The further I go, the more I know people with persistent pain, the more I realize how difficult it is to make people understand how chronic pain is a physiological problem (related to an organic function) rather than anatomical (related to the structure of the body).
We need to see what's broken in our body and, when we find something wrong, we cling with all our tenacity to that thing that, in an ideal body (where ideal would be better "fake"), not there should be, even minimal: that little thing there, becomes responsible for all our pain, even if it is not. But we see and we like this, it comforts us.
Maybe because my pain was abominable, migrant, "referred" not only to muscles and bones, but also to internal organs that were fine, so when it was explained to me that persistent pain is a problem of physiology and not of anatomy, the fact was obvious to me: "Here is an answer, finally".
But it is not so immediate for everyone.
To simplify, we can say that health professionals have a tendency to look for our pain in the building blocks (bones, muscles, etc.), while persistent pain is in the electrical system, in our nervous system (composed of the brain, spinal cord, from the sense organs and from the set of nerves that connect these organs with the rest of the body).
In short, we have a nervous system, which regulates all the functions of our body, and which nobody (none among the health professionals who have not been able to give us a solution) considers.
But how can the electrical system be seen? And how do you know if I suffer from persistent pain and not from an unknown disease that will lead me to the grave (which I know very well is the fundamental question for all of us)?
First of all, to put you at ease, there is one thing called differential diagnosis.
Differential diagnosis is a procedure that aims to eliminate pathologies based on the presence or absence of some symptoms, using a correct medical history, physical examination and various laboratory tests. The ultimate goal is a correct diagnosis. The health professionals you rely on are able to carry out a differential diagnosis, each for their own skills and, in the event of the slightest doubt, they are obliged to send you to another professional figure. If at the end of the process they tell you that you have nothing, you have nothing ... Nothing that will kill you, at least. Forgive me for being honest, but this is the topic.
One of the first things the practitioner will do is ask you to evaluate your pain. In fact, patient self-portrayals of pain are one of the most reliable sources of information and can help understand what kind of pain you are suffering from.
Some simply ask you questions about your pain, while others can use a more formal pain questionnaire, asking you to choose the words that best describe your pain (such as burning, tingling, sharp, dull, etc.).
After that, which seems to be unknown to most, there are tests that a person suffering from persistent pain can undergo. It is often possible to demonstrate a malfunction (or injury) of the nervous system in one or more modalities, by testing the affected areas with different types of touch, the temperature (using an ice cube or an alcohol swab) ... also take note of the presence and distribution of abnormal pain responses. These tests, a professional who deals with persistent pain, should know how to do them and explain to you what they are for, what they tell about your body and your pain.
But the proven proof of my pain?
Well ... All the questionnaires, questions and tests that are made to you are not the result of the madness of your physiotherapist or your doctor, but of the research on persistent pain, which has allowed us to understand how it works and therefore to develop questions and tests to recognize it and diagnose it. Your body, it is not true that it says nothing about pain. In reverse. It tells a lot. The proven proof you have it under your nose, even if it seems impossible to you.
Well ... yes. There are neuroimaging.
Thanks to neuroimaging in recent years it has been understood that the brain of patients suffering from chronic pain shows alterations with respect to function, structure and chemistry.
Neuroimaging is a relatively new technique that uses various methods for mapping the structure or function of the nervous system.
The use of brain imaging and other technologies has led to the understanding that chronic pain is mediated by the CNS ... It remains that the use of these tools as a standard diagnostic tool for persistent pain is inappropriate (according to IASP), because there are no protocols validated and this is potentially harmful to patients.
In short, even if in neuro-images we see, in people with persistent pain, the activation of certain areas of the brain, it is not possible to quantify the pain from the outside.
I can't tell you if you'll ever see pain. But I can tell you that the evaluation of chronic pain is made on the basis of your medical history, clinical examination, questionnaires ... It may seem trivial to you in our medical system made up of a thousand thousand specific tests for everything, but everything that comes to you proposed by a professional who really knows persistent pain, it is the result of research and clinical reasoning (ie the exercise of a set of complex skills, such as critical, reflective, creative thinking), not by chance.
Your body clearly tells the story of its pain. You need to know how to listen and have the knowledge to understand it, above all.
Schmidt-Wilcke, T. (2015). Neuroimaging of chronic pain. Best Practice & Research Clinical Rheumatology, 29 (1), 29–41. doi: 10.1016 / j.berh.2015.04.030
Davis KD, Flor H, Greely HT, et al. Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations. Nat Rev Neurol. 2017; 13 (10): 624-638.