. Look for other factors.

I am not a medical doctor, nor am I giving medical advice. I am merely reporting on the literature that has been produced. Do not make any medical decisions based on my opinions.