If You Have Severe Knee Pain, It’s Likely Because of Nerves and Not Arthritis
I’ve blogged before about our modern infatuation with imaging and about while MRI findings can be helpful, they can also mislead. In fact, I’ve blogged so much on this issue, you may want to take a look at the search of all blog posts on the topic of how MRI and pain often diverge. This is because pain is a phenomenon of nerves and not of structure. In fact, the title of a research study from 2010 says it all, “Arthritis doesn’t Cause Pain, Pain Causes Arthritis“. Huh? You mean nerves have something to do with arthritis? You bet. While 99.9% of the medical world is looking at MRI images with magnifying glasses, convinced that changes in structure like arthritis causes pain, high level research scientists are bringing into focus a new model – pain is a nerve problem that wrecks havoc on the body and causes arthritis. This is a big part of our Orthopedics 2.0 philosophy. Now yet another study supports this concept that’s turning orthopedic theory on it’s head. In a study just published on September 7th, researchers looked at specialized nerve tests and x-ray findings in more than 100 knee arthritis patients. What did they find? They found two distinct groups of patients. Patients with severe pain had less arthritis on x-ray and more abnormal nerve tests and patients with more severe arthritis on x-rays had less pain and less findings on their nerve tests. Huh? Shouldn’t that be reversed? Not if pain and arthritis don’t have much to do with each other. How is this possible? When you feel pain, you feel it through nerves. Pain is therefore a nerve issue. Arthritis is a structural problem where the cartilage and bone begin to break down. We see patients all the time with severe arthritis on imaging who have little pain and we also see patients with severe pain who don’t have much arthritis. The upshot? In order for many patients with chronic knee pain to get better, they need an evaluation by a physician who understands that pain is a nerve thing and that knee arthritis nerve pain is cause related not result related. In addition, while pretty MRI images have some real value in some patients, they are not at all the final arbiter of why a patient’s knee hurts!