Our medical systems are heavily based on the idea that pain is due to a physical problem with our body, e.g., with the skeleton, nerves, muscles. This leads to many mistaken beliefs of what our medical services can do to help. This includes:
Myth 1. Pain Meds Will Reduce my Pain
When pain strikes, many of us reach for the medicine cabinet or go to the GP to ask for pain meds.
But research increasingly questions whether pain meds are as helpful as we think, and indeed, whether they actually do more harm than good.
Generally, NICE (the UK’s National Institute for Health and Care Excellence, April 2021) reports that for most with chronic primary pain, it’s unlikely that the benefits of any drug treatment will outweigh the associated risks. In fact, NICE recommend that these meds should not be started if for pain relief alone.
NICE’s current exception is for those ages 18+, where antidepressants might help quality of life by improving sleep and psychological distress. But some research has suggested that antidepressants that aim to sedate (especially if combined with opiate analgesics/cannaboids) can increase disability. Further, there is rising concern about withdrawal symptoms (Royal College of Psychiatrists, 2020).
In fact, even the humble paracetamol is being questioned a) in terms of its ability to reduce pain, but b) most crucially for it’s rare, but serious side-effects – especially with long-term use (McCrae, et al, 2018).
Myth 2. Scans/Xray’s Will Show Why I’m In Pain.
Scans, e.g., Xrays & MRI, may or may not find a physical problem. But either way, it might not reveal the source of pain. Yes, it’s complicated. This is why…
Scans usually show bone fractures & significant tissue tears, so they should reveal any problems. BUT…
- There are many physical structures that scans can’t see.
- Even if physical damage is shown (which is normal as we get older), research shows that damage does not equate well with pain. For example:
- Those with no damage can be in agony, whilst those with damage, e.g., herniated disks, osteoarthritis, might have no pain.
- People can have the same damage, but range in pain from none to severe.
- Chronic pain often has no physical damage: Indeed, 9/10 people with chronic back pain have no physical damage.
- Pain is experienced when our brain perceives that the body’s in danger and causes physical changes to protect us, e.g., increased nerve sensitivity. Our beliefs, thoughts and emotions all affect our brain’s perception of danger. With chronic pain, our brain continues to detect danger and becomes more efficient at protecting us – even if there’s no physical damage. Alas, our brain overprotects us and wrongly keeps us in pain.
Myth 3. Surgery Will Solve/Reduce My Pain.
It’s difficult, but if we can accept that pain (particularly Chronic Primary Pain) does not equate well with physical damage, it becomes logical to question whether surgery is the gold plate solution.
Surgery might benefit some, but research shows that pain can remain after surgery: Think of ‘Phantom Limb Pain’ – where people who have had a limb amputated continue to feel pain in the amputated limb.
Research also shows that those with the most pain before surgery, are most likely to feel pain after surgery. Further, that the more anxious you are before surgery, the more likely you will feel pain after surgery.
Summary: So Where Does This Leave Us?
The ‘biomedical’ model of pain has led us to believe that physical damage is responsible for pain. But it’s now very widely recognised that pain is very individual, and that it’s the result of physical, psychological and social causes – indeed, very few medics would disagree.
So relying on pain meds, scans and surgery can:
- Prevent us from taking control and doing the things that would reduce pain.
- Lead us to wait for support (which often leads to pain-causing stress).
- Potentially (particularly with pain meds), lead to further health problems.
So to better manage pain it’s helpful to:
- Reconsider what you can expect from pain meds, scans and surgery.
- At the very least, be questioning and informed. Ask your medic/physio how helpful certain medical practices and procedures might be for you, and for any downsides.
- Understand how pain works: How it has physical, psychological and social causes and solutions.
- And crucially, to understand how your pain is affected by your physical, psychological and social situation.
I hope this article has been helpful.
- McCrae et al. (2018) Long-term adverse effects of paracetamol – a review, British Journal of Clinical Pharmacology, 84 (10), 2218-2230.
- Royal College of Psychiatrists (2020). Information for anyone who wants to know more about stopping anti-depressants.