Pain - Part 5 - The Importance of a Correct Diagnosis

The Neighbourhood Clinic was established to provide excellence in healthcare to our local community. Part of that role we see is sharing important clinical and scientific messages. Pain is a condition that is rife in our society and there is so much misinformation about what it is and how it works that we thought this series may help to be part of the solution.

The previous posts have been discussing the nature of how pain is a product of your body's assessment of risk. That calculation is influenced by previous experience, beliefs, context, responsibility and many other factors.

Snapping an achilles is a very different situation for a professional athlete than a farmer. i.e. it'll hurt more. If you're on a worksite and you step onto a nail your brain is likely to take a punt that the risk of damage was pretty high. Lots of pain.

This case is a bit different. A 68 year old woman had seen a lot of practitioners due to her hip pain. She was retired, pretty active, had a history of mental health issues. Her GP referred her to a physio, the physio tried but couldn't help and referred her to another physio.

That physio tried but couldn't help and sent her to a pain clinic. The patient was diagnosed with chronic pain and subjected to a long program on pain education. Part of that also included cognitive behavioral therapy with a clinical psychologist that specialised in pain management.

When seeking a second opinion this patient was put through a thorough orthopaedic examination. The practitioner at hand thought that the tests indicated that there was some pretty significant joint changes going on and referred her for an x-ray.

3 days later she was getting an emergency hip replacement. The ball of the hip joint was nearly bursting through the socket.

Conclusions

Pain that lingers for a long time can be more of a product from the brain but it can also be due to significant structural deformities. Which is why is super important for practitioners to take really thorough histories and use orthopaedic testing and imaging (if required) to determine what is occurring.

Sometimes pain is due to an over protective brain, sometimes pain is due to a severe pathology but often it is somewhere in between.