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Failure to account fully for relational components of discomfort might cause dilemmas for almost any patient. For SCD, mutual distrust shapes discomfort communication, further complicating medical assessments. Additionally, SCD discomfort is very extreme, making ratings hard to understand compared to reviews from non-SCD patients, potentially exacerbating problems in handling relief of pain. Retrospective case-control study. Vertebral end dish (EP) lesions feature Modic ch