This week's question -
I have pain, but my MRI/CT scan comes back fine. My doctor says its in my head, but I know I feel pain. What is going on?
My answer -
There are two important facts to discuss here and I ask that you please read through both!
First - it is important to remember that all pain DOES come from our brain. Without a brain, we could be stabbed in the chest, and not feel pain. Our brain acts like a filter that helps decide how we perceive and react to that pain. There are different factors that can affect how that filter works. This is why our brave military members can be shot multiple times and still continue fighting, while I stub my toe and may sit on the floor for 10 minutes feeling like I cannot move. Our brain assesses the situation around us to help determine how and when it is safe to let us feel that pain. While the examples above are extreme, even things like our brain being preoccupied can lead it to become overwhelmed and have trouble filtering out some of that pain. So yes, things like stress, anxiety etc can determine our perception and reaction to pain.
However, that does NOT mean that you are "making the pain up," just that there is no tissue damage that equates to that pain.
The second fact we need to address, is that even the most advanced MRI machine is still just a glorified camera. Do you remember in school those creative writing assignments where the teacher would show you a picture and you had to write a story about what was going on in that picture? 30 kids in the class, 30 different stories. That is because a still picture shows us a snapshot in time, usually, in the case of an MRI, while we are lying down. Well, if you typically do not have pain lying down but do have pain with movement, nothing may show on and MRI. It may be a movement dysfunction rather than a tissue dysfunction.
Ok, I know I said 2 facts, but I am going to drop a bonus. Most research shows that the level of tissue damage does not equal the level of pain in most case scenarios. Therefore, while MRI's are great at ruling out serious operable tissue damage, they are far from capable of ruling out all causes of pain.