Is my physio right?

woodbine

I’ve posted about this on the main forum page, and some of the replies suggested that I ask the helpline team about it too.

I have joint pains in my lumbar spine, knees, neck, and hands (my back was the first to ache, about 15 years ago). I have been told by my GP that my knees show definite signs of OA (lumps and clickiness), and an x-ray has revealed ‘excessive wear’ in my lower spine. She also told me that a small lump on my finger may also be an early sign of OA. It took a bit of persuading, but she eventually sent me to our local pain clinic.

The physio at the clinic examined my back and knees, and told me that he could find no problem with them. When I reminded him about the GP, the x-ray and the pain, he began to go in to detail about what he called the latest theories of pain. Apparently, there are no nerves that detect pain, only ones for pressure, and the reason that many people have chronic pain is that the brain becomes sensitized, and so if you have ever had a severe pain in an area, such as an injury or spasm due to moving awkwardly, your brain will feel severe pain there even when there is only something small setting it off. He feels that by rushing to label a pain the GP is being old-fashioned in her approach!
After a few sessions (where he has mostly talked rather than given me much physio) he has admitted that there might be a slight wear-and-tear issue with my knee.

What is really upsetting me is that what he says contradicts what I’ve been told by other medical staff over the years, and yet he just dismisses this when I raise it. For example, two physios and a GP have said that my lower spine has a particularly deep lordosis curve, which is probably why it has worn so much and also why the muscles in the area are so tight as this has affected my sacrum, as shown on the x-ray. This physio tells me that there is not a very deep curve in my spine, and that I just need to do more exercise to loosen it up. My mum has multi joint OA which started at the same age as mine, and followed a similar pattern, but he’s not interested in this either.
He wants me to concentrate on what I can do to reduce the pain by reducing or changing what do - not a bad thing in itself, I agree, but he said this is to de-sensitize my brain so that it stops feeling the same pain levels.

I know that you cannot offer any sort of diagnosis by email, but I was wondering if this is truly the latest theory on pain, and what you think about it at Arthritis Cares? Do you have any info about this idea of avoiding ’labelling’ the cause of someone’s pain?
Thanks in advance
Naomi

helpline_team

Dear Naomi,

Thank you for your post to Helplines. Our role is not to adjudicate in matters medical, but offer support, information, signposting that kind of thing. If you are dealing with a medical 'take' on your situation that seems at odds with what's been offered to date you may well want to take stock as you work out what's helpful.

Sometimes pain clinics are working to help people make changes in their lives and sometimes do try to 'reframe' people's views on their pain and what they do each time they experience pain. However I'm not going to know what was the intention of the physiotherapist you saw - i wonder whether you have any channel back to them to check out what you understood / give them some feedback?

I do believe that some pain clinics try to give phone numbers to their clients so they can at least speak to the specialist nurses for example.

If you'd like an informal chat, you are welcome to ring us here at Helplines.

All the best
Guy

woodbine

Hi - and thanks for replying so quickly.

I didn't expect you to say if he was right or wrong about my diagnosis, I was just wondering of you have come across this sort of thing before, (the key point was really my final paragraph, the rest is just background) and if you perhaps have some info, articles or opinions on this idea about pain. I assumed that if it really is the current thinking others must have had similar experiances.

The thing is, there's not much point in my asking for a 2nd opinion if this is what all professionals dealing with pain really think these days. However, if this is not mainstream thinking, I might speak to my GP about another physio. (There isn't a number to ring or a nurse to speak to, or anyone else to feed back to at the pain clinic as far as I know , by the way.)

Naomi

helpline_team

Hi Naomi,

I've read your original post with particular reference to the final paragraph and I just wanted to offer you some reassurance. I think the important words here are 'latest theory'. Because that's all it is. Somtimes when people hear a new theory they embrace it with an evangelical fervour and can't wait to tell anyone who'll listen. I'm only hypothesising but this could be what's happened with your physio. But I definitely wouldn't get too hung up on what he's said because it certainly doesn't reflect current mainstream medical opinion.
I'm not saying that this theory is without merit, but couldn't help noticing the irony when he says that by rushing to label a pain your GP is being old fashioned in her approach. So we musn't label pain, but it's fine to label people with a different opinion as old fashioned?!
So it's important to be aware that there a great many diverse and often contradictory ideas on the causes of pain and no one can lay claim to the Holy Grail yet. You could ask your physio to share his evidence based research with you. We don't have any specific info on it, but have worked closely with the co-authors of the latest research into osteoarthritis, which you can download here:
http://www.arthritisresearchuk.org/~/media/Files/Education/Hands On/HO10-Autumn-2011.ashx
http://www.arthritisresearchuk.org/~/media/Files/Education/Topical Reviews/TR10-Autumn-2011.ashx

Best wishes
Paul