Joint pain can be a debilitating and frustrating experience, but it doesn’t always have to be explained by a diagnosis. Many people struggle with unexplained joint pain and can feel helpless if they don’t have a diagnosis to explain the pain they are experiencing. However, just because a specific tissue isn’t named, doesn’t mean you can’t get better. Pain is its own diagnosis. You can do many things to manage the pain even without knowing its cause. In this blog post, we will discuss why you don’t need a name to explain your joint pain and how to manage it effectively.
It’s OK to not know what’s causing your pain
If you are asking yourself, “Why do my joints hurt?” or “Why do I hurt?”, you don’t have to worry about needing a specific diagnosis. Pain is often a sign that something is not right in your body and does not always require imaging and a specific tissue to be the culprit. Pain itself is a diagnosis. A diagnosis is only necessary for insurance purposes and is not essential to getting better. In other words, it is enough of a diagnosis to rehabilitate and get better!
A diagnosis is only necessary for insurance purposes and is not essential to getting better. Science teaches us that pain encompasses physical, emotional, psychological, social, and spiritual components, not simply physical symptoms. The science of pain helps us recognize that pain (of all kinds) is always an output of the brain. Research shows it is, in part, protective and adaptive. Alerting us that something is wrong so we can make the necessary changes to restore balance in our lives. Injury is not the only thing that something can be!
We want to know what this pain is, where it is coming from, and how we can get rid of it. However, seeking an exact diagnosis can often lead to unnecessary tests and treatments that do not address the real issue. This can leave you with an empty wallet and unanswered questions about what this pain is and why it keeps coming back or never leaves.
Pain is a complete diagnosis
In reality, most people who experience joint pain can’t remember when it began or why. It usually came on gradually and has been present for some time. For most cases, a tissue-specific diagnosis isn’t necessary for effective treatment. In fact, oftentimes, seeking a more comprehensive diagnosis can come with costs associated with it – such as MRI scans or medical tests. However, this isn’t always helpful.
An MRI cannot actually tell us what hurts and can often lead to overdiagnosis and over-treatment. In the end, having imaging done usually ends up costing us more and not making us any better. Realizing imaging is rarely needed and often not recommended is important.
This may save you from unnecessary costs and treatments without any benefit to your condition. Check out this blog post for more information on MRIs.
Many factors may be causing your joint pain, and diagnostic testing or imaging may not be able to determine them all. Imaging cannot reveal stress levels, activity levels, sleep, and many other factors contributing to pain. Yet, they are part of our pain. You don’t have to have a label to make sense of it or to take care of yourself. By taking the time to tune in and listen to your body, learning to pace, and using graded exercise, you can get the help you need to find relief. Healing can still happen even without a diagnosis; really, it can!
The medical system overdiagnosis
The way our system works makes us believe we need a diagnosis to get better. Until our system puts a name and a ICD-11 code to our pain we are stuck in medical limbo. It’s as if there is no critical thinking if there is no code. You know it. You’ve lived it. If you are reading this, you are probably living it right now!
More tests are not necessarily better. Insurance often pressures doctors to order more tests, even though research does not generally back the usefulness of such testing for most chronic pain cases. Yet, we as people experiencing pain often demand them even when we have doctors that are actually trying to help us by NOT ordering them!
Why it’s so hard to navigate the system to get answers
I spend a lot of time reading in order to put together these blog posts for you, and I really really liked what Howard Luk MD had to say in an article about navigating the healthcare system and why those of us with chronic pain, joint pain, and unnamed pain often feel like we aren’t ever going to get a diagnosis. I’m going to share his thoughts here, they are worthy of a read.
“We’ve all heard the stories of patients who keep seeing different doctors until someone gives them an answer, no matter how off-base or incorrect it may be…this is actually a real problem. Doctors may over-diagnose for a variety of reasons, including lack of time, insufficient training, financial incentives, and uncoordinated care.”
Lack of Time
Medicine is a business and volume is critical. Doctors are assessed by their “productivity” which often leaves little time to properly explain why a test isn’t necessary. Additionally, patient satisfaction scores (like Press-Ganey) factor into doctors’ performance ratings, so it’s easier to order tests to please patients than explain why they are not needed.
Insufficient Training
Most medical residency programs do not expose residents to enough office time. As a result, residents see us operating on meniscus or rotator cuff tears all the time without seeing the 100 patients from the prior few weeks who didn’t need surgery. Accreditation requirements for residency are mostly focused on surgical volumes— not necessarily how the decision to operate was arrived at.
Financial Incentives
MRIs and other tests increase revenue streams, as do unnecessary braces, surgeries, orthotics, etc. This is why surgeons are paid more than non-procedural doctors.
Uncoordinated Care
It can be difficult to keep track of the full history of a patient’s health when they have seen multiple specialists. Without access to a comprehensive overview of what has been done before, doctors may be less likely to take an integrated approach and instead opt for the most conservative answer— which is often an unknown diagnosis and what seems like an endless cycle of treatment.
Diagnosis from MRI and clinical findings are often normal
Many MRI “abnormalities” are, well… normal.
“Age-appropriate” findings on MRI readings are vastly under-appreciated. If you are over 50, have no pain, and place yourself into an MRI, you have at least a …
- A 20% chance of having a meniscus abnormality.
- An 80% chance of something being listed as an abnormality in your knee.
- A 10-15% or higher chance of having a rotator cuff tear.
- An 80% chance of having a disc bulge in your back or neck.
It is not uncommon for a patient to have pain but an MRI or clinical diagnosis to show no pathology. This is especially true for lower back, hip, and shoulder pain where we often see normal findings on imaging yet the person is still in pain.
The fact of the matter is, if you are in pain, there are certain treatments that are always beneficial regardless of what is causing the pain. So rather than trying to figure out what specific tissue is causing your pain, it’s often best to try out different approaches and monitor how your body responds. This may involve physical therapy, rest, stretching, massage therapy, etc. and all of these can be very effective in reducing pain levels, regardless of what is causing the pain.
Healing happens without a diagnosis
Tissue heals. A diagnosis doesn’t heal tissue. Time does. Our bodies are pretty amazing that way.
It is frustrating though that most medical professionals tell us things will get better in 6 weeks. Well, with an acute injury 6-8 weeks is fair. However, the healing process for tissues such as ligaments, tendons, and muscles can take 3 months or so, regardless of the unknown diagnosis.
Chronic Pain can take longer. Treatment for long-standing pain as I do involves making many mini-changes. Change takes time. But it’s worth it. You don’t need to make a diagnosis to begin with me. Even when a diagnosis is not clear, evidence-based strategies such as movement, education, manual therapies, self-discovery, and mindful practices can still help us to feel better. Focusing on what you can do is often a far better way to spend your energy in your quest to regain your life.
Conclusions about why you don’t need a diagnosis
Tissue heals. Imaging findings are often red herrings that end up costing you money and not helping much. Treatment plans rarely change much with the diagnosis of a specific tissue. Things really stay the same.
The way to get better is to learn to pace. Take care of your physical and emotional self. Develop a movement plan to get back to the things you love in a smart and reasonable way. Remember, healing happens without an insurance code. You can heal. You can get better. I’m here to help. Wanna know how – hit that work with me bubble at the top right of this page. I can’t wait to meet you.
