If Your MRI Is Normal, Is Your Pain All In Your Head?

A 2012 National Health Interview Survey showed that approximately 25.3 million Americans, almost 11% of the population, were suffering from pain every day for over 3 months. (nccih.nih.gov). If you are like most people troubled with mysterious pain, it is only fair that you've seen multiple specialists who have had you go for MRIs and CT scans, all of which turn up nothing unusual.


Have you been told: "Your MRI is normal, your pain is all in your head," or

"There is nothing more I can do for you, go see pain management,"? While you might be led to believe that the pain is in your head, you know deep down inside that something isn't right.


Do I Have Chronic Pain?

Now, this is a question many people start by asking themselves and then their doctor. If you have had the same pain that has carried on for 12 weeks or longer, despite treatment and medication, then you have chronic pain. Many people will often get back to normal after an operation or an injury. But there are instances where the pain tends to linger on for an unusually long time and may even come on without any prior history of an operation or injury to the region.





Which Conditions Cause Chronic Pain?

People who have chronic pain often assume that they are suffering from simply an injury to a specific joint, muscle, or ligament that just hasn’t healed or wasn’t treated correctly, and that may be the case. However, in addition to that, anyone who experiences pain for months, if not longer, is amongst the millions of Americans experiencing a condition referred to as chronic pain. It is a blanket term used for usually all types of pain that does not go away with medication and exercise. There can be many reasons the pain is perpetuating that do not have anything to do with the original injury or insult.


Chronic pain affects up to 50 million Americans, according to the American Pain Foundation. Years if not decades of research into chronic pain have yielded little in the way of results as chronic pain is still poorly understood and continues to be elusive at best. A recent survey conducted by the American Academy of Pain Medicine found that despite comprehensive treatment using painkillers, i.e. prescription drugs, only 58% of people seem to find some relief.


So, the question is, what causes chronic pain and what can you as a sufferer do about it?


To some extent, chronic pain has its roots in a prior injury that has not healed correctly or was complicated by a scar. For instance, a surgical incision, an injury, or a serious infection. Everyone’s history is different as to how they developed their pain and why it is perpetuating. That is why it is so important to address the underlying conditions that may be present to address the pain. However, even then, the pain for some may not go away completely. That's why many doctors are now considering pain to be a condition of its own, in which case special pain treatment is needed to address the person's psychological and physical health.


Who Is at Risk For Chronic Pain?

In a nutshell, just about anyone is at risk of chronic pain. However, some people are at a higher risk of having to suffer through chronic pain than others. The three major categories of risk factors include:


  • Biological risk factors – Usually, these will stem from a person's physical characteristics and medical history.

  • Lifestyle factors – A poor lifestyle can lead to instances of chronic pain.

  • Psychological risk factors – Generally, pain has been found to be linked with personality and mood.


Biological Risk Factors

Some factors can put you at risk of chronic pain, such as:


  1. Age – The older you get, the body tends to start breaking down in more ways than one. The process of getting old is physically painful for many people.

  2. Genetics – Manychronic pain types have genetic links. Numerous studies have found that genetic markers make some people more prone to persistent pain than others, so they will need a more specialized approach to their pain management than others.

  3. Race – Some studies have shown that Hispanics and African-Americas are at a higher risk of chronic pain.

  4. Obesity – Generally, carrying a lot of weight can be stressful for the body, and the longer you have to carry it for the more damage it does, eventually leading to chronic pain. Furthermore, it isn't uncommon for obesity to exacerbate numerous existing medical conditions, which also prevent your body from healing creating the need for a specialized approach to your pain..

  5. A Previous Injury – Anyone who has successfully recovered from a previous traumatic injury stands a greater risk of chronic pain. Research shows that the main pain neurotransmitter tends to be released in much higher quantities in people who were previously suffering from pain owing to an injury. The increase can be anywhere from 3-5 folds.


Psychological Factors

Childhood trauma is a major factor for people who might have experienced lots of parental neglect, sexual abuse, or bullying. All of these factors play a significant role in the odds of a person developing chronic pain-related issues later in life.


Another common reason is mood or anxiety disorders. Many neurotransmitters and areas in the brain tend to handle pain signals and manage mood. That's why people with a history of depression and anxiety can often experience more pain.


Overcoming Obstacles to Chronic Pain Diagnosis

Chronic pain patients have to deal with a lot of their own frustration at the inability to find proper treatment, and often doctors write off their pain as psychosomatic. However, many also need to face friends, family members, and co-workers, who feel angry, frustrated, and distressed at there being nothing that they can do to help the patient.


It comes as no surprise that job performance can and does often suffer. Workplaces generally aren't sympathetic or even supportive to many people suffering from chronic pain. In many workplaces, unless or until there is an accurate diagnosis of a problem, the report of there being a pain is seen as an excuse.


Diagnosing Chronic Pain

Many patients with chronic pain may later discover that, unfortunately, discovering the true cause of their pain can be a long and often very frustrating process. It is often as frustrating for a physician who may appear to be failing despite trying everything they know. However, pain can stem from many ailments, including myofascial scar, nerve entrapments, underlying inflammatory conditions, etc. . Doctors will typically use many approaches to try diagnosing pain, with the first step often is trying to get some background on how and when the pain began. Doctors will also want to know what the pain feels like and if it has gotten worse over time. Many times a physician will refer a patient to a specialist. That specialist can be a neurologist, sports medicine physician, pain medicine physician, PM&R practitioner, or orthopedist, depending on what the doctor suspects is the main issue.


Doctors have numerous tests at their disposal, which include an x-ray, CT scan, MRI, and electromyography (EMG), which helps with diagnosing anatomic causes of pain. Once the anatomic reason for any type of pain is found, the solutions can often range from medication/injections to physical therapy to surgery. Unfortunately, in some people, a diagnosis can't be made using those tools, so the usual treatment options prescribed don't offer any relief.


Often patients are told that there is nothing wrong with them, and some doctors tell the patient that they will need to live with the condition. For patients, this can be enormously frustrating, and for some, it may lead to them questioning their own sanity.


MRIs Often Do Not Show Chronic Changes in Soft Tissues

When dealing with musculoskeletal pain, doctors may order an MRI, but in many cases, that does not show the problem. An Ultrasound, however, is an ideal tool for looking at areas of chronic pain because not only does it pinpoint the structure that is causing you pain, but because ultrasound can look at your tissues in motion, it can diagnose issues that non-dynamic tests such as MRI and CT cannot. Ultrasound used correctly will look at the soft tissues in the area of pain as well as the ones in that structure’s biomechanical or kinetic chain to make sure that the whole group of tissues is working correctly and not putting strain on one structure or another.


Whether you have persistent pain in your hips, hands, feet, buttock, arms, or legs, an ULTRASOUND may be the tool that can ultimately give you the answers to what is causing your pain and how to treat it!


The high spatial resolution of musculoskeletal ultrasound is uniquely able to evaluate the internal details of:

  • Tendons

  • Muscles

  • Ligaments

  • Nerves

  • Fascia (the sheets of connective tissue overlying your muscles)


If there is physical pain caused by any of the above, an ultrasound should be able to reveal it.


Here are a few scenarios where diagnostic ultrasound may be helpful:


1. When you lie flat on your stomach, can you bend your knees to 90 degrees without pain in your upper thigh and buttock? If not, you likely have an old hamstring injury causing discomfort.


High-resolution ultrasound is excellent at evaluating and treating various instances of:

  • Chronic hamstring tendon pain

  • Chronic hamstring muscle injuries

  • Associated dysfunctions and/or injuries of the adjacent muscles, nerves, and ligaments


Ultrasound can detect a scar that may have formed around an injured tendon and muscle, which can entrap or stick to the adjacent soft tissue structures. This includes the sciatic nerve, which sits right next to the hamstring. The sticking of the sciatic nerve to the hamstring by scar may result in pain radiating down your leg. Sometimes nerve entrapments cannot be seen unless the muscles are actively contracting or the hip is rotating. We routinely ultrasound the hip in motion so we can directly see those types of dynamic entrapments that cannot be seen with MRI or CT scan.


2. Do you experience persistent radiating pain, numbness, tingling, or heaviness in your limbs?


If so, you may have:

  • Nerve injury

  • Nerve entrapment.


The high spatial resolution of musculoskeletal ultrasound is uniquely able to evaluate the structural details of your peripheral nerves as well as evaluate the surrounding soft tissues around the scar that may be entrapping the nerve.


Dr. Delzell is a national expert in peripheral nerve entrapments who uses ultrasound to find and treat chronic pain. Even when a patient has had a normal MRI or EMG, ultrasound often detects the injury to the nerve not identified with other tests. Ultrasound can even see abnormalities in very small submillimeter-sized nerves. In expert hands, ultrasound-guided treatments can also be performed easily, quickly, and painlessly.


3. Do you have perpetual knots in your muscles?


Have you had multiple normal MRIs and seen multiple specialists without relief? The high spatial resolution of musculoskeletal ultrasound is uniquely able to

  • Evaluate scars in the soft tissues that are not seen on other imaging diagnostic scans.

  • See muscle contractility issues while moving the muscles.


There are layers of multiple muscles and other supporting soft tissues, especially in:

  • Hip

  • Shoulder

  • Back


An Ultrasound can easily distinguish among these layers to identify scarring in any of the muscles and/or surrounding fascia. Through the addition of muscle motion, ultrasound can more reliably pinpoint the source of the pain and/or surrounding soft tissue dysfunctions for developing a successful treatment plan. As scar and motion abnormalities can be pinpointed with ultrasound, ultrasound-guided needle treatments will increase the likelihood of successful treatment and relief of pain.


4. Do you have persistent pain after joint replacement?


Soft tissue scar in the muscles and fascia can be the cause of pain that mimics joint pain. Ultrasound is the test of choice for evaluating the soft tissues, especially after joint replacement. Unlike on MRI or CT scans, there are no artifacts from the hardware that interferes with the ultrasound evaluation of the soft tissues around or near the replacement.







We Help People with Chronic Physical Pain


If you are suffering from chronic pain and require an evaluation of any type of chronic musculoskeletal pain issue, Advanced Musculoskeletal Medicine Consultants, Inc has the expertise and reputation you need to have a high-quality ultrasound and to develop an individualized treatment plan for you. Call 440-557-5156 to make your appointment and start your journey to healing today!