"UDN Girls" - Hurting all over but can't find the cause? Dr. Lu Ping-sheng discusses chronic pain
"The doctor said everything seems fine on the check-up, but I am clearly in severe pain."
"First my shoulder, then my waist, and then a headache. People around me are starting to wonder if I am just overthinking it."
This is the most frustrating part for some chronic pain patients.
In July 2023, UDN "Girls Style" published a special feature on chronic pain by Dr. Lu Ping-Sheng, the current director of Healer Clinic. The original media outlet titled it, "'Princess Disease' is real! Constantly hurting here and there—what should you do if people misunderstand you as faking it?" It discussed the mutual impact of chronic pain on sleep, mood, work, and daily life.
But let's make one thing clear first:
The absence of obvious structural abnormalities does not mean the pain is fake.
Why does it still hurt when the MRI is normal?
General imaging exams are very good at finding structural problems, such as:
Fractures
Obvious tendon tears
Disc herniation and compression
Tumors
Severe joint degeneration
Obvious nerve compression
If none of these are found, that is an important exclusion result.
However, "having no structural issues that require surgery" does not mean "the cause of the pain has been found."
The source of pain can still come from different levels, such as nerve irritation, deep myofascial issues, dynamic impingement that only occurs during movement, or abnormal microvessels around chronically inflamed tissues.
Some problems are naturally difficult to show on a static MRI.
Therefore, when the imaging report says "no obvious abnormalities" but the patient continues to feel pain, the next step should not just be to say, "Then you're fine."
Instead, we must look at it from a different angle.
Chronic pain also affects sleep and mood
If pain persists for months or even years, it can easily create a vicious cycle.
Pain makes it hard to sleep, and sleep deprivation can make the body more sensitive to pain.
Being unable to exercise for a long time, decreased work efficiency, and limitations on daily life can also increase anxiety and depression.
Conversely, stress, emotions, and long-term sleep disorders can further affect how the human body processes pain signals.
This does not mean:
"It hurts because you have psychological issues."
Rather, chronic pain inherently involves multiple aspects, including physical structure, the nervous system, inflammatory responses, sleep, and mood.
Therefore, what really needs to be done is to clarify different possibilities one by one, rather than categorizing all pain with "no answers from exams" as psychological factors.
If long-term pain is not getting cured, do not rush to switch to the next treatment
Some patients will go through a whole cycle of:
Painkillers → physical therapy → shockwave therapy → injections → PRP → then switching to another treatment.
But if the pain still hasn't improved, the question really worth asking is not:
"What is the next treatment we can try?"
But rather:
"Was the previous diagnosis actually correct?"
For example, for knee pain, the source might be the knee joint, or it could stem from the hip, lumbar nerves, tendons, or blood vessels.
Similarly, for shoulder and neck pain, it could be a muscle issue, cervical nerve root, peripheral nerve compression, or other causes.
If the area targeted in the beginning is not the true source of the pain, no matter how many treatments you switch to, you may not get the expected results.
Dr. Lu Ping-Sheng: Re-establishing the diagnostic path for pain first
Dr. Lu Ping-Sheng has a background in medical imaging, neuroradiology, and pain specialty.
For patients with recurrent pain and limited treatment results, the evaluation focus is not just looking at a single MRI report, but putting:
How symptoms present, provoking movements, physical examinations, past imaging, and past treatment responses
back together for re-interpretation.
If necessary, this is combined with dynamic ultrasound, X-rays, vascular imaging, or other exams to look for causes that may not have been identified before.
If it is confirmed that the pain is related to abnormal microvessels around chronic inflammation, then interventional treatments like TAME (Transcatheter Arterial Microembolization) will be discussed; if the cause is nerve compression, structural issues, or other diseases, the treatment direction will be completely different.
Find the cause first; only then does treatment make sense.
Being told you are "overthinking it" is not the answer chronic pain patients deserve
The most frustrating part of long-term pain is not necessarily just the pain itself.
It's going through exam after exam and still not knowing the cause, to the point of starting to doubt if you are just being too sensitive.
Pain is a signal that needs to be understood and interpreted.
A normal image only means that the current imaging did not detect a certain type of problem; it cannot prove on its own that the patient is "not in pain."
If pain has lasted for more than three months, significantly affects sleep, work, or activities, and you have received treatment but with limited improvement, gathering past imaging and treatment records to re-evaluate starting from the diagnosis is often more important than constantly switching treatments.
Further Reading
Why does it still hurt when the MRI is normal? Four sources of pain that imaging can't capture
Why do the results of PRP injections differ? Four key factors affecting PRP injection efficacy
Media Source: UDN Girls Style
Original Report Date: July 17, 2023
Original Report Topic: "Princess Disease" is real! Constantly hurting here and there—what should you do if people misunderstand you as faking it?
Author: Dr. Lu Ping-Sheng
This article compiles Dr. Lu Ping-Sheng's past public health education content, reorganized based on current chronic pain diagnosis and the health education framework of Healer Clinic. The causes of pain vary from person to person; this article cannot replace a doctor's diagnosis.
