Pain may be unpleasant—almost unbearable at times—but the sensation of pain is actually one of the body’s defense mechanisms. It creates awareness of distress in specific tissue. Examples of this include pain at the chest and the left arm as a symptom elicited by the heart to indicate that a heart attack is occurring…pain at the upper back elicited by the lungs to indicate that pneumonia is present…and pain at the back of the throat to indicate that you have irritated tonsils. This understanding of how the body works allows the tissue that is in distress to be identified and treated.
Different problems in the same general area produce distinct symptoms. Let’s say you have pain at the upper arm. What could be causing this symptom? Typically, you can look to three different tissues—bone, nerve and muscle.
Let’s start with bone. The most common reason a bone would elicit pain is from a fracture, which would elicit pain at the fracture site. If there were a fracture in the upper arm you would most likely feel a very small area of pain concentrated near the fracture itself. If you pressed on the bone an inch or two away from the fracture site, the level of pain would be greatly decreased, if not nonexistent. Pain from a fracture would be somewhat constant, regardless of whether the arm is at rest or moving. In most cases, you can associate the inception of the pain with a traumatic incident, such as a fall. An X-ray would confirm the presence of a fracture, and then the bone would be treated appropriately (usually with immobilization or surgery, depending on the severity).
Next let’s look at nerves. Nerve pain is not arbitrary. Nerve pain follows either a nerve root or a nerve. Each nerve root and nerve has a specific area of skin that it innervates. So the simple identification of a herniated disc, stenosis or pinched nerve that may show up on an MRI is meaningless unless the area of skin in which you are having your symptoms matches the area that the supposedly affected nerve root innervates. Two important things to understand about nerves:
- Nerves run long distances, not simply between joints. If pain is isolated to an area that stays between two joints, that pain cannot be coming from a nerve.
- Individual nerves do not simply begin to decay or develop structural abnormalities. A trauma is typically necessary to affect the health of a nerve.
With this understanding, nerve-related symptoms in the upper arm region would have to begin at least at the shoulder (if not above) and go beyond the elbow. While such symptoms could be directly from some structural variation of a nerve, the higher probability is that a muscle has strained and is impinging on the nerve. Those who have been told they have “neuropathy” or “radiculopathy” should be highly suspect of these diagnoses.
Finally, the muscles. Muscle pain results when a muscle strains and knots due to its inability to create enough force to perform a particular activity. Muscles do run between joints, so pain that stays between two joints is most likely the result of a muscular strain. This type of pain seems benign or even absent when the arm is at rest but worsens when the arm is used —especially when the arm is raised to shoulder height or above.
Another key indicator that your pain is muscular: If pressing on the painful spot increases the intensity of the pain, the tissue you are pressing on is eliciting the symptoms. (The upper arm consists mostly of muscle, but when you test yourself, be sure you are pressing on muscle and not the upper arm bone.) The area of pain is much wider with a muscle strain then a bone fracture.
So here you have it: three different kinds of pain running through the same area, the upper arm.
Now, if you take the existing medical-model approach of getting an MRI of either the neck or shoulder, you might be told that a herniated disc, stenosis, pinched nerve, arthritis or a labral tear is the cause of your pain. And the treatments prescribed will usually be incapable of resolving your symptoms.
I will always describe chronic pain as misdiagnosed acute pain. This is the primary reason for chronic pain for most people. Be smarter in how you determine the cause of your pain. Understand the relationship between the symptoms being experienced and the tissue in distress that is eliciting those symptoms. As I’ve shown, each type of tissue creates a distinct set of symptoms, and understanding the symptoms is the only true way to identify the tissue eliciting them. This allows for the right treatment to be performed and relief of your chronic pain.
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