Why It Doesn't Always Matter What You Call It

One of the things that doctors of all varieties will notice is that a patient has an overwhelming need to have a name for their problem, even if the naming of it gets them no closer to feeling better. As a chiropractor, I have struggled a bit with this over the years, and not because I don't know what is causing a particular problem. The problem is that the explanation doesn't always have a nice "official sounding" name to put with the pain. When you tell a patient that a muscle imbalance from left to right is causing uneven forces on the spine and creating inflammation and pain, they may understand you, but they have trouble taking that home and explaining it to their family. This can lead to confusion, distortion of the problem and patient's coming up with their own names for a problem. That is harmless until they try to tell their primary care physician what is wrong and the doctor suddenly thinks the chiropractor is crazy or just has no idea what they are talking about! Conversely, it can be very hard to sort through a patient's story to figure out what may be the truth of the matter when they are discussing past history of a problem.

I propose this...when it comes to many conditions, it makes no difference what you call it, only how you treat it. Labels don't relieve pain! For example, fibromyalgia is a very popular diagnosis right now. I hear a fibromyalgia diagnosis during my health history at least once a week. However, if you ask most fibromyalgia patients what makes them feel better, they will all tell you different things or they will tell you that nothing helps. That means that the diagnosis has not helped them one bit. They still had to try all kinds of things and most of them still don't feel better. The same thing is true with a pinched nerve. People are often told that they have a pinched nerve or ask if a pinched nerve could be causing their pain. Here is the problem with a pinched nerve diagnosis- it doesn't tell you anything about the where or what of the pinching. Most times, it isn't even a true "pinching" of a nerve. It is inflammation of the nerve root sleeve. A true nerve pinch could be a result of a disc herniation, a bone spur, a muscle spasm or, rarely, even a tumor. These are all very different conditions!

Diagnosis is OBVIOUSLY important when treating patients, but there are a lot of cases where your doctor is taking a guess. And I mean ALL of your doctors. The key is to rule out the dangerous stuff (heart attack, stroke, cancer, fracture) and then take your best guess based on the details of the examination and the history. I will give you a medical example. You come to the office with a headache. Your doctor will ask you where it hurts, what triggers it, how long it lasts, what makes it better, etc. Based on your answers, he or she chooses a category that is most likely the cause. He or she will then prescribe therapy based on that information. If the prescribed therapy does nothing to help the headache, then a different therapy will be tried until something is found that is effective. It is THE BEST method for dealing with the headache, but it is still guessing. The same happens with low back pain. There are multiple conditions that will present with very similar appearances. They will also most likely respond to the same treatment. So, I will make my best determination based on the history and examination and will work from there. If the pain goes away, does it matter if it was a facet syndrome or a sacroiliac pain? A mild disc injury will look and act pretty much the same. To complicate the picture, you may have a herniated disc that shows up on MRI, but that may have nothing to do with the current pain you are having. Just because it is there doesn't mean it hurts! A third of the population has a disc herniation and doesn't even know it!

I am not at all saying that doctors should stop diagnosing conditions. I just think that we need to stop focusing on the label so much. A diagnosis can become a crutch. It can become a part of how someone views him or herself. This can do a lot of damage to some people. You see people stop doing all of the things they like because someone told them they have a disc herniation, even if they have no pain. Pain behavior is a real thing and can be more debilitating than the condition that caused it. There are no rules that govern all people based on their health conditions. I have seen horrible spinal or knee arthritis in people who claim to have NO PAIN. And these folks are out there running and playing sports and having fun! Don't let the label change you just by its existence. Most things can be overcome with therapy and exercise. Just a thought...