Could A Medical Diagnosis Make Chronic Pain Worse?
Updated: Jul 30
Have you ever stopped to think of the real value of a medical diagnosis?
For instance if you have persistent or chronic pain, does a medical diagnosis, presented with a name, help or hinder? Before you say that it's a ridiculous idea, of course we need a diagnosis when we are ill. We need a diagnosis so the doctor can treat our disease or illness. I believe that is an over simplification especially when working in my area of chronic pain.
Could we be easily impressionable? We listen to an 'expert', a doctor or specialist, accepting a 'sticky label' or button we'll wear forever - our diagnosis.
I'd like to take your focus away from chronic pain to explore other symptoms as not all of you will have chronic pain or know someone with chronic pain. To suggest, sometimes a diagnosis may be dangerous or damaging.
Here are examples of when we go searching for a diagnosis.
o If we have a pain e.g. once or twice, but it's severe.
o If we have a continual pain that cannot be "cured" by over-the-counter medication.
o If we have sensations, such as nausea, or a twitch, or dizziness.
o If we have physical symptoms such as vomiting, broken or damage to our body.
o If we develop a disability such as limping, difficulty going up and down stairs.
o If we have a bad back - we want to know why it is painful!
Doctor "give me a diagnosis"
"Tell me what is wrong with my body?"
Here's the question I want you to consider.
"Is it good to have a diagnosis or is it harmful?"
Recently I needed some bedtime reading, but I wasn't in the mood for fiction, so I picked up the book by Dr. H. Gilbert Welch, "Over-diagnosed". In his book Dr Welch questions the fact that people who are basically healthy are given 'health' tests. Then if they don't fit into normal limits (whatever they are) they're given a diagnosis and classified as unhealthy. I think that 'unhealthy' or 'I have an illness', would be the assumption of most of us who failed to fit within the limits of these medical tests.
He went on to clarify this 'over-diagnosis'. He documented in his book this question - is there something wrong that will harm us by affecting our life expectancy from the progression of a possible diagnosis? But we have no symptoms.
I think it should be obvious to you the list of problems at the beginning of this article need to be taken to your doctor. But the question remains are these symptoms self-limiting - that means they will clear up on their own with a little bit of rest, or a bit less stress, or perhaps there are some behaviours we need to change.
And these self-limiting options above are certainly something your local Naturopath is trained to discuss. Generally they have much longer appointments than a doctor, and will be able to take the time to explain what is happening in your body.
Can A Medical Diagnosis Cause Us Harm
My question becomes can a diagnosis cause us harm. The reason I asked, is once we have been given a diagnosis there is a possibility we might live up to that diagnosis or become that illness or disease. What we hear, what we understand, what we react to and most importantly, what we remember and file away particularly in our emotional brain may make or create literally a mountain of worry out of a mole hill of symptoms.
Today with doctors having so little time and with Dr Google at our fingertips for self-diagnosis I am getting concerned not so much about people being ill, but people worrying about being ill.
There's Belief that Stress is Bad for our Health
Kelly McGonigal makes an interesting comment in her TedGlobal talk
"People who experienced a lot of stress but did not view stress as harmful... had the lowest risk of anyone of dying in the study."
What we think, how we react and construct neural networks that play in our minds can really make a difference to our health, irrespective of a diagnosis?
Clinical Experience of Thoughts Causing Panic Attacks
In many of my articles I have a clinical story to tell. This is a composite story, about the problem of how a diagnosis can affect our health, and I think more specifically our mind.
Several years ago a new client came to my clinic. She was in her 50s and had always felt she was healthy. Recently she had developed anxiety that quickly progressed to panic attacks. She felt there was absolutely no reason for panic attacks as her life was great as were her relationships, and her work.
The erratic nature of these panic attacks were destroying her life. Neither knowing when they would happen nor being able to stop them - she now lived in fear.
Naturopathy Treatment For Sudden Onset of Panic Attacks
She decided to visit a naturopath, me, to get a remedy for her panic attacks.
I took a full history.
After some time an interesting conversation developed. Interesting as this healthy person had decided to accompany her husband, paying for health checks with a cardiologist. Her husband had some risk factors but as far as she was concerned she was completely healthy.
However, problems were lurking in the background, in the form of her calcium score from a scan to measure the amount of plaque in her blood vessels.
Happily her husband's results were fine they were normal for his age although the cardiologist suggested statins and blood pressure medication - just in case.
Sadly, my clients results were not good and she was put into the high risk category at the same time she was prescribed statins and blood pressure medication as she was at such a high risk of a cardiac event. As I have no expertise in this area I cannot comment on the procedures, diagnosis or medications.
The problem becomes:
o She had no symptoms - not even high blood pressure
o Her diet seemed okay.
o The medications she was on didn't really give any indication of side effects for anxiety much less panic attacks.
"Aha," I said.
"Can I just clarify when you started to get anxious?"
"Was it following the test results?"
"Oh, perhaps around that time" She said.
"Aha," I said, again.
Of course she was now worrying, night and day that she was going to die.
o She could just die any time,
o Have a heart attack anywhere.
o I believe she was already feeling or contemplating the embarrassment of having a heart attack anywhere!
This was an opportunity to talk to her and for her to explore how she was feeling about the diagnosis, how ill health had suddenly been presented to her.
To help with anxiety I taught her different ideas of relaxation, meditating and to begin to work with her anxiety.
Find some free ideas and techniques here on this website.
Importance Of Diet And Lifestyle In Chronic Diseases
But, there is a sting in the tail of this story. Just to check how well she was looking after herself I gave her a food journal to keep for a week and then return it to me to see if there was any other advice I could give her.
Imagine my surprise when I read that her husband and she had a bottle of wine with their dinner every evening. On the food journal she had three glasses of wine seven days a week!
My next action was to get back to her with some advice. Making small changes in her diet and advice about cardiovascular disease. You should not be drinking this much alcohol. In my email I also included some recent relevant research from the UK that was actually saying we really need to reduce the allowable or recommended number of drinks, the 'no harm' limits for alcohol way down.
However, I never found out if she had managed to reduce her panic attacks or her anxiety, after talking with me and using some anxiety busting meditation techniques.
I really believed she didn't like my advice. Three glasses of wine with dinner every night when you're over 50 and you have a high calcium score it's just not the best thing to do!
How helpful was this real diagnosis that could impact her life expectancy? The amount of fear and anxiety that precipitated panic attacks following the diagnosis has caused, is somewhat ironic as stress is a contributor to cardiac disease?
If you were curious about my other diet recommendations, it was to eat your veggies
Fear And Anxiety About Chronic Pain Diagnosis
Now, lets consider diagnosis problems surrounding chronic pain, more specifically chronic musculoskeletal chronic pain.
Returning to the second symptom on the list at the beginning of this article.
A persistent pain in your knee -
o Some relief from over the counter medications
o No pain when sitting down
o No pain at night
o Hurts every time you stand up
o Goes away when you start to move
o Had this pain for a more than a month
o Don't remember any injury
o Not sure when it started
If your job involves a lot of getting up and down, for example a delivery driver, this pain can really impact on how you feel. Your doctor checks your knee and movement. He thinks it could be self-limiting (as mentioned above - the knee will get better on it's own).
Your workplace provides a good health fund so you'd like further investigations. Understandable, as you are worried that it could impact on your work that you enjoy, being out and about meeting regular customers and cannot afford to be off work.
Now, remember apart from pain in his knee on getting up
His general health is good,
and regular exercise that includes a low impact social sports team, let's say golf or bowls.
With the development of technology there is now research being done not only on people with intermittent knee pain, but also on people who have no symptoms of knee pain at all.
How Do MRI's Relieve Knee Pain?
Of course, they don't.
A MRI is just a diagnostic tool that takes a picture of the structure of your knee. However the results can have a colossal effect:
o On your treatment
o On you clinicians and their opinion
o On your future
o On your ability to work
o On your ability to have a secure income
o On you mental health
o On your physical health
o On your emotions - as in the story above
I once again refer to "Over-diagnosed" for information. However Dr Welch is not alone in his opinion and research is being done to compare the symptom-free people with those who have pain. We no longer rely on the physical examination of your doctor and his advice, even after years of experience with sore knees!
We no longer rely on the expertise of our doctors. But has technology given us a questionable way of magnifying bodies - just like we can zoom in on a Google map to see our own house, even the kids trampoline in the garden.
As scanning has increased and become included in the process of diagnosis "we are finding more abnormalities that we would otherwise never have known about" (Welch, 2011).
I offer you two findings from research Dr Welch's has included in his book.
"Damaged knee cartilage - in people without knee pain or a history of knee injury, about 40% have meniscal damage in their knees when scanned by an MRI"
We could also consider people who have chronic back pain, that have been diagnosed caused by damaged discs in their back.
"Bulging discs in the back - in people without any back pain, over 50% have bulging lumbar discs when scanned by an MRI." p.36
If we return to the fictitious knee pain story and the myriad of worries that has caused been caused to this person - let's call him Simon, whose doctor has now found abnormalities in his knee? Following an MRI it's most likely the damage has been found. But is it the cause of his pain?
What if Simon:
o Has been covering for a colleague at work necessitating very long hours
o He and his wife's relationship is not good, possibly heading for divorce
o Serious changes have recently developed in his parents’ health, or their ill health.
This list of things going on in Simon's life could be endless.
Shouldn't we be considering that emotional turmoil could be the cause of his knee pain?
"Getting up to move on with life is a challenge every day and throughout the day. Painful in fact!"
I hope this article and the points I've made have given you pause for thought. We need to consider carefully the effect of any diagnosis we are given. Fortunately, we are not a piece of machinery with a part that is broken or failing, we have feelings and emotions that can rapidly become intermingled with any disease or illness. It can be difficult for any of us to remain neutral.
Keller A, Litzelman K, Wisk LE, Maddox T, Cheng ER, Creswell PD, Witt WP. Does the perception that stress affects health matter? The association with health and mortality. Health Psychol. 2012 Sep;31(5):677-84.
McGonigal. Kelly. How to make stress your friend. (2013)
Welch. H.G. Over-diagnosed: Making people sick in the pursuit of health. (2011). Beacon Press.
Jean Jordan - Natural Therapist
Want to find simple effective ways to reduce your chronic pain and anxiety about your diagnosis, without increasing your stress and overwhelm? This is where I can help! Ideas can be found in the articles on my website. You can sign-up to regular updates or spend time using some of the collection of self-help techniques.
After over 20 years of having my own pain clinics pain clinics I started online Natural Pain Solutions to reach more people, rather than one person at a time. Therefore when I completed my postgraduate pain management studies I wanted to spread the word about holistic self-help techniques that people can use at home. Learn more about me here.