Chronic Pain Is a Hidden Epidemic. It’s Time for a Revolution.
January 12, 2025 10:54 AM Subscribe
As many as two billion people suffer from chronic pain, can science finally bring us relief? [NYT / Archive]
I sincerely hope that the stigma around prescribing pain medication is ending. I am currently at the end of an arthritis issue that caused me such spectacular agony that I thought my foot was broken. The doctor identified the problem and wrote me a prescription for steroids. As I struggled to put my boot back on, I said, "So, there's one other thing I wanted to ask you about," and her face squeezed into a wince that abated immediately when I said, "I need a note for -- " and she said, "Oh, of course, you need two days to recover at least! I'll write you a letter." I'm sure she expected me to ask for pain medication, which frankly I need. I have taken over the counter medication like candy, and it does absolutely fucking nothing. I'm sorry that depressed people killed themselves with opiates, but I don't see why that should be my problem.
posted by kittens for breakfast at 11:02 AM on January 12 [22 favorites]
posted by kittens for breakfast at 11:02 AM on January 12 [22 favorites]
Depressed people killing them selves with opiates is an odd way of describing the opioid crisis.
posted by MisantropicPainforest at 11:07 AM on January 12 [10 favorites]
posted by MisantropicPainforest at 11:07 AM on January 12 [10 favorites]
Well, when you're in agonizing pain, you may also feel differently about what exactly the nature of this crisis is.
posted by kittens for breakfast at 11:09 AM on January 12 [26 favorites]
posted by kittens for breakfast at 11:09 AM on January 12 [26 favorites]
Yeah that is...not why it's hard to get opiates, and not what they mean by "opioid crisis."
posted by We put our faith in Blast Hardcheese at 11:09 AM on January 12 [6 favorites]
posted by We put our faith in Blast Hardcheese at 11:09 AM on January 12 [6 favorites]
You're going to find this hard to believe, but I am much less interested in the political nuances of why the medical industry has decided it's cool for me to be in pain than I am in not being in pain. I will allow you to continue your measured discussion, though.
posted by kittens for breakfast at 11:12 AM on January 12 [18 favorites]
posted by kittens for breakfast at 11:12 AM on January 12 [18 favorites]
Dropping a shitty comment and then responding to push back with a defense that you have bigger problems so it’s ok to be shitty isn’t cool.
posted by MisantropicPainforest at 11:30 AM on January 12 [13 favorites]
posted by MisantropicPainforest at 11:30 AM on January 12 [13 favorites]
I will allow you to continue your measured discussion, though.
How deeply gracious.
ANYWAY, yes, this is actually super fascinating in what they are finding and (for someone who does not work in science) how they are studying it. Opiates are not by any means a perfect, restorative solution to chronic pain although they are better than most current alternatives, and it is wonderful to think that the solutions may not, ultimately, require careful management of addictive substances and their non-trivial side effects which, while better than chronic severe pain, are also no walk in the park.
That said, the article is also at pains to point out that none of that work will matter if we can't change our medical system to better incentivize actually giving any level of a shit about patients who require actual work (since apparently so many doctors won't do that on their own). Having encountered myself a fair number of doctors who seem mad that people have the temerity to get ill or need a doctor at all...I don't know what the solution to that is. Would it be solved by a decent society wherein medicine isn't ruled by profit motive? I honestly don't know.
But doctors of all stripes seem happy to throw Ozempic and its relatives at any and all people so if the treatments they're working on truly are "Ozempic but for pain," maybe it won't be an issue after all.
posted by We put our faith in Blast Hardcheese at 11:31 AM on January 12 [11 favorites]
How deeply gracious.
ANYWAY, yes, this is actually super fascinating in what they are finding and (for someone who does not work in science) how they are studying it. Opiates are not by any means a perfect, restorative solution to chronic pain although they are better than most current alternatives, and it is wonderful to think that the solutions may not, ultimately, require careful management of addictive substances and their non-trivial side effects which, while better than chronic severe pain, are also no walk in the park.
That said, the article is also at pains to point out that none of that work will matter if we can't change our medical system to better incentivize actually giving any level of a shit about patients who require actual work (since apparently so many doctors won't do that on their own). Having encountered myself a fair number of doctors who seem mad that people have the temerity to get ill or need a doctor at all...I don't know what the solution to that is. Would it be solved by a decent society wherein medicine isn't ruled by profit motive? I honestly don't know.
But doctors of all stripes seem happy to throw Ozempic and its relatives at any and all people so if the treatments they're working on truly are "Ozempic but for pain," maybe it won't be an issue after all.
posted by We put our faith in Blast Hardcheese at 11:31 AM on January 12 [11 favorites]
whats truly wild is drs prescribing these absurd nsaid regimens that do nothing for pain, wreck your stomach and damage your liver.
posted by AlbertCalavicci at 11:34 AM on January 12 [26 favorites]
posted by AlbertCalavicci at 11:34 AM on January 12 [26 favorites]
I know it's not the answer for everyone, but so many of my friends in chronic pain (and myself as well) have discovered that hypermobility was the underlying cause (or at least a major part of it). Part of why it goes undetected for so long is that every person I've talked to about this has scoffed and said they aren't hypermobile--they're stiff and tense and moving hurts, the idea that any part of them could be "too" flexible is laughable. But that's what happens, especially as you get older, with hypermobile joints--all of the muscles start to tense up to try and hold your joint in place. There's usually still clues, though (knees and elbows bending too far, for example, or thumb being able to cross the far edge of the palm, or knees touching the ground when sitting cross-legged, etc.), and basically instantly visible differences in how they move if they try out neoprene compression garments, so I've taken to occasionally just bringing it up in every new social group and I invariably find 2-3 people with unexplained chronic pain who are hypermobile and didn't know it. Many of them go on to get treatment and improve--though not eradicate--their pain. I really hope that gets more recognition, because hypermobile pain is very resistant to medication of any kind.
And for those whose problem is not this, I wish better policy and science and culture all around. Where I am, pain management clinics are so far behind every other department in patient respect and quality of healthcare it's just... appalling.
posted by brook horse at 11:35 AM on January 12 [26 favorites]
And for those whose problem is not this, I wish better policy and science and culture all around. Where I am, pain management clinics are so far behind every other department in patient respect and quality of healthcare it's just... appalling.
posted by brook horse at 11:35 AM on January 12 [26 favorites]
I have taken over the counter medication like candy, and it does absolutely fucking nothing.
I've been watching this play out with relatives in pain lately, and it matches what I used to see doing medical records for a pain clinic, where the level of suspicion was just ridiculous. You are given enough NSAIDs to drill a hole through your stomach lining, and are allowed to supplement with hepatotoxic levels of acetaminophen, but if you so much as acknowledge the existence of narcotics, you are treated as drug-seeking. (The experience with the clinic, as well as with some of my own docs, left a mark on me...I was in my late forties before I worked up the nerve to ask for tranquilizers because I was so convinced I'd be treated badly for it. (and the other day a pharmacy worker looked at it me like i was trying to rob the place when i got a refill of my ativan))
I mean, the article is great, and I'm glad alternatives to opioids are being worked on, and I'm even gladder that the mechanics of pain are being researched, and I hope that all goes really well. But there is just something psychologically wrong with a medical system that will with one hand pass out enough oxycodone to cause a major health crisis, and on the other withhold everything so people are living in pain.
posted by mittens at 11:40 AM on January 12 [32 favorites]
I've been watching this play out with relatives in pain lately, and it matches what I used to see doing medical records for a pain clinic, where the level of suspicion was just ridiculous. You are given enough NSAIDs to drill a hole through your stomach lining, and are allowed to supplement with hepatotoxic levels of acetaminophen, but if you so much as acknowledge the existence of narcotics, you are treated as drug-seeking. (The experience with the clinic, as well as with some of my own docs, left a mark on me...I was in my late forties before I worked up the nerve to ask for tranquilizers because I was so convinced I'd be treated badly for it. (and the other day a pharmacy worker looked at it me like i was trying to rob the place when i got a refill of my ativan))
I mean, the article is great, and I'm glad alternatives to opioids are being worked on, and I'm even gladder that the mechanics of pain are being researched, and I hope that all goes really well. But there is just something psychologically wrong with a medical system that will with one hand pass out enough oxycodone to cause a major health crisis, and on the other withhold everything so people are living in pain.
posted by mittens at 11:40 AM on January 12 [32 favorites]
Last summer, the company Vertex Pharmaceuticals announced that it had had promising results for a painkiller, Suzetrigine, which worked on a related channel, NaV 1.8. If approved, it will be one of the first non-opioid painkillers to reach patients in more than 20 years.As someone who's been watching the progress of that prospective med, I'm sorry to say that results released last month of a study on sciatica patients found similar results to placebo.
Vertex's pain trial hits endpoint but sinks stock as placebo comparison spooks investorsI'd be thrilled to be wrong about those doubts.
Mean NPRS [numeric pain rating scale] fell 2.02 points after 12 weeks of treatment with suzetrigine, causing the trial to meet its primary endpoint with a p-value of 0.0001. In comparison, mean NPRS fell 1.98 points after 12 weeks of treatment with placebo, meaning the trial found placebo had a statistically significant effect on pain as measured using NPRS.
Vertex didn’t design or power the trial to detect a difference between the suzetrigine and placebo arms. But the near-identical reduction in NPRS in the arms invited comparisons between the cohorts—and investors didn’t like what they saw.
posted by jocelmeow at 11:46 AM on January 12 [5 favorites]
I can't believe they wrote an entire article about chronic pain and completely missed the boat on the emerging types of evidence-based psychotherapy that have been shown, for some people at least, to actually reverse pain instead of just helping people cope with it. Instead, we get some blase references to CBT (often not very helpful for chronic pain, ends up making people feel gaslit) and a barely-visible link to Dr. John Sarno.
Please, please, if someone you care about has chronic pain or other long-term symptoms that are difficult to manage, consider looking into some of the newer modalities that can actually make a real difference. The gist of these approaches is that many people with chronic pain (but certainly not all) have brain circuits that are being activated inapporiately to generate painful sensations. This does not mean that pain isn't real or that someone is making it up - on the contrary, anyone - including doctors - who suggests that it isn't real is cruel or ignorant, or both. But the truth is that all pain is "felt" in the brain, whether it's from someone being stabbed with a knife or from shingles or arthritis or whatever. And for some people, treating chronic pain as a brain circuit issue helps a lot. (For others, of course pharmacological help or other approaches might be better.)
If you're interested...
posted by greatgefilte at 11:46 AM on January 12 [51 favorites]
Please, please, if someone you care about has chronic pain or other long-term symptoms that are difficult to manage, consider looking into some of the newer modalities that can actually make a real difference. The gist of these approaches is that many people with chronic pain (but certainly not all) have brain circuits that are being activated inapporiately to generate painful sensations. This does not mean that pain isn't real or that someone is making it up - on the contrary, anyone - including doctors - who suggests that it isn't real is cruel or ignorant, or both. But the truth is that all pain is "felt" in the brain, whether it's from someone being stabbed with a knife or from shingles or arthritis or whatever. And for some people, treating chronic pain as a brain circuit issue helps a lot. (For others, of course pharmacological help or other approaches might be better.)
If you're interested...
- "This Might Hurt - great documentary (made by a chronic pain survivor) about Dr. Howard Schubiner, one of the clinicians trying to bring these approaches into public awareness.
- The Reign of Pain - free Coursera course by Dr. Schubiner
- The Association for Treatment of Neuroplastic Symptoms
- "The Way Out," a book by Alan Gordon - focuses on Pain Reprocessing Therapy, which seems particularly useful for chronic back pain. One well-regarded study showed that 66% of patients with chronic low back pain were pain-free or nearly so after four weeks of treatment.
- Another trial looking at the effect of Emotional Awareness and Expression Therapy, again showing it to be vastly superior to CBT.
posted by greatgefilte at 11:46 AM on January 12 [51 favorites]
greatfefilte, YANMD, but would any of this work if someone has cervical spinal cord compression?
posted by headspace at 11:59 AM on January 12 [2 favorites]
posted by headspace at 11:59 AM on January 12 [2 favorites]
Pain reprocessing therapy relies on teaching people that painful activities are not injurious. This is sometimes true and sometimes not. I was trained on some version of this many times in physical therapy. Turns out it is in fact injurious to constantly overstretch your joints, and I was unable to distinguish between "good pain" (feeling the burn) and "bad pain" (injuring yourself) because every movement I made was in fact "bad pain" until I got the appropriate compression gear to prevent my joints from overstretching. I think these methods are promising for some conditions, but we need to get way better at assessment before we push them farther than we already have. (Though AFAIK emotional awareness and expression therapy doesn't focus on increasing engagement in painful activities, just handling stressors and relationship issues as someone in chronic pain, so that is probably less likely to be potentially harmful to someone experiencing a connective tissue disorder.)
posted by brook horse at 12:02 PM on January 12 [14 favorites]
posted by brook horse at 12:02 PM on January 12 [14 favorites]
jocelmeow, that’s a real shame! On top of my chronic pain, I slipped and sprained my ankle recently, hoping this stays acute and not chronic 🙏🏻
posted by ellieBOA at 12:20 PM on January 12 [2 favorites]
posted by ellieBOA at 12:20 PM on January 12 [2 favorites]
On my first stint away from the corporate world in the 2012-2016 range I worked as a massage therapist for a few years and ended up studying modern pain science for fun on the side. A decade later it is unsurprising that things have improved a bit, but not much. It's great to see a doctor in this thread who is up on this stuff though. This quote from the article:
“One of the big insights of the past decade is that chronic pain is a disorder of the central nervous system,” Gereau told me. “It has been a huge change in how we understand these conditions. Before, we were basically just mystified by persistent pain.”
Does point in the right direction but articles like these are still failing to fully grasp the core tenets of sensory experience -
Your sensory experience of your body is a product of the mind; your tissues don't "feel" like anything. They are a holographic projection in a sense. This is why people can have phantom limb pain and sensations - no limb is required to experience a limb.
Pain wise: again, as a sensory experience it is a product of the mind. Nerve input from the periphery (ie, nociceptors and others) is only one of the inputs the mind uses in its decision as to whether or not you will feel pain in a particular area. The average doctor does not know this.
Part of why pain can become chronic is that the mind learns to experience pain in a particular area. This is efficient in the same way that learning anything is efficient, creating processes in the mind dedicated to things like reading or driving. So instead of the brain spending a lot of resources reading a bunch of nociception coming in from an injured muscle in the periphery, it sets up a process that says "we experience pain here." Then at some point you're healed (usually 12 months at most) but that pain process is still in place. So part, if not all of the potential cure is unlearning what amounts to "bad" habits, like overcoming dysfunctional tools you picked up living a traumatic childhood, for example. Like all mental therapy nothing about it is straightforward or "algorithmic" the way that say something more mechanical and well understood like removing a burst appendix is.
Of course doctors with no training in this area are baffled - if the tissues are healthy, well, maybe you're just making it up. The framework and infrastructure for medicine to handle all this is still provisional at best.
I've been linking the very long article below on threads and asks like this for over a decade, looking at it today he's still editing and updating it with new info.
Pain is Weird
posted by MillMan at 12:40 PM on January 12 [12 favorites]
“One of the big insights of the past decade is that chronic pain is a disorder of the central nervous system,” Gereau told me. “It has been a huge change in how we understand these conditions. Before, we were basically just mystified by persistent pain.”
Does point in the right direction but articles like these are still failing to fully grasp the core tenets of sensory experience -
Your sensory experience of your body is a product of the mind; your tissues don't "feel" like anything. They are a holographic projection in a sense. This is why people can have phantom limb pain and sensations - no limb is required to experience a limb.
Pain wise: again, as a sensory experience it is a product of the mind. Nerve input from the periphery (ie, nociceptors and others) is only one of the inputs the mind uses in its decision as to whether or not you will feel pain in a particular area. The average doctor does not know this.
Part of why pain can become chronic is that the mind learns to experience pain in a particular area. This is efficient in the same way that learning anything is efficient, creating processes in the mind dedicated to things like reading or driving. So instead of the brain spending a lot of resources reading a bunch of nociception coming in from an injured muscle in the periphery, it sets up a process that says "we experience pain here." Then at some point you're healed (usually 12 months at most) but that pain process is still in place. So part, if not all of the potential cure is unlearning what amounts to "bad" habits, like overcoming dysfunctional tools you picked up living a traumatic childhood, for example. Like all mental therapy nothing about it is straightforward or "algorithmic" the way that say something more mechanical and well understood like removing a burst appendix is.
Of course doctors with no training in this area are baffled - if the tissues are healthy, well, maybe you're just making it up. The framework and infrastructure for medicine to handle all this is still provisional at best.
I've been linking the very long article below on threads and asks like this for over a decade, looking at it today he's still editing and updating it with new info.
Pain is Weird
posted by MillMan at 12:40 PM on January 12 [12 favorites]
greatfefilte, YANMD, but would any of this work if someone has cervical spinal cord compression?
It might...but it really depends on whether the symptoms are caused by the spinal cord compression, or if the compression is simply coincidental - there are tonnes of people with disc herniations, cord compression, etc out there who have no symptoms whatsoever, which really calls into question whether what we see on scans is the cause of the pain. as brook horse says, you can't just assume that a person's symptoms will respond to psychotherapy - you really need to do a thorough evaluation, otherwise people could seriously get hurt!
posted by greatgefilte at 1:06 PM on January 12 [4 favorites]
It might...but it really depends on whether the symptoms are caused by the spinal cord compression, or if the compression is simply coincidental - there are tonnes of people with disc herniations, cord compression, etc out there who have no symptoms whatsoever, which really calls into question whether what we see on scans is the cause of the pain. as brook horse says, you can't just assume that a person's symptoms will respond to psychotherapy - you really need to do a thorough evaluation, otherwise people could seriously get hurt!
posted by greatgefilte at 1:06 PM on January 12 [4 favorites]
brook horse:
I think these methods are promising for some conditions, but we need to get way better at assessment before we push them farther than we already have.
I can see why that's important based on your experience, but the thing is, we have the ability to do thorough assessments, but it takes the right kind of knowledge and experience, and enough time. And most practitioners don't have enough of any of those! If the training is merely to tell people to not be afraid of their pain no matter the source, you're going to get a lot of frustrated patients who get worse.
(Though AFAIK emotional awareness and expression therapy doesn't focus on increasing engagement in painful activities, just handling stressors and relationship issues as someone in chronic pain, so that is probably less likely to be potentially harmful to someone experiencing a connective tissue disorder.)
This is the interesting part - EAET and theory upon which it's based (which derives from dynamic psychotherapy) posit that the symptoms are happening because of the stressors and relationship issues, rather than the other way around. Which sounds wacky and woo-ey, and I myself was really skeptical at first, but I've seen enough from both the scientific literature and in my own practice to be convinced that there's something to this.
To wit: a patient comes to me with chronic pelvic pain, which she has been told is due to endometriosis, but it doesn't respond to any of the typical treatments we use. I do an extensive evaluation, and together we discover that she is carrying huge emotional burdens of trauma and abuse. I ask her to imagine, while sitting in a chair in my office, the one activity that exacerbates her pain like no other. She does so, and what do you know, her pain instantly gets incredibly intense just thinking about it. You can chalk it up to coincidence, but when it happens multiple times under the same degree of emotional pressure, you have to wonder, is it endometriosis causing the pain? Partially, sure, but it seems like the chronicity and intensity of it have other causes beyond just the physical cellular abnormalities in her pelvis.
But I recognize that I'm a cis/straight/white/privileged male physician, and that historically speaking many, many people have suffered from doctors like me telling others in more vulnerable positions what's wrong with them. So I implore patients not to explore this approach because I tell them to, not to believe me because I'm some kind of expert (which I'm not, at this stage), but to see for themselves if things makes sense to them viewed through a brain circuit lens, and if they feel better when we go through the process.
posted by greatgefilte at 1:24 PM on January 12 [7 favorites]
I think these methods are promising for some conditions, but we need to get way better at assessment before we push them farther than we already have.
I can see why that's important based on your experience, but the thing is, we have the ability to do thorough assessments, but it takes the right kind of knowledge and experience, and enough time. And most practitioners don't have enough of any of those! If the training is merely to tell people to not be afraid of their pain no matter the source, you're going to get a lot of frustrated patients who get worse.
(Though AFAIK emotional awareness and expression therapy doesn't focus on increasing engagement in painful activities, just handling stressors and relationship issues as someone in chronic pain, so that is probably less likely to be potentially harmful to someone experiencing a connective tissue disorder.)
This is the interesting part - EAET and theory upon which it's based (which derives from dynamic psychotherapy) posit that the symptoms are happening because of the stressors and relationship issues, rather than the other way around. Which sounds wacky and woo-ey, and I myself was really skeptical at first, but I've seen enough from both the scientific literature and in my own practice to be convinced that there's something to this.
To wit: a patient comes to me with chronic pelvic pain, which she has been told is due to endometriosis, but it doesn't respond to any of the typical treatments we use. I do an extensive evaluation, and together we discover that she is carrying huge emotional burdens of trauma and abuse. I ask her to imagine, while sitting in a chair in my office, the one activity that exacerbates her pain like no other. She does so, and what do you know, her pain instantly gets incredibly intense just thinking about it. You can chalk it up to coincidence, but when it happens multiple times under the same degree of emotional pressure, you have to wonder, is it endometriosis causing the pain? Partially, sure, but it seems like the chronicity and intensity of it have other causes beyond just the physical cellular abnormalities in her pelvis.
But I recognize that I'm a cis/straight/white/privileged male physician, and that historically speaking many, many people have suffered from doctors like me telling others in more vulnerable positions what's wrong with them. So I implore patients not to explore this approach because I tell them to, not to believe me because I'm some kind of expert (which I'm not, at this stage), but to see for themselves if things makes sense to them viewed through a brain circuit lens, and if they feel better when we go through the process.
posted by greatgefilte at 1:24 PM on January 12 [7 favorites]
After years of worsening pain in my neck and shoulders, last year it was confirmed that I have severe stenosis in my cervical region. I'm fighting the idea of epidural injection. Doc's pretty sure fracturing 3 lumbar vertebrae resulting in rods and screws isn't helping my upper back, either.
I recently went in with an arthritis flareup that was almost incapacitating, and after testing, oh joy, it's not just old-age beat-myself-up regular arthritis, it's psoriatic arthritis. Doc says the immune issues may also explain my iffy aching gut.
I'm a pretty tough broad, but this is getting old. On a scale of one to ten what's my pain level? Crap, how do I answer that? Some days better, some days worse, but there's always pain. I recently had an evaluation with a pain specialist, and he said I'm one of the best blockers and bracers he's ever run into. Just one little poke, and I can go into muscle spasms, which certainly doesn't help. I am exhausted just bracing against pain to do the things I need to do. I've tried gabapentin, tramadol, cyclobenzaprine, tranquilizers, psychotropics.... I'm so sick of stuff that either doesn't work or has really sucky side effects. I wish I could take NASIDS, because they actually work a bit, but with blood thinners, that's out. Meanwhile, as mittens mentions, I'm allowed to supplement with hepatotoxic levels of acetaminophen, and the insurance thinks that's just dandy. PT's been useful, and it's good to know how to move so as not to exacerbate issues, but what really works for pain is massage and myofascial release. It's a total relief for muscles, joints, and mood. Not covered. I'd be more than willing to do CBT or some other psychotherapy. Insurance will pay for a bit, but ha ha, try to get in. The pain doc put my name down and said there's a six year wait list.
Just last week my doc said it's time to pull out the big guns because I'm not sleeping, so she's prescribed Norco. She apologized because it will take a while to be approved--because of my age! She's livid. Apparently if you're younger it's easier to get, because there's nothing worse than old people being able to sleep at night without pain. Buncha addicts.
But doctors of all stripes seem happy to throw Ozempic and its relatives at any and all people...
Blast hardcheese, that feels pretty dismissive and contemptuous to those of us who are fighting insurance to be allowed to try semaglutide or tirzepatide for actual health reasons. I've been fighting being overweight for over 30 years. I put weight on during a period of severe depression and while trying to find a bipolar med that worked. WeightWatchers, nutritionist, gym memberships haven't worked. My ejection fraction is down 15%. Adult-onset asthma has knocked me down. Carrying more weight doesn't help my aching joints. I don't care about my dress size, I just want to be able to move and exercise easier to keep functioning. My heart doc, my pulmonologist, my pain doc, and my primary are all going to bat for me, and I'm just hoping it goes through. Then I have to worry about side effects and whether or not it will work. Let me reference what kittens said and put a twist on it: I'm sorry that selfish people want to take drugs just to be fashionable, but I don't see why that should be my problem.
posted by BlueHorse at 1:34 PM on January 12 [11 favorites]
I recently went in with an arthritis flareup that was almost incapacitating, and after testing, oh joy, it's not just old-age beat-myself-up regular arthritis, it's psoriatic arthritis. Doc says the immune issues may also explain my iffy aching gut.
I'm a pretty tough broad, but this is getting old. On a scale of one to ten what's my pain level? Crap, how do I answer that? Some days better, some days worse, but there's always pain. I recently had an evaluation with a pain specialist, and he said I'm one of the best blockers and bracers he's ever run into. Just one little poke, and I can go into muscle spasms, which certainly doesn't help. I am exhausted just bracing against pain to do the things I need to do. I've tried gabapentin, tramadol, cyclobenzaprine, tranquilizers, psychotropics.... I'm so sick of stuff that either doesn't work or has really sucky side effects. I wish I could take NASIDS, because they actually work a bit, but with blood thinners, that's out. Meanwhile, as mittens mentions, I'm allowed to supplement with hepatotoxic levels of acetaminophen, and the insurance thinks that's just dandy. PT's been useful, and it's good to know how to move so as not to exacerbate issues, but what really works for pain is massage and myofascial release. It's a total relief for muscles, joints, and mood. Not covered. I'd be more than willing to do CBT or some other psychotherapy. Insurance will pay for a bit, but ha ha, try to get in. The pain doc put my name down and said there's a six year wait list.
Just last week my doc said it's time to pull out the big guns because I'm not sleeping, so she's prescribed Norco. She apologized because it will take a while to be approved--because of my age! She's livid. Apparently if you're younger it's easier to get, because there's nothing worse than old people being able to sleep at night without pain. Buncha addicts.
But doctors of all stripes seem happy to throw Ozempic and its relatives at any and all people...
Blast hardcheese, that feels pretty dismissive and contemptuous to those of us who are fighting insurance to be allowed to try semaglutide or tirzepatide for actual health reasons. I've been fighting being overweight for over 30 years. I put weight on during a period of severe depression and while trying to find a bipolar med that worked. WeightWatchers, nutritionist, gym memberships haven't worked. My ejection fraction is down 15%. Adult-onset asthma has knocked me down. Carrying more weight doesn't help my aching joints. I don't care about my dress size, I just want to be able to move and exercise easier to keep functioning. My heart doc, my pulmonologist, my pain doc, and my primary are all going to bat for me, and I'm just hoping it goes through. Then I have to worry about side effects and whether or not it will work. Let me reference what kittens said and put a twist on it: I'm sorry that selfish people want to take drugs just to be fashionable, but I don't see why that should be my problem.
posted by BlueHorse at 1:34 PM on January 12 [11 favorites]
To wit: a patient comes to me with chronic pelvic pain, which she has been told is due to endometriosis, but it doesn't respond to any of the typical treatments we use. I do an extensive evaluation, and together we discover that she is carrying huge emotional burdens of trauma and abuse.
That's great. I'm glad you were able to help that patient. Here's my experience--I go to a rheumatologist describing (what I now know to be) all the classic symptoms of ankylosing spondylitis. But he just sees a young, healthy looking woman, so he tells me my symptoms must be because I have PTSD from trauma such as sexual assault. Except I have no such trauma. Luckily, I was able to get another referral to a young, female rheumatologist who recognized my symptoms as AS and got me the proper treatment. Which is biologic drugs, not psychotherapy.
posted by hydropsyche at 1:59 PM on January 12 [21 favorites]
That's great. I'm glad you were able to help that patient. Here's my experience--I go to a rheumatologist describing (what I now know to be) all the classic symptoms of ankylosing spondylitis. But he just sees a young, healthy looking woman, so he tells me my symptoms must be because I have PTSD from trauma such as sexual assault. Except I have no such trauma. Luckily, I was able to get another referral to a young, female rheumatologist who recognized my symptoms as AS and got me the proper treatment. Which is biologic drugs, not psychotherapy.
posted by hydropsyche at 1:59 PM on January 12 [21 favorites]
Narcotic pain treatment for legitimate pain sufferers is a victim the war between drug-war enforcers and drug-seekers.
Drug-seekers are highly motivated to scam Rxs and regulators and lawyers are perfectly happy to throw to the wolves doctors who get scammed, because they are still angry about the spectacular malfeasance throughout the health care system that led to the opioid crisis.
The worst part is that drug-seeking is quite advanced in strategy. The smart ones -- who are just likely to be sourcing drugs for resale as they are to be addicts -- no longer ask for drugs. They simply present a profile that is precisely qualified for narcotics Rx under traditional standards, and they'll get one every so often without even asking.
posted by MattD at 2:06 PM on January 12 [2 favorites]
Drug-seekers are highly motivated to scam Rxs and regulators and lawyers are perfectly happy to throw to the wolves doctors who get scammed, because they are still angry about the spectacular malfeasance throughout the health care system that led to the opioid crisis.
The worst part is that drug-seeking is quite advanced in strategy. The smart ones -- who are just likely to be sourcing drugs for resale as they are to be addicts -- no longer ask for drugs. They simply present a profile that is precisely qualified for narcotics Rx under traditional standards, and they'll get one every so often without even asking.
posted by MattD at 2:06 PM on January 12 [2 favorites]
we have the ability to do thorough assessments, but it takes the right kind of knowledge and experience, and enough time. And most practitioners don't have enough of any of those!
I mean, yes, this is what I mean by getting much better at assessments. :) For example, the Beighton screening test for hypermobility is well established in the literature as having poor validity. I've had probably six or seven Beighton screens in the past ten years--prior to my JHS diagnosis every PT I saw (and my neurologist every 3 years or so when he'd forgotten he'd previously done this) squinted at me and asked me to do the Beighton. The conclusion was that I was just "a little hypermobile" and this warranted no further assessment, until I brought it to my amazing advocate of a PCP who happened to know a physical medicine doctor who specialized in it. I only ended up doing this because I read an article about how underdiagnosed and easily missed this condition is; I had accepted the previous declarations that my hypermobility was not the cause of my pain and I just needed to get better at doing my PT and improving my relationship to pain.
This is the interesting part - EAET and theory upon which it's based (which derives from dynamic psychotherapy) posit that the symptoms are happening because of the stressors and relationship issues, rather than the other way around.
...
is it endometriosis causing the pain? Partially, sure, but it seems like the chronicity and intensity of it have other causes beyond just the physical cellular abnormalities in her pelvis.
These two statements contradict each other. If it's positing that she has endometriosis but her relationships and stressors significantly exacerbate the intensity and chronic nature of the pain... yeah? That's a very old psychological theory. In fact the basic diagnosis of PTSD would support this for most forms of chronic pain, as tension and increased reactivity in the body is a symptom of PTSD and treatment of the PTSD would result in improvement of physical tension and reactivity and, for many people, subsequent improvement in pain--regardless of the underlying issue triggering the pain.
If it's saying that that the endometriosis was caused by the abuse/trauma, or that she doesn't have endometriosis at all, that's entirely different.
posted by brook horse at 2:12 PM on January 12 [3 favorites]
I mean, yes, this is what I mean by getting much better at assessments. :) For example, the Beighton screening test for hypermobility is well established in the literature as having poor validity. I've had probably six or seven Beighton screens in the past ten years--prior to my JHS diagnosis every PT I saw (and my neurologist every 3 years or so when he'd forgotten he'd previously done this) squinted at me and asked me to do the Beighton. The conclusion was that I was just "a little hypermobile" and this warranted no further assessment, until I brought it to my amazing advocate of a PCP who happened to know a physical medicine doctor who specialized in it. I only ended up doing this because I read an article about how underdiagnosed and easily missed this condition is; I had accepted the previous declarations that my hypermobility was not the cause of my pain and I just needed to get better at doing my PT and improving my relationship to pain.
This is the interesting part - EAET and theory upon which it's based (which derives from dynamic psychotherapy) posit that the symptoms are happening because of the stressors and relationship issues, rather than the other way around.
...
is it endometriosis causing the pain? Partially, sure, but it seems like the chronicity and intensity of it have other causes beyond just the physical cellular abnormalities in her pelvis.
These two statements contradict each other. If it's positing that she has endometriosis but her relationships and stressors significantly exacerbate the intensity and chronic nature of the pain... yeah? That's a very old psychological theory. In fact the basic diagnosis of PTSD would support this for most forms of chronic pain, as tension and increased reactivity in the body is a symptom of PTSD and treatment of the PTSD would result in improvement of physical tension and reactivity and, for many people, subsequent improvement in pain--regardless of the underlying issue triggering the pain.
If it's saying that that the endometriosis was caused by the abuse/trauma, or that she doesn't have endometriosis at all, that's entirely different.
posted by brook horse at 2:12 PM on January 12 [3 favorites]
For a few years, I’ve been putting off having a surgery I need because I’m afraid that the surgeon will not take help me manage my pain during recovery. This affects my quality of life every day but I’m afraid of the pain so shrug emoji.
posted by prefpara at 2:19 PM on January 12 [4 favorites]
posted by prefpara at 2:19 PM on January 12 [4 favorites]
@prepfara:
I have joint issues and I just keep praying the pendulum swings before I injure myself again. I’m aware I might dangerously put off treatment to avoid extra untreatable pain. A friend got sent home from her-section with just advil, so my faith in medical concern for pain is not high.
posted by vim876 at 2:34 PM on January 12 [1 favorite]
I have joint issues and I just keep praying the pendulum swings before I injure myself again. I’m aware I might dangerously put off treatment to avoid extra untreatable pain. A friend got sent home from her-section with just advil, so my faith in medical concern for pain is not high.
posted by vim876 at 2:34 PM on January 12 [1 favorite]
The worst part is that drug-seeking is quite advanced in strategy. The smart ones -- who are just likely to be sourcing drugs for resale as they are to be addicts -- no longer ask for drugs. They simply present a profile that is precisely qualified for narcotics Rx under traditional standards, and they'll get one every so often without even asking.
This is totally the liberal version of talking about welfare queens. I am not sure why there is such a political investment in this narrative.
posted by kittens for breakfast at 2:36 PM on January 12 [11 favorites]
This is totally the liberal version of talking about welfare queens. I am not sure why there is such a political investment in this narrative.
posted by kittens for breakfast at 2:36 PM on January 12 [11 favorites]
hydropsyche: I'm sorry, that sounds like such a shitty experience for you to have to go through. I come from the primary care world and it's no secret that specialists, especially the antiquated sexist/patriarchal types, often have such a narrow view of what it means to practice medicine that they lose sight of the person in front of them and just make assumptions about how they want things to be, rather than how things are. But sometimes even the folks we hope are going to be understanding and actually pay attention aren't any better. I had to get into this myself with a rheumatologist recently, when I saw a patient (a young woman) who I believed to have a rare inflammatory condition that was causing her significant pain, and tried referring her to a rheumatologist I know (a young woman), only to be told, "Oh, no, that doesn't sound like [condition x], she probably just had a weird reaction to a viral infection." I treated her for condition x, she got better, and I referred her to a different rheumatologist, who concurred with the diagnosis.
When it comes to recommending psychotherapy, the key is do a thorough assessment and make sure you've really crossed your t's and dotted your i's before you attribute something to brain circuits, lest something truly medical be missed. Otherwise we're doing no better than the dismissive assholes who have colonized medicine for so long.
posted by greatgefilte at 2:56 PM on January 12 [6 favorites]
When it comes to recommending psychotherapy, the key is do a thorough assessment and make sure you've really crossed your t's and dotted your i's before you attribute something to brain circuits, lest something truly medical be missed. Otherwise we're doing no better than the dismissive assholes who have colonized medicine for so long.
posted by greatgefilte at 2:56 PM on January 12 [6 favorites]
brook horse: If it's saying that that the endometriosis was caused by the abuse/trauma, or that she doesn't have endometriosis at all, that's entirely different.
You're right, I was not precise. I'm not suggesting that emotional stress causes endometriosis, and I don't think anyone is. However, the question is, even if there is endometriosis present, to what degree is it responsible for pain, vs being an incidental bystander that might cause some symptoms, but not the ones that are most disabling. This is different from saying that stress exacerbates a physical cause of pain; it suggests that stress causes pain in a distinct manner from the ascribed physical cause.
I try to always ask people to be introspective and examine what they risk by considering the possibility that their symptoms are brain-based. Often times people have fought tooth and nail to get a diagnosis for their pain after being dismissed again and again, by both medical professionals as well as family members or friends or partners. And I respect that, because we all have people in our lives who make us feel small and unworthy and not deserving of a break, and no one should have their pain ignored or diminished. In the end, though, if there's a possibility of reversing a person's symptoms, it's really up to each and every patient to determine if it's worth it for them to go down that path and see if it helps, at the cost of giving up the label and the diagnosis. That's not a decision that I can ever make for someone else.
posted by greatgefilte at 3:10 PM on January 12 [2 favorites]
You're right, I was not precise. I'm not suggesting that emotional stress causes endometriosis, and I don't think anyone is. However, the question is, even if there is endometriosis present, to what degree is it responsible for pain, vs being an incidental bystander that might cause some symptoms, but not the ones that are most disabling. This is different from saying that stress exacerbates a physical cause of pain; it suggests that stress causes pain in a distinct manner from the ascribed physical cause.
I try to always ask people to be introspective and examine what they risk by considering the possibility that their symptoms are brain-based. Often times people have fought tooth and nail to get a diagnosis for their pain after being dismissed again and again, by both medical professionals as well as family members or friends or partners. And I respect that, because we all have people in our lives who make us feel small and unworthy and not deserving of a break, and no one should have their pain ignored or diminished. In the end, though, if there's a possibility of reversing a person's symptoms, it's really up to each and every patient to determine if it's worth it for them to go down that path and see if it helps, at the cost of giving up the label and the diagnosis. That's not a decision that I can ever make for someone else.
posted by greatgefilte at 3:10 PM on January 12 [2 favorites]
Definitely [[NOT]] a recommendation: I have suffered from chronic pain for over a decade from a spinal cord injury. And, more recently, I have also enjoyed the pleasures of Long COVID. I also have 30+ years in the bar business. Therefore, ethyl alcohol was something I felt I should explore. It is well known as an effective depressant. Beer proved far too dilute and hard spirits far too difficult to measure and control. But white wine, specifically Chardonnay, seemed to be a sweet spot. Flavorful, meant for sipping slowly and big-box affordable. And yes, alcohol can have significant downsides but be sure to read the tiny, tiny print on your prescriptions as well. As I like to mention, humanity has thousands of years of experience with alcohol and we're still here... YMMV
posted by jim in austin at 3:10 PM on January 12 [6 favorites]
posted by jim in austin at 3:10 PM on January 12 [6 favorites]
Yeah, a friend of mine used to dope his meds with alcohol after being run over by several cars.
Be careful mentioning this to a doctor. They've typically never been run over by cars or similar, and will have a decidedly negative response.
I've heard that they'll yammer on about various extraneous psych "solutions".
Wouldn't personally know, either way.
posted by pdoege at 3:32 PM on January 12 [5 favorites]
Be careful mentioning this to a doctor. They've typically never been run over by cars or similar, and will have a decidedly negative response.
I've heard that they'll yammer on about various extraneous psych "solutions".
Wouldn't personally know, either way.
posted by pdoege at 3:32 PM on January 12 [5 favorites]
Have people suffering with chronic or severe pain simply tried not being in pain, or a heating pad
posted by Ray Walston, Luck Dragon at 3:44 PM on January 12 [12 favorites]
posted by Ray Walston, Luck Dragon at 3:44 PM on January 12 [12 favorites]
Blast hardcheese, that feels pretty dismissive and contemptuous to those of us who are fighting insurance to be allowed to try semaglutide or tirzepatide for actual health reasons.
Where did I say anything about insurance in my comment? I said that doctors seem happy to prescribe GLP-1 type drugs for a wide variety of situations. And I think it is EXCELLENT that doctors have decided they should prescribe a drug that works to anyone who has a condition it might work for.
And you describe all your doctors as...being willing to prescribe a drug that works. I think it is monstrous that the insurance industry and other factors make those working drugs inaccessible. So I am not sure where anything I said dismisses you? Insurance isn't refusing to cover your drug because they want to cover it for celebrities losing 10 lbs. They are refusing because refusing coverage is what they do.
posted by We put our faith in Blast Hardcheese at 3:45 PM on January 12 [2 favorites]
Where did I say anything about insurance in my comment? I said that doctors seem happy to prescribe GLP-1 type drugs for a wide variety of situations. And I think it is EXCELLENT that doctors have decided they should prescribe a drug that works to anyone who has a condition it might work for.
And you describe all your doctors as...being willing to prescribe a drug that works. I think it is monstrous that the insurance industry and other factors make those working drugs inaccessible. So I am not sure where anything I said dismisses you? Insurance isn't refusing to cover your drug because they want to cover it for celebrities losing 10 lbs. They are refusing because refusing coverage is what they do.
posted by We put our faith in Blast Hardcheese at 3:45 PM on January 12 [2 favorites]
However, the question is, even if there is endometriosis present, to what degree is it responsible for pain, vs being an incidental bystander that might cause some symptoms, but not the ones that are most disabling. This is different from saying that stress exacerbates a physical cause of pain; it suggests that stress causes pain in a distinct manner from the ascribed physical cause.
Ah, so you’re saying “you do have this condition but it’s not responsible for (some/most of/any of) the pain,” that clarifies it.
Yes, stress can cause all sorts of weird symptoms unconnected to the expected physical cause, for sure. I typically explain it as “your brain has been sending out ‘we’re in danger’ signals (the typical symptoms of stress) for ages, but it hasn’t helped get you out of the stressful situation, so now it’s started flipping random switches to get your attention (the unexplained pain/numbness/seizures/etc.)” or something along those lines, when appropriate.
I guess I’m confused—I don’t know a single person with chronic pain who hasn’t been offered this as an explanation and treatment option. Not necessarily specifically EAET, so maybe there’s something unique about that I’m not getting (your description of it as kind of woo made me expect something more than “stress can cause physical symptoms unconnected to disease and treating the stress can alleviate those symptoms” which is where the original confusion stemmed) but this is standard for pain that has been designated as somatoform/FND. Which is a label (whether official or not) that everyone I know with chronic pain has been given before.
Is it the answer for some people? Sure. But is already the favorite recommendation of doctors treating chronic pain, at least where I live. Often without making an appropriately comprehensive assessment—because if it’s brain-based, they get to refer to psych instead and it’s our job to figure it out now. And if that psych isn’t familiar with how the medical industry treats chronic pain, they’ll probably assume that a thorough assessment has already been made. Just as an example, I had a patient with unexplained genital area pain that had been told it was related to their history of sexual assault. Turned out to be a fragrance sensitivity and switching to fragrance-free soap fixed it. Not pain specific, but another patient with severe years-long low mood hadn’t had any blood panels in equally as long; turns out they had Vit D deficiency severe enough to cause rickets. I didn’t initially question the MD’s conclusions when these patients were referred to me for therapy, but then started piecing things together based on comments they had made and dug into their medical assessment history to find they basically hadn’t had any.
I have had one or two patients where at least some of the symptoms are likely somatoform—we’ve had conversations about that which have gone well. But I’ve had way, way more who haven’t received any kind of adequate assessment before being funneled to psych. Which is why I think, yes, these treatments are helpful for some people but shouldn’t be pushed any further than they have been without medical getting a lot better at assessment. The balance is already on “more harm than good” in my experience as someone who has provided therapy for a lot of chronically ill folks. This does not mean the treatments are bad, but that they’re already used inappropriately and I don’t think marketing them more will reach the people that they would actually help, but they will be used against folks who need actual medical assessment and treatment.
Obviously, my sample is biased as I’m the person who sees the folks MDs refer for stuff like this. But the fact that I’ve gotten a lot of referrals along these lines and only found a few truly somatoform cases suggests to me it isn’t being utilized appropriately. I mean, it’s nice that I can do the psych assessment piece and go “yeah I don’t think this is a somatoform thing” but it wastes a lot of patients’ time (especially when the waitlist to get back in to see the doctor is so long) and most psychs do not have the background I do that lets me review their medical history with a critical eye, which can result in accepting the doctor’s “assessment” at face value and mistreating.
posted by brook horse at 4:39 PM on January 12 [10 favorites]
Ah, so you’re saying “you do have this condition but it’s not responsible for (some/most of/any of) the pain,” that clarifies it.
Yes, stress can cause all sorts of weird symptoms unconnected to the expected physical cause, for sure. I typically explain it as “your brain has been sending out ‘we’re in danger’ signals (the typical symptoms of stress) for ages, but it hasn’t helped get you out of the stressful situation, so now it’s started flipping random switches to get your attention (the unexplained pain/numbness/seizures/etc.)” or something along those lines, when appropriate.
I guess I’m confused—I don’t know a single person with chronic pain who hasn’t been offered this as an explanation and treatment option. Not necessarily specifically EAET, so maybe there’s something unique about that I’m not getting (your description of it as kind of woo made me expect something more than “stress can cause physical symptoms unconnected to disease and treating the stress can alleviate those symptoms” which is where the original confusion stemmed) but this is standard for pain that has been designated as somatoform/FND. Which is a label (whether official or not) that everyone I know with chronic pain has been given before.
Is it the answer for some people? Sure. But is already the favorite recommendation of doctors treating chronic pain, at least where I live. Often without making an appropriately comprehensive assessment—because if it’s brain-based, they get to refer to psych instead and it’s our job to figure it out now. And if that psych isn’t familiar with how the medical industry treats chronic pain, they’ll probably assume that a thorough assessment has already been made. Just as an example, I had a patient with unexplained genital area pain that had been told it was related to their history of sexual assault. Turned out to be a fragrance sensitivity and switching to fragrance-free soap fixed it. Not pain specific, but another patient with severe years-long low mood hadn’t had any blood panels in equally as long; turns out they had Vit D deficiency severe enough to cause rickets. I didn’t initially question the MD’s conclusions when these patients were referred to me for therapy, but then started piecing things together based on comments they had made and dug into their medical assessment history to find they basically hadn’t had any.
I have had one or two patients where at least some of the symptoms are likely somatoform—we’ve had conversations about that which have gone well. But I’ve had way, way more who haven’t received any kind of adequate assessment before being funneled to psych. Which is why I think, yes, these treatments are helpful for some people but shouldn’t be pushed any further than they have been without medical getting a lot better at assessment. The balance is already on “more harm than good” in my experience as someone who has provided therapy for a lot of chronically ill folks. This does not mean the treatments are bad, but that they’re already used inappropriately and I don’t think marketing them more will reach the people that they would actually help, but they will be used against folks who need actual medical assessment and treatment.
Obviously, my sample is biased as I’m the person who sees the folks MDs refer for stuff like this. But the fact that I’ve gotten a lot of referrals along these lines and only found a few truly somatoform cases suggests to me it isn’t being utilized appropriately. I mean, it’s nice that I can do the psych assessment piece and go “yeah I don’t think this is a somatoform thing” but it wastes a lot of patients’ time (especially when the waitlist to get back in to see the doctor is so long) and most psychs do not have the background I do that lets me review their medical history with a critical eye, which can result in accepting the doctor’s “assessment” at face value and mistreating.
posted by brook horse at 4:39 PM on January 12 [10 favorites]
Of course, if anyone wants to look into this treatment for themselves I don’t see anything wrong with that—just that all of the people I know socially (I’m excluding the professional stuff for obvious sampling bias) with chronic pain have already been suggested some version of “your pain is caused by stress/trauma so let’s treat the stress/trauma to treat the pain,” so I’m struggling to see what’s new about these methods that will meaningfully help people who have been failed by the pain management system.
posted by brook horse at 4:54 PM on January 12 [3 favorites]
posted by brook horse at 4:54 PM on January 12 [3 favorites]
Just sharing my own experiences in response to the article -
I've had an experience exactly similar to the writer, a kind of sharp, electric shock pain through one arm that was incapacitating. During an attack the muscles and tendons would spasm and writhe under the skin. Scans were done but showed nothing wrong. A physiotherapist said here was nothing physically wrong. I couldn't change gears in my vehicle, I had to reach around with my other hand, at least I drove an automatic. I had to type with one hand at work, and my work productivity dropped. I stopped cooking and ate out every night. I learned to play video games with one hand.
And contrast this to - at the same time - having surgery under general anesthesia on my neck - and basically going, I don't need post-operative pain relief for my neck, but is there a way to fix my arm please? Which is to say, I'm pretty sure I have a high pain tolerance.
The pain relief drugs we have aren't great for chronic pain. Paracetamol is on par with placebo - here's one which covers 10 controlled trials but if you go through the literature they all largely point in the same direction. NSAIDs like ibuprofen have their own risks - GI issues, MI risk, stroke, etc, so you wouldn't take them if the pain is manageable. I can't even take NSAIDS because my eyelids swell up and make it hard to see, I'm basically allergic to them. And if you exclude those, you are left with opioids, which are even worse.
I had a headache that was quite severe for a period of about a month (unfortunately I was travelling for work), I spoke to a doctor when I got back and he said that it is most likely muscle related referred pain, and unfortunately treating it is difficult - some patients suffer from it for years and years and it can be quite debilitating. Persuading the trapezius muscle to relax (and not spasm) isn't easy. Treatment goes from ergonomics, massage, hot packs, sleep hygiene, reduced stress, then as a last resort a muscle relaxant like Norgesic or something in the Valium class of drugs to help patients relax. But you can see how the feedback loop intensifies it: you tense up in response to pain, which further aggravates the muscle that is causing the pain. You're anxious and stressed because you're anticipating pain, which tenses you up, which aggravates the muscle. I ended up self treating - relaxing into the pain when an attack came instead of tensing up, and just feeling reassured that there was nothing really wrong with me, and the pain got better and eventually disappeared after 2 weeks.
As for my arm/ hand issue, the physiotherapist showed me a set of exercises which were perfectly safe, reassured me that there was nothing wrong with my hand, that it was still strong and powerful. A bit like grasping a nettle firmly, performing those daily tasks without expecting pain, without fearing pain, actually significantly reduced its impact - it's like, the pain is still there, but it mattered less, and then later the pain reduced and went away entirely, after being a disabling issue for about 4 months.
posted by xdvesper at 5:00 PM on January 12 [5 favorites]
I've had an experience exactly similar to the writer, a kind of sharp, electric shock pain through one arm that was incapacitating. During an attack the muscles and tendons would spasm and writhe under the skin. Scans were done but showed nothing wrong. A physiotherapist said here was nothing physically wrong. I couldn't change gears in my vehicle, I had to reach around with my other hand, at least I drove an automatic. I had to type with one hand at work, and my work productivity dropped. I stopped cooking and ate out every night. I learned to play video games with one hand.
And contrast this to - at the same time - having surgery under general anesthesia on my neck - and basically going, I don't need post-operative pain relief for my neck, but is there a way to fix my arm please? Which is to say, I'm pretty sure I have a high pain tolerance.
The pain relief drugs we have aren't great for chronic pain. Paracetamol is on par with placebo - here's one which covers 10 controlled trials but if you go through the literature they all largely point in the same direction. NSAIDs like ibuprofen have their own risks - GI issues, MI risk, stroke, etc, so you wouldn't take them if the pain is manageable. I can't even take NSAIDS because my eyelids swell up and make it hard to see, I'm basically allergic to them. And if you exclude those, you are left with opioids, which are even worse.
I had a headache that was quite severe for a period of about a month (unfortunately I was travelling for work), I spoke to a doctor when I got back and he said that it is most likely muscle related referred pain, and unfortunately treating it is difficult - some patients suffer from it for years and years and it can be quite debilitating. Persuading the trapezius muscle to relax (and not spasm) isn't easy. Treatment goes from ergonomics, massage, hot packs, sleep hygiene, reduced stress, then as a last resort a muscle relaxant like Norgesic or something in the Valium class of drugs to help patients relax. But you can see how the feedback loop intensifies it: you tense up in response to pain, which further aggravates the muscle that is causing the pain. You're anxious and stressed because you're anticipating pain, which tenses you up, which aggravates the muscle. I ended up self treating - relaxing into the pain when an attack came instead of tensing up, and just feeling reassured that there was nothing really wrong with me, and the pain got better and eventually disappeared after 2 weeks.
As for my arm/ hand issue, the physiotherapist showed me a set of exercises which were perfectly safe, reassured me that there was nothing wrong with my hand, that it was still strong and powerful. A bit like grasping a nettle firmly, performing those daily tasks without expecting pain, without fearing pain, actually significantly reduced its impact - it's like, the pain is still there, but it mattered less, and then later the pain reduced and went away entirely, after being a disabling issue for about 4 months.
posted by xdvesper at 5:00 PM on January 12 [5 favorites]
brook horse: I guess I’m confused—I don’t know a single person with chronic pain who hasn’t been offered this as an explanation and treatment option. Not necessarily specifically EAET, so maybe there’s something unique about that I’m not getting (your description of it as kind of woo made me expect something more than “stress can cause physical symptoms unconnected to disease and treating the stress can alleviate those symptoms” which is where the original confusion stemmed) but this is standard for pain that has been designated as somatoform/FND. Which is a label (whether official or not) that everyone I know with chronic pain has been given before.
Things must be very different where you are! I can only speak for how things are taught/practiced on the medical side of things, but here there is virtually no recognition, at least in primary care, that there are effective psychological treatment protocols for chronic pain. Sure, we learn about "hurt =/= harm" and trying to get people to not see their pain as dangerous, but there's never a recognition that the pain is brain-based. Instead, we start from the assumption that the pain is being generated wherever it's being felt, and all our recommendations flow from that.
EAET and similar treatments are, I would say, very different from pain reprocessing and other more cognitive techniques because it allows people to actually find and experience the unconscious feelings/impulses that may be driving their symptoms and bring them out into the open, where they can be confronted and dealt with rather than being avoided. The way I usually describe it is that (as you've alluded to) pain is a signal that you need to do something different. If you grab a hot pan on the stove, pain is a signal to drop it. But if you have chronic pain without an obvious stimulus, it may be a signal that you're being hurt in another way (e.g. emotionally) and that you need to do something about it (e.g. experience the emotions associated with that hurt, and do something positive, like speaking up and setting better boundaries with the people doing the hurting - when that's actually possible). The difficulty is that we often learn to hide or defend ourselves against these unconscious feelings from a very young age, for good reason - they can be utterly terrifying and overwhelming for a young child. This is where it starts to get into more psychoanalytic territory, but unlike classical Freudian woo, this approach is heavily researched and is being validated more and more as time goes by. (Here is a list of studies supporting EAET and related treatments.)
posted by greatgefilte at 6:25 PM on January 12 [1 favorite]
Things must be very different where you are! I can only speak for how things are taught/practiced on the medical side of things, but here there is virtually no recognition, at least in primary care, that there are effective psychological treatment protocols for chronic pain. Sure, we learn about "hurt =/= harm" and trying to get people to not see their pain as dangerous, but there's never a recognition that the pain is brain-based. Instead, we start from the assumption that the pain is being generated wherever it's being felt, and all our recommendations flow from that.
EAET and similar treatments are, I would say, very different from pain reprocessing and other more cognitive techniques because it allows people to actually find and experience the unconscious feelings/impulses that may be driving their symptoms and bring them out into the open, where they can be confronted and dealt with rather than being avoided. The way I usually describe it is that (as you've alluded to) pain is a signal that you need to do something different. If you grab a hot pan on the stove, pain is a signal to drop it. But if you have chronic pain without an obvious stimulus, it may be a signal that you're being hurt in another way (e.g. emotionally) and that you need to do something about it (e.g. experience the emotions associated with that hurt, and do something positive, like speaking up and setting better boundaries with the people doing the hurting - when that's actually possible). The difficulty is that we often learn to hide or defend ourselves against these unconscious feelings from a very young age, for good reason - they can be utterly terrifying and overwhelming for a young child. This is where it starts to get into more psychoanalytic territory, but unlike classical Freudian woo, this approach is heavily researched and is being validated more and more as time goes by. (Here is a list of studies supporting EAET and related treatments.)
posted by greatgefilte at 6:25 PM on January 12 [1 favorite]
This does not mean the treatments are bad, but that they’re already used inappropriately and I don’t think marketing them more will reach the people that they would actually help, but they will be used against folks who need actual medical assessment and treatment.
Agreed 100%. Proponents of EAET make this very, very clear - thorough assessment first, then start treatment, and always be ready to revisit the diagnosis of things change or treatment is not going as planned.
posted by greatgefilte at 6:35 PM on January 12
Agreed 100%. Proponents of EAET make this very, very clear - thorough assessment first, then start treatment, and always be ready to revisit the diagnosis of things change or treatment is not going as planned.
posted by greatgefilte at 6:35 PM on January 12
I was walking on a broken foot for five days because the pain was not worse than a severe migraine, which is how I learned that evaluating everything against sepsis is not a useful marker (sepsis is worse than childbirth for sure). I have had chronic pain for so long that I can't trust my own evaluation of pain and have to use logic and other people's opinions for when to seek medical help - the DOD incapacitating scale is super helpful because it turns out so many vets have chronic pain too.
Chronic pain just steals so much time. Like, if I had to choose between giving up a decade of my life for no pain, I'd make that swap immediately. I've finally gotten back on the migraine preventative that works (amivog!) due to a paperwork delay of seven months and it's just easily an extra 3-5 hours a day back.
I wish doctors would have explained early on more about opiates. I've been stable on the same dose of opiates for over a decade and put myself through needless anxiety and pain by not knowing what an addiction looked like - escalating doses and needing it even when the pain was low. My doctor was able to reassure me that I was taking them at a reasonable rate and walk me through signs of over-reliance because 'helpful' people who of course had no chronic pain experience were warning me about my painkillers and recommending I reduce them in case I became an addict. I'm still so mad at them.
posted by dorothyisunderwood at 7:13 PM on January 12 [12 favorites]
Chronic pain just steals so much time. Like, if I had to choose between giving up a decade of my life for no pain, I'd make that swap immediately. I've finally gotten back on the migraine preventative that works (amivog!) due to a paperwork delay of seven months and it's just easily an extra 3-5 hours a day back.
I wish doctors would have explained early on more about opiates. I've been stable on the same dose of opiates for over a decade and put myself through needless anxiety and pain by not knowing what an addiction looked like - escalating doses and needing it even when the pain was low. My doctor was able to reassure me that I was taking them at a reasonable rate and walk me through signs of over-reliance because 'helpful' people who of course had no chronic pain experience were warning me about my painkillers and recommending I reduce them in case I became an addict. I'm still so mad at them.
posted by dorothyisunderwood at 7:13 PM on January 12 [12 favorites]
greatgefilte: Yeah, I took a look at your profile and if it's still accurate we're definitely in very different medical systems! In the Midwest USA, the general pattern I've see is that doctors (in both primary care and other fields, primarily neurology is what I have the most exposure to) first try PT and maybe one or two medications, and if the first pass at that fails they send them for psychotherapy. If the patient comes back after that, then they might do a more thorough assessment, but a lot of people drop off because they struggle to implement the PT/therapy suggestions, blame themselves for it and think "if I could just do my PT/therapy I would get better, and the fact that I can't do them regularly is a personal failure of motivation/willpower." Without ever having any testing or further examination than "well it's not broken and your reflexes are intact."
I haven't ever had a doctor suggest a more thorough examination of the body part that's in pain before sending me to therapy. I have had a doctor try one medication and then tell me "your symptoms are because you're depressed, and this medication won't help your symptoms if you're depressed, you need therapy." The medication was literally an antidepressant, and I had no symptoms of depression other than the fatigue and pain. She did not take kindly to me pointing this out and made me get a psychological assessment to prove I wasn't depressed.
I would not call this an accurate understanding of how the brain contributes to pain, of course. It's more of a "hand them over to someone else" sort of thing than actually taking brain-based understandings of pain into account as part of the assessment. I'm glad to hear it's different elsewhere, and shouldn't have painted with such a broad brush--I was speaking from a perspective where "we've tried nothing and are all out of ideas, off to therapy with you" is a common approach to pain management.
But if you have chronic pain without an obvious stimulus, it may be a signal that you're being hurt in another way (e.g. emotionally) and that you need to do something about it (e.g. experience the emotions associated with that hurt, and do something positive, like speaking up and setting better boundaries with the people doing the hurting - when that's actually possible). The difficulty is that we often learn to hide or defend ourselves against these unconscious feelings from a very young age, for good reason - they can be utterly terrifying and overwhelming for a young child.
This sounds like basically prolonged exposure therapy for PTSD, at least how I was taught to practice it. PTSD places the body in a state of hyperarousal that can, over time, lead to strange symptoms such as pain, psychogenic seizures, numbness and tingling, etc. with no direct cause other than the nervous system reactivity that is "centered" in HPA axis dysfunction seen in PTSD. Trauma work focuses on identifying the feelings and emotions we are avoiding, processing them in the present in a safe space, and taking action as appropriate. Over time this reduces the overarousal and normalizes function in the HPA axis and can subsequently improve those somatoform symptoms. EAET might differ some in style, but the basic "you are avoiding a feeling/memory and need to stop avoiding it to process and move through it" theory is the foundation of PE (which is a second wave CBT). I'd be curious to look into it more to see if it diverges from that. Though it sounds like at the very least, being firm on comprehensive medical assessment first is a difference and a positive one--over here people with a lot of medical symptoms and a history of trauma will be sent for PE or other therapies with minimal medical assessment and no follow-up unless the patient advocates for it (at least at the hospital I worked at).
posted by brook horse at 8:03 PM on January 12 [5 favorites]
I haven't ever had a doctor suggest a more thorough examination of the body part that's in pain before sending me to therapy. I have had a doctor try one medication and then tell me "your symptoms are because you're depressed, and this medication won't help your symptoms if you're depressed, you need therapy." The medication was literally an antidepressant, and I had no symptoms of depression other than the fatigue and pain. She did not take kindly to me pointing this out and made me get a psychological assessment to prove I wasn't depressed.
I would not call this an accurate understanding of how the brain contributes to pain, of course. It's more of a "hand them over to someone else" sort of thing than actually taking brain-based understandings of pain into account as part of the assessment. I'm glad to hear it's different elsewhere, and shouldn't have painted with such a broad brush--I was speaking from a perspective where "we've tried nothing and are all out of ideas, off to therapy with you" is a common approach to pain management.
But if you have chronic pain without an obvious stimulus, it may be a signal that you're being hurt in another way (e.g. emotionally) and that you need to do something about it (e.g. experience the emotions associated with that hurt, and do something positive, like speaking up and setting better boundaries with the people doing the hurting - when that's actually possible). The difficulty is that we often learn to hide or defend ourselves against these unconscious feelings from a very young age, for good reason - they can be utterly terrifying and overwhelming for a young child.
This sounds like basically prolonged exposure therapy for PTSD, at least how I was taught to practice it. PTSD places the body in a state of hyperarousal that can, over time, lead to strange symptoms such as pain, psychogenic seizures, numbness and tingling, etc. with no direct cause other than the nervous system reactivity that is "centered" in HPA axis dysfunction seen in PTSD. Trauma work focuses on identifying the feelings and emotions we are avoiding, processing them in the present in a safe space, and taking action as appropriate. Over time this reduces the overarousal and normalizes function in the HPA axis and can subsequently improve those somatoform symptoms. EAET might differ some in style, but the basic "you are avoiding a feeling/memory and need to stop avoiding it to process and move through it" theory is the foundation of PE (which is a second wave CBT). I'd be curious to look into it more to see if it diverges from that. Though it sounds like at the very least, being firm on comprehensive medical assessment first is a difference and a positive one--over here people with a lot of medical symptoms and a history of trauma will be sent for PE or other therapies with minimal medical assessment and no follow-up unless the patient advocates for it (at least at the hospital I worked at).
posted by brook horse at 8:03 PM on January 12 [5 favorites]
brook horse: if you have a chance, I'd recommend looking at Hidden from View, by Howard Schubiner and Allan Abbas. I believe it precedes the development of EAET proper but certainly describes the theory behind it, with actual case transcripts. I think, in the end, all approaches to the psychotherapy of chronic pain involve an exposure therapy of sorts, but they probably vary on what the patient is being exposed to and what path to take to get there safely. (I imagine that PE is to PTSD what EAET and its forebears are to 'small-t' attachment trauma and the consequences thereof.)
I'm trying to raise awareness in my own medical community so that folks doing primary care are aware of these therapy options and can recommend them, but only once they've determined that a thorough medical investigation has been done and that it's safe to go ahead with psychological treatment. Not that the treatment is unsafe, but as you and others have pointed out, if what you need is a biologic or a surgical procedure, it's insulting at the least, and more often an unnecessary prolongation of suffering, to wash one's hands and determine you are someone else's problem.
posted by greatgefilte at 8:37 PM on January 12 [1 favorite]
I'm trying to raise awareness in my own medical community so that folks doing primary care are aware of these therapy options and can recommend them, but only once they've determined that a thorough medical investigation has been done and that it's safe to go ahead with psychological treatment. Not that the treatment is unsafe, but as you and others have pointed out, if what you need is a biologic or a surgical procedure, it's insulting at the least, and more often an unnecessary prolongation of suffering, to wash one's hands and determine you are someone else's problem.
posted by greatgefilte at 8:37 PM on January 12 [1 favorite]
But doctors of all stripes seem happy to throw Ozempic and its relatives at any and all people so if the treatments they're working on truly are "Ozempic but for pain," maybe it won't be an issue after all.
This is funny to me, cause Ozempic may be the Ozempic for pain. There is significant, emerging evidence that glp-1 agonists significantly decrease inflammation in the body. This activity is separate from any decreases in inflammation that may occur due to weight loss. A search of Reddit will return Ozempic, Zepbound, etc. users reporting significant reductions in pain, migraines, arthritis.
I know this, because I am a chronic pain patient, and I just started Wegovy in hopes of it helping my pain. I work in clinical research and have a MSc, so I can read medical journals and stay on top of emerging therapeutic options. I started seeing anecdotal reports of pain reduction on social media, so I did some research and found discussions in the medical literature of the potential application of these drugs to pain conditions. When I saw my rheumatologist, PCP, and psychiatrist (who manages my existing pain meds) and asked them if this would be something to consider, they each were very enthusiastic about the possibility. (My rheum said he was actually giving a keynote speech on the subject in a few months.)
Of course, my insurance won’t cover the drugs purely for weight loss, and this obviously isn’t an approved indication (yet), so I’m paying out of pocket. I took my second injection a couple of days ago, and while I’m not pain free, I am definitely noticing a difference (and I’m still at the lowest dose). It’s like the background noise on my pain has been turned down. I’m optimistic about the future of my health for the first time in years.
posted by bluloo at 8:56 PM on January 12 [12 favorites]
This is funny to me, cause Ozempic may be the Ozempic for pain. There is significant, emerging evidence that glp-1 agonists significantly decrease inflammation in the body. This activity is separate from any decreases in inflammation that may occur due to weight loss. A search of Reddit will return Ozempic, Zepbound, etc. users reporting significant reductions in pain, migraines, arthritis.
I know this, because I am a chronic pain patient, and I just started Wegovy in hopes of it helping my pain. I work in clinical research and have a MSc, so I can read medical journals and stay on top of emerging therapeutic options. I started seeing anecdotal reports of pain reduction on social media, so I did some research and found discussions in the medical literature of the potential application of these drugs to pain conditions. When I saw my rheumatologist, PCP, and psychiatrist (who manages my existing pain meds) and asked them if this would be something to consider, they each were very enthusiastic about the possibility. (My rheum said he was actually giving a keynote speech on the subject in a few months.)
Of course, my insurance won’t cover the drugs purely for weight loss, and this obviously isn’t an approved indication (yet), so I’m paying out of pocket. I took my second injection a couple of days ago, and while I’m not pain free, I am definitely noticing a difference (and I’m still at the lowest dose). It’s like the background noise on my pain has been turned down. I’m optimistic about the future of my health for the first time in years.
posted by bluloo at 8:56 PM on January 12 [12 favorites]
what really works for pain is massage and myofascial release
Can strongly confirm.
Even aside from any strictly physical musculoskeletal effects (and really, is there any such thing as a strictly physical effect?) the experience of having nowhere to be and nothing to do other than be actively cared for for an hour by somebody extremely skilled at doing just that is healing to an extent that really shouldn't be as astonishing as it is.
posted by flabdablet at 5:23 AM on January 13 [4 favorites]
Can strongly confirm.
Even aside from any strictly physical musculoskeletal effects (and really, is there any such thing as a strictly physical effect?) the experience of having nowhere to be and nothing to do other than be actively cared for for an hour by somebody extremely skilled at doing just that is healing to an extent that really shouldn't be as astonishing as it is.
posted by flabdablet at 5:23 AM on January 13 [4 favorites]
I took my second injection a couple of days ago, and while I’m not pain free, I am definitely noticing a difference (and I’m still at the lowest dose).
As somebody who bounced hard off liraglutide for weight loss after I managed to induce completely intolerable side effects by conscientiously following the suggested dose-ramping protocol, may I offer the suggestion that perhaps sticking with the lowest dose that you personally find useful might be a wise course of action?
In other words, if it's already working for you, don't ramp up the dose purely because somebody else thinks you should. These drugs have profound effects all over the body, and I wish I'd taken that knowledge more seriously and listened to my own body more carefully before rushing headlong into nope-out territory.
It will take a long time for those memories to fade to the extent that I'm willing to take another GLP-1 agonist for any reason. Chili was way easier to deal with.
posted by flabdablet at 5:41 AM on January 13 [1 favorite]
As somebody who bounced hard off liraglutide for weight loss after I managed to induce completely intolerable side effects by conscientiously following the suggested dose-ramping protocol, may I offer the suggestion that perhaps sticking with the lowest dose that you personally find useful might be a wise course of action?
In other words, if it's already working for you, don't ramp up the dose purely because somebody else thinks you should. These drugs have profound effects all over the body, and I wish I'd taken that knowledge more seriously and listened to my own body more carefully before rushing headlong into nope-out territory.
It will take a long time for those memories to fade to the extent that I'm willing to take another GLP-1 agonist for any reason. Chili was way easier to deal with.
posted by flabdablet at 5:41 AM on January 13 [1 favorite]
This is totally the liberal version of talking about welfare queens. I am not sure why there is such a political investment in this narrative.
Jesus H Christ.
I personally know 3 people that have died from opiates, and no, they weren't just a bunch of "depressed people". I know a bunch more that have been addicted at various times in their lives. Almost every single one of them started their addiction because they were prescribed opiates by a doctor. Surgery recovery, chronic pain, the fucking flu once. And several of my family and friends continued their addiction through drug seeking behavior in the medical system. This is not a joke or a myth.
I am sorry that you are in pain, truly. I also want a medical system that treats people fairly and gives them the care and medicine they need. The level of callousness to an ongoing crisis in this thread is astounding. More than one thing can be wrong at the same time, and you talking shit about the dead, and the people they left behind, isn't going to help you get the medicine you need.
posted by pickinganameismuchharderthanihadanticipated at 6:35 AM on January 13 [4 favorites]
Jesus H Christ.
I personally know 3 people that have died from opiates, and no, they weren't just a bunch of "depressed people". I know a bunch more that have been addicted at various times in their lives. Almost every single one of them started their addiction because they were prescribed opiates by a doctor. Surgery recovery, chronic pain, the fucking flu once. And several of my family and friends continued their addiction through drug seeking behavior in the medical system. This is not a joke or a myth.
I am sorry that you are in pain, truly. I also want a medical system that treats people fairly and gives them the care and medicine they need. The level of callousness to an ongoing crisis in this thread is astounding. More than one thing can be wrong at the same time, and you talking shit about the dead, and the people they left behind, isn't going to help you get the medicine you need.
posted by pickinganameismuchharderthanihadanticipated at 6:35 AM on January 13 [4 favorites]
Not to mention the utter disdain implied for people with mental health issues.
posted by pickinganameismuchharderthanihadanticipated at 6:36 AM on January 13 [1 favorite]
posted by pickinganameismuchharderthanihadanticipated at 6:36 AM on January 13 [1 favorite]
as others noted, it is amazing how drug centered this article is. i have two close friends who have had amazing results(lower back pain) with brain retraining programs. dnrs and guptamethod. from various emotional/psych/meditative work i've done with my own chronic illness(crohns), i'm a fan of this style of intervention. imho, these methods in general are way closer to addressing root cause than drugs. and despite claims that these programs are expensive, most seem to be less than a single doctor visit for a year's worth of programming($350-$450USD). granted they require you to do the work yourself which is tough when people are squeezed with their lives already.
posted by danjo at 7:53 AM on January 13 [1 favorite]
posted by danjo at 7:53 AM on January 13 [1 favorite]
I want to add to greatgefilte's excellent list of resources:
- "Tell Me About Your Pain:", a podcast by Alan Gordon and Alon Ziv that essentially walks through their entire program outlined in the book "The Way Out".
- Nicole Sachs podcast: "The Cure for Chronic Pain". She has a book coming out next month, "Mind Your Body". She was a patient and then student of Dr. John Sarno who has updated and advanced his work. If you start at the beginning of her podcast, she explains her method. The podcasts are entirely free and you can essentially learn what you need to know to do their programs without anything further. And Gordon and Sachs have their own extreme chronic pain journeys so it is not just hypothetical for them.
Thanks, brookhorse, for mentioning connective tissue disorders -- I was only diagnosed 2 years ago after decades of problems, so the more publicity it gets the better!
I also want to do a PSA about my own chronic pain experience, since I wish someone had figured this out for me sooner:
I had 7 years of shoulder pain after an injury (rotator cuff tendinitis). No physiotherapist could make it go away. After my hypermobility diagnosis I was sent for a 12-week program with a hypermobility team at a rheumatology clinic, and one of the things we figured out together was that that my shoulder was definitely fully healed and I was experiencing central sensitization, or brain-induced pain. They had me do a protocol, and the pain is now completely gone, which after 7 years of pain is amazing.
How do you know that your pain may be only brain-generated:
- It's diffuse around a certain area, and can move around a bit, rather than being pin-point on a particular spot.
- It ramps up when you're stressed, and calms down when you're chill (this pattern is harder to notice than you would think)
- If you do exercises that directly work the achy area, you can make the pain go away (this is the part where you're showing your brain nothing is broken, it's ok, so it calms down, but I think a lot of people don't try to load up a painful area and so they don't discover this)
And this is how the protocol worked:
- Time all your provoking activities for a week. So for me that was knitting, cooking, and working at a computer. Start the timer when you start the activity, and write down the time elasped as soon as the pain comes on.
- Average the times at the end of the week, and then reduce by around half (so if it took 8 minutes on average for the pain to start, your starting time will be 4 minutes)
- For the first 2 weeks, every time you do one of the provoking activities, set a timer first for the time you calculated, and when the timer goes off STOP and stand up/sit down, move your limbs around in big circles, just get well out of the position you were in and get a little blood flowing. Then you can go back to what you were doing.
- Each week after the first two you can increase the time by 10%.
For me this worked like magic, and I was able to drop the timer thing altogether after about 6 weeks. The idea is to never trigger the pain so that your brain forgets about it. If you have a heavy (weight-wise) exercise that you can do for the area or limb that doesn't trigger the pain, keep doing that.
posted by antinomia at 9:09 AM on January 13 [7 favorites]
I also want to do a PSA about my own chronic pain experience, since I wish someone had figured this out for me sooner:
I had 7 years of shoulder pain after an injury (rotator cuff tendinitis). No physiotherapist could make it go away. After my hypermobility diagnosis I was sent for a 12-week program with a hypermobility team at a rheumatology clinic, and one of the things we figured out together was that that my shoulder was definitely fully healed and I was experiencing central sensitization, or brain-induced pain. They had me do a protocol, and the pain is now completely gone, which after 7 years of pain is amazing.
How do you know that your pain may be only brain-generated:
- It's diffuse around a certain area, and can move around a bit, rather than being pin-point on a particular spot.
- It ramps up when you're stressed, and calms down when you're chill (this pattern is harder to notice than you would think)
- If you do exercises that directly work the achy area, you can make the pain go away (this is the part where you're showing your brain nothing is broken, it's ok, so it calms down, but I think a lot of people don't try to load up a painful area and so they don't discover this)
And this is how the protocol worked:
- Time all your provoking activities for a week. So for me that was knitting, cooking, and working at a computer. Start the timer when you start the activity, and write down the time elasped as soon as the pain comes on.
- Average the times at the end of the week, and then reduce by around half (so if it took 8 minutes on average for the pain to start, your starting time will be 4 minutes)
- For the first 2 weeks, every time you do one of the provoking activities, set a timer first for the time you calculated, and when the timer goes off STOP and stand up/sit down, move your limbs around in big circles, just get well out of the position you were in and get a little blood flowing. Then you can go back to what you were doing.
- Each week after the first two you can increase the time by 10%.
For me this worked like magic, and I was able to drop the timer thing altogether after about 6 weeks. The idea is to never trigger the pain so that your brain forgets about it. If you have a heavy (weight-wise) exercise that you can do for the area or limb that doesn't trigger the pain, keep doing that.
posted by antinomia at 9:09 AM on January 13 [7 favorites]
More than one thing can be wrong at the same time, and you talking shit about the dead, and the people they left behind, isn't going to help you get the medicine you need.
Funny thing about dead people. They're dead. So, I'm not terribly worried about them.
posted by kittens for breakfast at 9:18 AM on January 13 [1 favorite]
Funny thing about dead people. They're dead. So, I'm not terribly worried about them.
posted by kittens for breakfast at 9:18 AM on January 13 [1 favorite]
I had a dear friend who was a junkie, and he died of an OD (to this day we're not sure whether it was accidental or deliberate). And i'd like to state for the record that the problem of opioid abuse and OD is not actually helped by making it functionally impossible for chronic pain patients to get their damn meds. Stigma and prohibition make overdose harder to prevent and treat, not easier!
posted by adrienneleigh at 2:18 PM on January 13 [4 favorites]
posted by adrienneleigh at 2:18 PM on January 13 [4 favorites]
They're dead. So, I'm not terribly worried about them.
Well bless your heart. Good luck with the foot.
posted by pickinganameismuchharderthanihadanticipated at 5:35 PM on January 13 [2 favorites]
Well bless your heart. Good luck with the foot.
posted by pickinganameismuchharderthanihadanticipated at 5:35 PM on January 13 [2 favorites]
All I know is that the spiral that triggered the late Mr. Nerd's suicide a decade ago was caused by my inability to find painkillers for him. Doctors just saw a white man with long hair and bad teeth as drug seeking (he had bad discs and stenosis), so I pulled any and all strings I could to keep his pain managed as best as I could for six years.
And Sarno? Sigh, no.
posted by luckynerd at 3:43 PM on January 15 [3 favorites]
And Sarno? Sigh, no.
posted by luckynerd at 3:43 PM on January 15 [3 favorites]
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