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Bulges. Degeneration. Wear and tear. Bone on bone. Does pain mean damage?

Posted by Nicholas Dang on
https://commons.wikimedia.org/wiki/File:Disc_herniation_--_Smart-Servier.png

If you’ve ever had pain, then you might’ve had imaging to find out what was going on, such as an X-ray or MRI. You might’ve then found ‘abnormal’ changes in your body. While it can be intuitive that those tissue changes or ‘damages’ are causing your pain, it mightn’t be that simple.

We often label changes as ‘abnormal’ but many of these changes are commonly found in people with ‘no’ pain. For example:

  • 30% and 37% of people in their 20s with no back pain have disc bulges and disc degeneration in their spine, respectively, on CT scan or MRI.
  • 96% of athletes aged 11‒26 years with no back pain had spine abnormalities on MRI.
  • 57% of people aged 20‒50 years with no hip pain had cartilage defects and/or labral tears on MRI.
  • 19‒43% of people aged ≥40 years with no knee pain had osteoarthritis on MRI.

Imaging findings are sometimes relevant but sometimes not so much. For example, findings can be more relevant if your new pain was related to trauma. However, even with this, it can sometimes be unclear whether it was a new tissue change or just something you already had but only now became aware of.

Imaging findings should always be interpreted with a thorough assessment with your healthcare provider.

Pain is affected by many factors and tissue changes are just one factor. Tissue changes don’t always need to be ‘fixed’, and there are many other factors that you can work on to help your pain, such as doing more physical activity and working on your diet!

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References:

  • Brinjikji et al. (2015) (PMID: 25430861)
  • Culvenor et al. (2019) (PMID: 29886437)
  • Rajeswaran et al. (2014) (PMID: 24691895)
  • Tresch et al. (2017) (PMID: 27981665)

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