Important Chronic Pain Facts
Explained by International Authority on Chronic Pain, Developer of Pain Test

I've been told my pain is all in my head. Can that be true?

No. If you feel pain, you really do have pain. Fewer than 1% of people who feel pain have a psychological cause for it. 1

How often are chronic pain patients misdiagnosed?

A number of published medical articles show that most chronic pain patients are misdiagnosed 40%-71% of the time. 2, 3, 4

I've been told that my pain is a sprain (or strain) even though it has lasted more than one month. Is this possible?

No. Sprains or strains are self-limited problems. Strains are defined as over-extensions of a muscle which move bone, with separation of muscle fibers. By definition, they shouldn't last more than 3 weeks. 5, 6 Government statistics show that sprains cause an average of 7.5 days restricted activity, 2 days of bed disability, and 2.5 days work loss. 7

As mentioned above, medical research has shown that 40%-71% of people with chronic pain have been misdiagnosed and that one of the most common misdiagnoses is calling a problem that has lasted more than a month a strain or sprain. 8, 9, 10

depressionIs it normal to get depressed as the result of chronic pain?
Yes. Medical research has shown that after 6 months chronic pain produces depression in most people. 11, 12

Is it normal to think of suicide due to chronic pain?

Yes. Research from the University of Miami reports that the suicide rate amongst chronic pain patients is 2 to 3 time higher than it is amongst the general population. 13

Is there such a thing as a "slipping disc" in the neck or back?

No, this is a misconception. A "disc" refers to the cushion between the vertebral bodies in the neck, chest and lower back. It keeps the bones from rubbing on one another, and can be compressed and when the pressure is removed, it can spring back to its original shape. A disc looks like a jelly donut. The outside of the donut is called the annulus, and the inside, jelly-like portion, is called the nucleus polposa. Pain fibers are found in the rear 1/3 of the annulus (outside of donut). A herniated disc has the jelly (nucleus polposa) protrude from the donut (annulus). This anatomical distortion, or herniation, is sometimes painful, and can be detected by MRI, CT or myelogram. However, the pain fibers in the rear 1/3 of the disc can be disrupted, which may cause pain, without any anatomical distortion of the annulus, so the MRI, CT and myelogram are normal. This is called internal disc disruption or (IDD). Pain from internal disc disruption (IDD) feels like a painful herniated disc. 14

Can an MRI accurately determine whether a disc in my neck or back is causing my pain?

No. The MRI is a very poor test for determining if a disc is causing pain in your neck, arms, back or legs. Recent medical studies have shown that

  • 77% of the time an MRI failed to detect damage to a disc even though a subsequent provocative discogram - a much more reliable test 15 - proved that there really was damage.16
  • 28% of the time an MRI told doctors that patients had herniated discs even though these patients had no back pain whatsoever.17

Statistically, flipping a coin is more accurate than an MRI for accurately determining whether or not a disc in your neck or back is the cause your pain.

What is the advantage of using a 3D-CT scan instead of just a CT scan?
A CT or CAT (computerized axial tomography) scan is used to provide a series of X-rays which is much more comprehensive than just X-rays alone. An X-ray takes a picture that is like looking at a slice of bread in a loaf. A CT takes a series of pictures that is like looking at the whole loaf of bread. However, a 3D-CT is like taking a picture of the whole loaf of bread from various angles, so you can see what the loaf of bread really is. In a group of 100 patients with bad back pain but normal CT scans, 56% of the time a 3D-CT scan found boney damage that had been missed by the plain CT. 18

What is a provocative discogram?
The provocative discogram is a physiological test, not an anatomical test. Saline (salt water) is injected into the donut (annulus) portion of the disc, where the pain fibers are. This injection distends the pain fibers. If this injection reproduces the pain in the distribution the patient normally feels pain, this is a positive provocation test. If local anesthetic injected into the damaged disc takes away the pain the patient normally feels, this is a positive anesthetic test. A combination of both tests is considered a complete provocative discogram. This test tells the doctor if a particular disc is causing the pain you feel. 19

What is RSD (reflex sympathetic dystrophy) or CRPS I (complex regional pain syndrome Type I)?

There are many clinical features of RSD (CRPS I), some of which are classic and some of which may appear in some people but not in others. The most important features of RSD (CRPS I) is that there must be pain all around the affected limb, thermal allodynia (a painful response to a normally not painful stimulus, like dropping ice water on your hand) and total relief of all pain during the time a sympathetic block is effective. 20 Other features, such as mechanical allodynia (pain to light touch, sort of like having a sunburn), swelling, skin discoloration, burning pain, and pain with pressure are found in many other diagnoses, and are not unique features of RSD (CRPS I) 21. One of the other features, "pain disproportionate to what one might expect," promoted by various organizations, is totally judgmental, and of little use, since pain is a totally subjective experience.

What are the most common "diagnosis" that are usually not accurate diagnoses?
Lumbar strain, cervical strain, lumbar sprain, cervical sprain, low back pain, fibromyalgia, low back pain, whiplash, reflex sympathetic dystrophy (RSD), complex regional pain syndrome, type I, (CRPS I), psychogenic pain, depressive equivalent, hypochondriac, and conversion disorder. 22, 23, 24, 25

What is a nerve block?  
A nerve block is the injection of a numbing chemical around a nerve that lasts for several hours.

What is the purpose of a nerve block?
To determine whether a particular nerve is the one that is causing the pain a patient is experiencing. If the pain disappears when the nerve gets numb, then the doctor knows that it is that nerve which is damaged and causing the pain.
What is a facet block?
A facet block consists of injecting a numbing medicine around the vertebral bodies, called the facet joint.

What is the purpose of a facet block?

To determine whether that particular joint is the one that is causing the pain that a patient is experiencing. If the pain disappears when the joint gets numb, then the doctor knows that it is that joint which is damaged and causing the pain.

What is a nerve root block?
A nerve root block is the injection of a numbing chemical around a nerve root that lasts for several hours.

What is the purpose of a nerve root block?
To determine whether that particular nerve root is the one that is causing the pain a patient is experiencing. If the pain disappears when the nerve root gets numb, then the doctor knows that it is that nerve root which is damaged and causing the pain.

Why do anti-depressants help chronic pain?

People with chronic pain get depressed and anxious, have trouble sleeping at night, wake up in the middle of the night due to pain, and, of course, have pain. Certain anti-depressants have the ability to reduce anxiety and depression, help produce natural sleep, and reduce the perception of pain.

Why should I use a brace?

A brace is used to answer the question "what happens if I hold this part of the body still, using a brace?" The brace will not cure a chronic pain problem. The brace is really just a test, like a CT or MRI or X-ray.

What do EMG/Nerve Conduction Velocity studies measure?

EMG stands for electromyelography, which means electronic measurement of the activity of a muscle. Muscles are stimulated by motor nerve activity. Nerve conduction studies measure the speed with which a nerve conducts an electrical impulse along the nerve's path. If there is damage in the muscle or in the nerve that supplies the muscle, doctors can use EMG/nerve conduction velocity studies to measure this problem. 27

Why is it important to get an accurate diagnosis?
In order to correct a problem, it is important to understand what causes a problem. If you have a flat tire, before you can repair it you have to know whether you have a leaky valve stem, a cut sidewall, a nail in the tread or a lost tire bead. Sometimes you can have two problems at the same time, such as a leaky valve stem and a nail in the tread. The same principles apply to diagnosing and treating chronic pain. There can be multiple causes of pain, and until you diagnose the cause or causes of the pain you can't treat the pain.

Can you accurately measure pain?
It is very hard to measure pain, since pain is a subjective experience. Beecher at Harvard, Melzack at McGill, and Wolfe at NYU are the leaders in the field, but all efforts have produced highly variable results.