Your MRI & Persistent Lower Back Pain: A Modern Day Horror Movie

Scene One: The Setup

Imagine this: you’ve been dealing with low back pain that just won’t quit. You’ve tried everything from physiotherapy, ancient yoga poses to bizarre internet remedies involving onions and vinegar (yes, it’s a thing). Finally, your doctor orders an MRI. Cue the ominous music and a eerie image of an old haunted house, because that’s how scary an MRI report can seem. But wait, don’t change the movie! This story isn’t as terrifying as you might think.

Scene Two: The Report Arrives

Now, here comes the part that usually sends shivers down your spine (pun intended): the MRI report. It arrives, filled with medical terms that sound like they belong in a horror movie. You know the one’s i’m talking about, words like “disc degeneration,” “herniation,” and “spinal stenosis” jump off the page like ghouls in a haunted house. The type of stuff that sends popcorn flying across the cinema. But hold on a second. Let’s break this down.

Scene Three: Understanding the Jargon

These terms might sound intimidating if you’re not in the know. But let me let you in on a secret: much of what pops up in an MRI report is as routine and inconsequential as finding cobwebs in the corners of a rarely used room.

Disc Degeneration: This is just a fancy way of saying your spine is getting older, like the rest of you. Think of it as grey hair for your back. Not a big deal.

Herniated Disc: Sounds painful, right? But lots of people have herniated discs and don’t even know it. It’s kind of like that dent in your car that often doesn’t affect how it drives.

Spinal Stenosis: This means there’s some narrowing in your spine. Again, super common as we age and often doesn’t cause any problems.

Still not convinced? Let’s have a look at a systematic review of imaging features of spinal degeneration in asymptomatic (no pain) populations:

The Authors Concluded: ‘‘Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. These imaging findings must be interpreted in the context of the patient's clinical condition’’

Ok, let’s really break this down, Tarantino style:

Disc Degeneration: By the tender age of 20, a chilling 37% of folks show signs of disc degeneration. Fast forward to age 80, and a staggering 96% are marked by it. But don’t panic, this isn’t a death sentence. Remember like we said, think of it as grey hair for your spine. Just a part of aging, and guess what? Most of these people are walking around without a hint of pain.

Disc Signal Loss: Picture this – at 20, 17% of people have disc signal loss. By 80, it’s a hair-raising 97%. But here’s the twist: it’s as common as a cup of coffee in the morning, and most people with it are pain-free, living their lives, completely unaware of their ‘condition’.

Disc Height Loss: It hits 24% of 20 year olds and escalates to 84% by the time you hit 80. Like that inconspicuous dent on your classic car, it’s there, but doesn’t mess with the ride. Many people with these changes? Yes. No symptoms? Nope. Nothing. Nada.

Disc Bulge: 30% of 20 year olds and an eyebrow-raising 84% of 80 year olds sport a disc bulge. It’s like a thriller plot twist – unexpected, but often doesn’t affect the storyline. Most don’t even feel it.

Disc Protrusion: 29% at 20 and 43% at 80. Sounds like a villainous feature, right? But here’s the kicker – most people have these without ever knowing, living their lives in blissful ignorance, and without pain.

Annular Fissure: Found in 19% of young guns at 20 and 29% of the wise elders at 80. Common, yes. Dangerous? Not really. Most who have it feel perfectly fine, living life large.

Facet Degeneration: Affecting a mere 4% of 20 year olds, but by 80, it climbs to a daunting 83%. They can also be like age related changes, like the marks on your favourite pair of shoes. And many of these people? They feel no pain whatsoever.

Spondylolisthesis: It creeps up in 3% of 20 year olds and skyrockets to 50% by 80. But don’t let that scare you. Often, it’s as harmless as a ghost story told at a campfire – spookier in theory than in reality. Many live with it without any issues, completely asymptomatic.

Another study concluded ‘'Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0 to 10 pain scale.’

These findings are common, often painless, and just part of the grand narrative. Relax, and enjoy the show – your spine’s just adding some special effects to the story of you. Is the horror movie feeling as scary now?

Non Specific Low Back Pain (NSLBP): The Elusive Phantom

The vast majority of back pain falls into the shadowy realm of non specific low back pain (NSLBP). This isn’t caused by a clear-cut villain like a infection, tumor, fracture, inflammatory disorder, or cauda equina syndrome. Instead, it’s the work of an elusive phantom – a blend factors that, when combined, create the sensation of pain. This phantom lurks in the background, making it difficult to pin down and treat with a single solution. It’s like trying to catch smoke with your bare hands, always shifting and blending into the shadows, yet undeniably present, much like the hidden traps in a haunted house.

Scene Four: Consulting the Expert

Enter the scene: Overzealous health professionals who see an MRI report and immediately hit the panic button. They’re like characters in a horror film, jumping at shadows and mistaking normal aging signs for a full-blown crisis. They freak out at any hint of an ‘abnormality,’ ready to sound the alarm for what might just be normal age-related changes.

But then, there’s the seasoned detective in this thriller of spinal mysteries. They’ve seen it all and aren’t easily spooked by the shadows cast by an MRI report. To them, the MRI is just another piece of the puzzle, not the whole story. They know how to separate the crucial plot points from the background noise.

The seasoned detective recognises an MRI doesn’t capture the full picture of your health. It’s a snapshot, not the entire movie. They decode the medical jargon, peeling back layers to reveal what’s truly important. They provide clarity, explaining things in a way that makes sense, stripping away the spooky terminology.

They keep their cool. They know better. They understand that millions of people walk around with these so-called ‘abnormalities’ without any pain or symptoms. They guide you through the findings, distinguishing between what’s important and what’s just normal aging. They’ll cut through the drama, ensuring you see the MRI for what it is – a tool, not a prophecy.

Scene Five: The Plan

We’ve navigated the haunted corridors of MRI reports, and now we face the climax of our story: the plan. This isn’t just any plan; it’s crafted within the biopsychosocial (BPS) model of pain, which is the complex web of factors contributing to your discomfort.

The Biopsychosocial Model: Unmasking Pain

Pain is the villain in this tale, and like any good antagonist, it’s multifaceted. The BPS model helps us understand that pain isn’t just a physical sensation but a blend of biological, psychological, and social factors:

Biological Factors: Think of these as the classic monsters – the physical things on your spine. Disc degeneration, bulges, and protrusions might sound terrifying, but remember, just like a creaky floorboard in a horror movie, they’re often more bark than bite. Many people have these changes and experience no pain at all. Then there’s inflammation, the sneaky ghost that can ramp up pain, It’s like adding fuel to the fire, making everything seem scarier than it actually is.

Psychological Factors: Now we step into the realm of the psychological thriller. Your mood, stress levels, and mental health can twist and amplify pain, turning minor discomfort into a perceived nightmare. Imagine anxiety as the lurking presence behind every creaking door, amplifying every small noise into a cacophony of terror.

Social Factors: The eerie settings and atmospheric tension of your life – your environment, support system, work stress, and social interactions all contribute to the plot. Isolation or stressful relationships can enhance the sensation of pain. Imagine living in a gothic mansion, isolated from the world, with creaky doors and whispering walls – it’s a recipe for heightened fear and anxiety. Similarly, if your social environment is filled with stress, conflict, or lack of support, it can amplify your perception of pain. Your job demands, the pressure to meet deadlines, and unsupportive relationships all play their part in this horror narrative, making pain feel more intense and inescapable.

Just like the intricate plot of a horror movie, the BPS factors are deeply intertwined, shaping your experience of pain. The biological factors lay the groundwork – the creaky floors and shadowy corners. Psychological factors, like anxiety and depression, add layers of tension and dread, making the shadows seem darker and the creaks louder. Social factors provide the eerie backdrop, with isolation and stress amplifying every scare.

Imagine your pain experience as a haunted house where each factor contributes to the overall atmosphere. The physical changes in your spine might be the old, creaky structure. Psychological stress adds the howling wind and flickering lights, while social stressors create the ominous music and distant whispers. Together, they create a full sensory experience, making the pain feel more vivid and menacing. Imagine your pain experience as a haunted house where each factor contributes to the overall atmosphere, all intertwined together, a little like this:

A paper published in JOSPT by Jacek Cholewicki et al. dives deep into the multifaceted nature of low back pain. Take a look at this image from the paper, reminiscent of a horror movie poster (ok, thats a stretch), it uses colour circles to represent the different forces contributing to LBP. This research reveals that LBP is a complex, multi-factorial beast, lurking in the shadows with many intertwined elements. It emphasises the importance of seeing the big picture when looking at your pain, much like understanding the full plot of a horror story rather than focusing on individual jump scares.

A metamodel illustrating factors (colored circles) contributing to low back pain, disability, quality of life, and other outcomes (white circles) and their interactions (colored lines). This metamodel was constructed with input from the multidisciplinary panel of 27 experts in preparation for the symposium at the 26th Annual Meeting of the North American Spine Society (2017). Diameters of the circles are proportional to the number of experts identifying these factors and the number and strength of connections with other factors.

Who would have thought a horror film could be so complex?

Scene Five: Turning The Horror Movie into a Romcom

Recovery from persistent pain is a journey unique to each individual. What works for one person may not work for another, and the path to recovery is often complex and multifaceted. This blog post provides a brief insight into starting your recovery, but remember, this is just the beginning. True recovery often requires a comprehensive approach beyond the scope of a single blog post. With that said, let’s dive into the initial steps you can take to face your pain monster and start to reduce the fear of the horror film. Keep in mind, these are some quick short tips to get you started.

Acknowledge the Monster

First things first, you need to recognise that pain is there, just like how you accept that the creepy doll in the horror movie is indeed staring right at you. Pain is real, but it doesn’t have to control you. Understand that pain is an alarm system meant to protect you, not something to be feared endlessly.

Flip the Script

Just like in a horror movie where the protagonist turns the tables on the villain, you can flip the script on pain. Start by learning about your pain. Pain is not just about physical damage; it’s also about sensitivity. So, the pain you feel doesn’t necessarily mean there’s something drastically wrong with your body. Changing how you think about pain can empower you to manage it more effectively.

Get Moving, Slowly

Remember the scene where the hero cautiously steps out, armed and ready? That’s you! Begin by gently moving your body. Movement is crucial. Even if it hurts a bit, gentle and progressive movement helps in reducing pain sensitivity. It’s like getting used to the eerie music in the background until it no longer scares you.

Build a Support Squad

No hero fights alone. Gather your support squad—this includes healthcare providers, friends, and family. They’re like the trusty sidekicks who keep you grounded and remind you that you’re not alone in this journey. Pain is influenced by many factors, including emotional and social ones, so having a strong support network is important.

Challenge the Beliefs

In every good horror movie, there’s a moment of clarity when the protagonist realises that the monster isn’t invincible. Challenge your beliefs about pain. Have you been told your posture is to blame? Or that you need to be fixed before you can feel better? Often, these beliefs can be more of a hindrance than a help. You are strong, adaptable, and capable of change. Our bodies are bioplastic.

Gradual Exposure Therapy

In horror movies, the protagonist often faces their fear incrementally. Start exposing yourself to activities you’ve been avoiding due to pain, but do it gradually. This is like taking small steps into the haunted house instead of a full-on sprint. Gradual exposure helps in reducing fear and building tolerance, remember, you can be ‘sore but safe’

Set Realistic Goals

Aim for small victories. Set goals that are meaningful and attainable. It’s like the hero deciding to escape the haunted house one room at a time. Celebrate each achievement, no matter how small, and use it as motivation to keep moving forward.

Embrace the Weirdness

Pain can be weird and unpredictable, just like the plot twists in a horror movie. Sometimes it doesn’t make sense, but that’s okay. Pain is multidimensional, influenced by many factors beyond just physical injury. Embrace the weirdness, and don’t let it scare you off your path to recovery.

Recovery from persistent pain is less about defeating an invincible monster and more about reclaiming your power. Just like in a horror movie where the hero finds strength they never knew they had, you too can discover your resilience. Remember, you’re not alone in this; your support squad is here, and you have the knowledge to face your fears. ChronicallyFit is here to help. It’s time to step out of the shadows and take control of your pain story.

And who knows? As you progress, your horror film might just turn into a romantic comedy, where the scary scenes are replaced by laughter, love, and happy endings.