NYTimes: The Evidence Gap. The Pain May Be Real, but the Scan is Deceiving

Gina Kolata has an interesting piece in the NYTimes right now, looking at the gap in evidence between use of scanning technology like MRIs and CAT scans to track down causes of pain, the discovery of a problem, and whether or not fixing the problem found via scan fixes the actual problem.

This hits home for me, because several years ago I went through a long series of scans to see what in the world was possibly causing the severe pain in my right arm. The MRI eventually discovered a disc bulge very high up in my c-spine, at an area that would have significant risks attached to surgery. Thankfully, my primary care physician, anesthesiologist and neurologist held a joint meeting with me and took the time to explain not only how to read MRIs, but the number of people who have something "wrong" with them without that "wrongness" being the cause of their pain.

In my case, terror about the risks associated with surgery high on my spinal column evaporated, and I was left with a different diagnosis and management routine for the disease.

But many people aren't so lucky, and go through unnecessary surgery because they have a pain, a scan shows a deviation, therefore the deviation must be linked to the pain. They have surgery, expecting to feel fine after your typical recovery period, and instead, no dice. (And if someone is unlucky enough to have some kind of pain condition that likes to spread when nerves are injured, things could be made even worse.)

Because of this, it's nice to see people - reporters and medical folks alike - are actually taking a look at the prevalence of "abnormal" scan results. Results that, in the end, are not so abnormal after all. However, it would have been nice to see whether or not doctors who realize that disc bulges or torn meniscus's aren't necessarily related to the pain you're feeling treat the pain, rather than the absence of a fixable issue. Knowing you have arthritis and that's the cause of your pain issues means very little if you're not getting pain relief.

Moving away from a concept of a single norm for the body is good - but hopefully as we make that transition, people recognize that simply because there is not a fixable cause to pain, doesn't mean the pain itself cannot be successfully treated.
-Kelly Hills

Worth Noting

Stumbled across this gem of an article about 7 Medical Myths Even Doctors Believe from LiveScience. The British Medical Journal found out that when it comes to urban myths, doctors aren't immune. For example:

"Myth: We use only 10 percent of our brains.

Fact: Physicians and comedians alike, including Jerry Seinfeld, love to cite this one. It's sometimes erroneously credited to Albert Einstein. But MRI scans, PET scans and other imaging studies show no dormant areas of the brain, and even viewing individual neurons or cells reveals no inactive areas, the new paper points out. Metabolic studies of how brain cells process chemicals show no nonfunctioning areas. The myth probably originated with self-improvement hucksters in the early 1900s who wanted to convince people that they had yet not reached their full potential, Carroll figures. It also doesn't jibe with the fact that our other organs run at full tilt."

For the other six myths and the rest of article, click here.