You Can’t Take a Picture of Pain

Why the most important part of treating lower back pain is the connection between a patient and a clinician

Recently, R. Nick Bryan, M.D., Ph.D., Director for Diagnostic Services at UT Health Austin and Chair of the Department of Diagnostic Medicine for the Dell Medical School, described some of the amazing advances in the field of medical imaging that he has personally witnessed during his career (Seeing is Believing: How Advanced Imaging Changed Healthcare Forever). And while the ability of today’s X-Rays, MRIs, PET scanners and other imaging systems to non-invasively capture ever-more detailed images of the deepest of the body’s internal structures, as Mark Queralt, M.D., Back Pain Clinical Director in UT Health Austin’s Mulva Clinic for Neurosciences observes, to date, there is no imaging system that can take a picture of pain. Which is why images are just one of the three important tools he and his interdisciplinary team use when caring for their patients.

“Lower back pain is one of most common issues that motivates people to visit a medical professional,” he says. “It’s estimated that as many as 80 percent of adults will experience lower back pain during their lifetime; and back pain is the leading cause of disability for people around the world. People miss work; their lives are disrupted; they can’t sleep—it can be a really serious problem. So when an X-Ray or an MRI shows a bulging disk, or a bone with signs of age-related wear and tear, it can be really tempting to believe that doing something to the physical structure will make the pain go away.

“But it’s important to remember that physical changes over time are extremely common, to the point that 96 percent of people over the age of 80 have some level of disk degeneration. More often than not, these ‘abnormalities’ are asymptomatic—which means that they don’t always cause pain. An estimated five to 50 percent of patients report unsuccessful outcome following lumbar spine surgery (commonly called failed back surgery syndrome), so it is very important to understand the significance of imaging findings before undergoing aggressive intervention. The evaluation of back pain is a process that involves a collaboration of medical and rehabilitation experts.”

As Dr. Queralt describes it, the process leading to an effective strategy for treating pain should include a thorough review of a person’s history by a experienced pain professionals: when did the pain begin? What makes it worse? What makes it better? Are there any other issues involved that might indicate that the pain is part of a larger set of problems? Secondly, there should be a thorough physical examination performed during which the spine team compares the patient’s descriptions of their pain and function to the results of their exam (which must include maneuvers to assess response to stressing and de-stressing potentially painful structures). And the third part of the process, if needed, may be a set of images of the area where the pain occurs. The combination of a patient’s history and the clinical care team’s observations creates a detailed picture of that patient’s unique and personal circumstances.

“Because many of the degenerative changes that can appear on an imaging study are a natural part of the aging process, and often don’t result in pain,” Dr. Queralt concludes, “it’s very important that patients and clinicians work together to create a full picture of a person’s situation. Chronic pain is a complex and personal experience. Addressing it effectively requires a purposeful diagnostic method and a treatment plan that is the right mix of physical rehabilitation, medications, and other approaches leading up to and, in some appropriate cases, including surgery. And while the goal of this process is always to arrive at a treatment approach that is uniquely right for you, the first step, in every case, is connecting with your own, personal care team.”

To begin your personalized process toward lower back pain relief, please call 1-833-UT-CARES (1-833-882-2737), or visit uthealthaustin.org/conditions/back-pain.