The Language of Back Pain

The Language of Back Pain Blog  Back pain

The language of back pain — how people describe the pain — is noteworthy and revealing. It reflects the different beliefs that are held by patients, doctors and therapists. Understanding these beliefs is important because it directly affects a person’s response to pain.

Patients use common descriptions to convey their suffering. For example, they say they have a “slipped disk,” a “disk bulge,” a “weak spine,” a “worn out spine,” a “weak core,” “weak muscles,” “worn out joints,” or “wear and tear” on their backs. Many patients use expletives to describe their pain and, sometimes, their doctors or therapists.

Health professionals spend their days listening to patients’ stories, and they hear it all. They try to make sense of the pain stories so they can plan effective, therapeutic treatments. It is a daily challenge.

Where do people learn the language of back pain? Some people learn it from family or friends with similar pain experiences. Others learn it from Internet research in their attempts at self-diagnoses. Unfortunately, the words people use to describe back pain are often incorrect. The wrong language can lead to wrong beliefs, wrong treatments and further pain.

Doctors and therapists should use the right words when they talk to their patients about back pain. They are in a unique position to deliver the right message at the right time, so they should choose their words carefully. The right language creates an understanding that promotes healthy responses to pain.

Health professionals have their own beliefs about pain, and they may be chronic sufferers themselves. Rather than referring their patients to research findings, they should be honest about what they know — or do not know — about back pain. By sticking to the facts — and highlighting possibilities over limitations — they can educate their patients.

Spine problems affect people across the globe and everyone, from doctors and therapists to patients, needs to think about these problems in a new, whole-person way. Since words form an internal dialogue in the minds of patients, health professionals should choose their words carefully. The right language is crucial for a better understanding of back pain.

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In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)

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Complete tear of rectus femoris
with large hematoma (blood)

image

Separation of muscle ends due to tear elicited
on dynamic sonography examination

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