It is no secret that the primary reason patients cross my threshold is because they are in pain. It falls upon me to help them get out of pain as quickly as possible and as effectively as possible. To this end, I have to find what is causing their pain. I like to call this the pain generator. As part of my initial exam I am looking at the overall biomechanics of the patient. Is the pelvis level? Are the joints moving and aligned properly? Do x-rays show signs of degeneration or any other pathologies? Getting the patient out of pain and back to their activities entails examining and addressing all these issues and more. But we can’t lose sight of finding the pain generator or pain generators.
Studies have found only a weak correlation between degenerative joint disease (basically worn out joints) and pain. I see this in my practice all the time. One patient might be in tremendous pain and yet their x-rays look pretty good. Another patient may have relatively less pain while their x-rays show severe degeneration.
As a side note, this becomes more critical if the patient is undergoing surgery. For example, an MRI of a patient with knee pain might show a tear in their meniscus (the shock absorber in their knee). Surgery is performed to cut away the part that is torn. And yet, after the patient recovers from surgery, the pain has not changed because the torn meniscus was not causing the pain. The tear was, in fact, asymptomatic. Something else was causing the pain. It may have been something that did not even show up on the MRI.
This is not to say that when I identify the pain generator I ignore all else. On the contrary, the poor biomechanics in a patient’s body may be what led to the creation of that pain generator. If I only address what is causing the pain, it may feel better for a while then come back because the underlying conditions that created that pain generator were not addressed.
In a nutshell, when working on my patients I try to come at their complaints from both ends. By addressing whatever it is that is causing their pain as well as the underlying conditions that created their pain generator, the patient has the best chance to get out of pain as quickly as possible and stay out of pain.