If a person has intermittent pain (the one that appears every other hour) even if it is acute and strong, that alone does not justify the performance of imaging tests because, in this case, when someone has pain that appears and disappears in certain positions or times of the day, there is a high chance that a mechanical change is producing such symptoms. And what would that be? Any position or movement that generates some mechanical tissue alteration can cause the production of some type of symptom (numbness, pain, tingles, muscle spasms and so on). Once these positions or movements are stopped, the symptom is also abolished.
Mechanical pain brings the sensation and the finding that a joint is blocked (from mild to the most severe degrees), with one or more painful movements, reminding you often that you have a back, leg or arm, for example.
In case of a fall - when the person hits the back or the head on the floor - or even a car accident, then it is essential to perform imaging exams, before making any other decision, to rule out any possibility of fracture, which in itself is already a relevant event.
Another case is when a person who has a family history of cancer and begins to feel tiredness, lack of appetite, nausea: those signs and symptoms could be caused by a serious condition. This condition must be investigated through the clinical examination, together with the imaging examination, which will then enable the patient's diagnosis confirmation.
Therefore, if none of those conditions are present and the person is experiencing intermittent pain throughout the day, only in certain situations, the first information to have is: it is not serious, do not despair. Today, the statistics show, unfortunately, that the majority of Brazilians and also citizens in different countries (USA, for example) daily perform imaging exams inappropriately and unnecessarily.
There is a very delicate issue there: any individual, from the second life decade onwards, who undergoes imaging exams, will have changes in any researched tissue (bones, cartilage, tendon, ligament, etc). The problem is that in most cases (more than 90%) these changes are not compatible with the pain or symptoms experienced, but are thought to have a connection.
The vast majority of these patients, when evaluated, present a positive response, with the reduction or abolition of pain, as well as the improvement of their daily functions and gain in movements. If they decide or their doctors recommend to repeat the exams, in most of the cases the images will not have changed. And why? Let's think from the logical side. Is there any possibility that such images (such as bones that articulate, or ligaments, or the size of a foramen, or a tendon) may change within a few days? One week? Or even in a few months?
Imagine that any symptom you feel (be it pain, numbness, tingling or any other sensation) has changed for the better and remained so in the first week of treatment. If you decide to repeat the same imaging exam, the chance of the same changes be shown (herniated disc, osteophytes, degenerative signs, etc) are almost 100%, as they occur over several and even many years of life.
So, if there is a rapid change in the symptom, it means that those changes in the image are not responsible for what you feel. It also means that such changes in the exam are normal findings, which increase over the years, such as wrinkles and expression marks on the face that are nothing more than natural signs of our aging.
We can conclude that imaging exams are in fact of great importance in the detection of fractures or tumors, which are severe cases (they represent less than 2% of the population) and bring constant pain. Therefore, it is not justified to perform them in all patients, since most have intermittent pain.
What happens in most cases - maybe you are a part of it - is that people with this pain condition go through the medical care protocol, are referred to a MRI or a CT scan, and are bombarded with countless medical information, technical names for the findings, which represent, for the most part, the natural aging of the joints and the structures they involve: the internal wrinkles, which we gain in the course of life.
But the process continues: following the model of medical evaluation and treatment, the symptoms are, unfortunately, reached and treated only partially, since medicines are able to treat only the chemical part of the pain, but not the mechanical part. Often the patient even undergoes surgical procedures, without at least being first mechanically assessed and tested.
In Denmark, for instance, it was proven that through the use of a structured System, desgined for the mechanical evaluation and screening of patients who would need surgery, there’s a 50% reduction in their surgery rates (Rassmussen, 2005).
Here lies the big question: the patient certainly needs to be investigated from a mechanical and physical point of view, through tests of movements or positions done by the specialized professional, to bring enough information and outline the appropriate treatment for each case. This information will certainly be very useful in making the decision on the most appropriate approach for each case. Does the world know that?
