Pain as a Symptom

Almost everyone views pain as a symptom. Since the time of Hippocrates it has been widely accepted that the task of medicine is to find the cause of symptoms and treat that cause. If only the symptom is treated then the problem causing it remains.

However, there are problems with this seemingly self-evident truth. Take the case of chronic mechanical low back pain, possibly the most common pain problem in the world. It has been widely studied. All kinds of treatments abound: medicine, surgery, physiotherapy, chiropractic, massage, acupuncture, and psychotherapy are only a few examples. Many of them are effective in reducing symptoms but no cure has ever been found. The sad fact is that billions of dollars a year continue to be spent in Canada on this one problem alone.

There are as many different ideas as to cause as there are treatments. These often conflict with each other. Degenerative spinal changes (shown in radiological studies to be present in many without pain), spinal misalignment, emotional trauma, depression, anxiety, muscle imbalance, blocked emotions, diet and many other causes of back pain have their adherents. None have definitive evidence to support them although there is likely some truth to many of them. Current medical research supports a multi factorial cause but all the factors involved and how they interact have yet to be discovered.

So here we have a big problem whose cause or causes remain unclear. We are therefore stuck with treating a symptom – pain – and not the cause. What if we viewed pain as a disease in itself? Is this just verbal trickery to justify our current treatments or is there real value in this point of view? Our long-standing inability to deal adequately with back pain certainly suggests we need to rethink our approach. I will expand on this in the next post.

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