telophase: (Default)
telophase ([personal profile] telophase) wrote2010-11-09 12:29 pm

Now on the wishlist...

Review of Melanie Thernstrom's The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing, and the Science of Suffering. from the review: "She shows that medical treatment of pain is suboptimal because most doctors have not yet incorporated recent scientific discoveries into their thinking, discoveries indicating that chronic pain is a disease in its own right, a state of pathological pain sensitivity."

Essentially, if I'm reading this right, her argument is that a certain amount of chronic pain is caused by the pain itself: sometimes because the people who have it behave or carry themselves in maladaptive ways which cause muscles to be disused and new pain to occur, and sometimes because the pain itself or the treatment of the pain causes changes in the brain or body.

[identity profile] vom-marlowe.livejournal.com 2010-11-09 06:49 pm (UTC)(link)
Well, it's true that pain itself causes massive changes in the body, including causing chemical depression, etc.

What makes me wary about this book is the idea of thinking the pain away, which is not in fact new, but very old, and very punishment based. That's Dr Sarno all over and he makes flames shoot up the side of my face. (I have encountered him before.)

Part of the problem with his treatment approach and some other similar approaches, is that it leaves out the true psycho-social dynamics, emphasis on the social. That is to say, if you treat someone with chronic pain by telling them that it is all in their head, and that they need to think their way out of it, especially if they are female, they will seem to 'get better' but only because they are lying their ass off. And then they go see another doctor. I look at some of these dudes reports on 'curing' chronic pain and discovered that part of what they said was success was that patients weren't going back to them. Which....is not a sign of a cure. At all. There's so much shame around having pain at all that many people with it just lie anyway, and essentially don't get better, but suffer.

Anyway. It is true that pain changes the body, but...eh. There's lots there, reading between the lines, that makes me go hmmmmm.

[identity profile] telophase.livejournal.com 2010-11-09 07:01 pm (UTC)(link)
Yeah, I'm not impressed by the straightforward "it's all in your head, suck it up and walk it off" approach, but as Dr Hall says in the review, there's probably a grain of truth in it, in that the person who's got a self-image of being a chronic pain sufferer, a thing separate from the pain, is going to find it harder to recover than someone who doesn't. I can see that in miniature when I injure myself badly, like when I broke my toe or pulled my back ligament. Once they were past the chronic part (the back taking a year), as they healed, I tended to overcompensate for it because I "knew" that moving in such-and-such a way would cause me significant pain, even though that wasn't the case anymore. So I can see where that sort of thing might be applicable: sort of a need to rewrite interior scripts that had been written when things were physically a problem, but were still running when the underlying problem had changed or cleared up.

And having read about the problems Japanese baseball players had in the 1980s (I haven't read anything more recent about it, so I have no idea if this still occurs), I know the suck-it-up and work-through-the-pain attitude is a serious problem if there's something physically wrong: IIRC, several pitchers screwed themselves up permanently because the cultural ethos on those teams was, when something started hurting, to work it harder so they'd, say, strain their shoulder from pitching, then spend hours continuing to work it in order to work through the pain, and cause more and more damage.

(However, I don't have medical training and would not presume to diagnose anyone's pain or treatment thereof!)

[identity profile] vom-marlowe.livejournal.com 2010-11-09 07:57 pm (UTC)(link)
Oh definitely, I think maladjustment is a big problem, but I haven't seen it in my own care as something that isn't known, I guess? Maybe I've been much luckier than I knew!

I think it depends on what the chronic pain sufferer's internal tapes read and whether they match what is helpful (or not). Fer instance, one of the first things I was taught in PT was that limping is the Devil. It's better to not walk than limp, because it'll just screw up my back and cause New Exciting Problems. (That's why I have the cane, because it reduces limping; counter intuitively, it's better for me to use the cane than to limp.) There's lots of maladjustments that can cause injury, like never excercising, but on the other hand, the wrong kind will cause injury. It often startles people that I'm OK'd to do very twisty yoga, but not to do long walks, because to a lot of people, twisty yoga is hard, but walking is easy. Arthritis really improves for a lot of people if they walk, which is one of those that isn't common knowledge, I think. (And heat is OK for me, for some times, but most people will scream that heat is BAD.) I'm definitely all for adjusting the tapes. And I've gotten some good relief from fairly woo-y guided imagery. It's just the "repressed emotion" dude that flips all my internal Aiiieee switches, heh. (Simmer down VM self.)

That's very interesting about the baseball players. I read something similar about early years Navy Seal training.

[identity profile] fmanalyst.livejournal.com 2010-11-10 03:09 pm (UTC)(link)
I'm having trouble with the limp issue at the moment. My foot hurts. A lot. I had one neuroma operated on, but apparently there was a second neuroma hiding beside the first one. Because my foot hurts, it's affecting my gait, making the ankle and knee of the same leg hurt. A lot. It only hurts when I walk, and when I walk, it soon hurts very badly. I also have back problems. I'm feeling very frustrated and discouraged at the moment. I don't want drugs. Drugs only give me side effects. I want to walk without pain.

[identity profile] rachelmanija.livejournal.com 2010-11-09 07:43 pm (UTC)(link)
Isn't it fairly well-established that at least some chronic pain is caused by, basically, the pain circuits in the brain going off on their own, long after the original cause was resolved? (Such as phantom limb pain.)

But that pain is still real, and not amenable to "thinking it away." The V. S. Ramachandran book I read discussed a treatment of his for phantom limb pain which essentially changed the brain's perception of itself, and so made it stop sending pain signals. But it didn't work in all cases, and was much more sophisticated than "think it away." (It involved an elaborate arrangement of mirrors.)

[identity profile] telophase.livejournal.com 2010-11-09 07:46 pm (UTC)(link)
I think the point is supposed to be that it's not actually that well-known. The phantom limb pain thing doesn't seem to have crossed over into non-phantom-limb chronic pain territory, and lots of patients aren't getting treated properly because of that.

I also suspect it's a lot more complicated than "thinking it away," but as I haven't read the book yet, I'll decline on commenting about what might be contained in the book on the subject.

[identity profile] vom-marlowe.livejournal.com 2010-11-09 07:48 pm (UTC)(link)
Yes, absolutely, some of it is basically the nerves continuing to fire, long past the pain existed. Also, some medications can cause strange body changes which create pain (opioids backfire that way sometimes). But as I understand it, those two are fairly rare, and in fact, sometimes what happens is the person gets that diagnosis and then finds out later that there was a biological pain cause.

I'm absolutely pro changing the circuits of the brain to redirect the feeling in new ways, for sure. Plenty of studies on meditation and imagery, etc, are helpful and I do some of that myself. What I reject out of hand is Dr Whatsits thesis which is that chronic pain is caused by "repressed negative emotions". Paging Dr Freud!
ext_7025: (cure for anything)

[identity profile] buymeaclue.livejournal.com 2010-11-10 01:14 am (UTC)(link)
For whatever it's worth, my perception (which may of course be incomplete) from listening to the author interviewed on NPR and listening to part of the book on audiobook, is that she's not really so much arguing for thinking the pain away as she is for learning to live with it. I'm not sure if that distinction makes sense outside of my head? But I didn't get the sense that she thought chronic pain could be wished away or cured.

On the other hand, while I found the interview fascinating, I was not so enthralled by the book. (No particular reason, just didn't care for its approach and pacing.) So y'know.

[identity profile] vom-marlowe.livejournal.com 2010-11-10 01:58 am (UTC)(link)
There are two arguments.

1. Dr. Sorsen (or whatever, I'm too exhausted to go look), literally believes that chronic pain is caused by repressed negative emotions and that therefore, if people fix their thoughts, hey presto. I hate him.

2. The author, who is arguing that people can learn to live with pain. (Among other things. I am fine with the physical maladaption problems that can happen.) Goodie for her.

This is being presented as some new idea. It's not. It's the way things have been done forever, and it does. not. work. Unless you consider people killing themselves to be working, which I don't. Look at any psych group arguing against assisted suicide and they will tell you that a big part of it is incomplete pain control and draconian ideas (learn to live with it) about pain that make suicide seem like a rational option. This is a disability issue, and a huge one, and I do not give a shit if people use the word lame ever, but if I could wave my wand and have any one thing, it is to not tell people that they should learn to live with their pain or that there's some societal good in doing so, because if it was actually liveable and dealable, people would already be doing it, because many do. If it's gotten to the point where you're in a doctor's office, begging, then it's not 'liveable'. Also, any learning to live with does not solve the very real, very ongoing destructive chemical changes that pain causes. But anyway. More than you wanted to know, probably.
ext_7025: (thirty-five minutes ago)

[identity profile] buymeaclue.livejournal.com 2010-11-10 02:01 am (UTC)(link)
I think I have inserted my foot squarely into my mouth, and I apologize. Will attempt to educate myself more thoroughly going forward. (ETA: I didn't mean, fwiw, to suggest that live-with-it was necessarily a good solution or a solution at all, in general or in a particular case. I do know I don't know enough to make prescriptions! So if that's how it sounded, that was careless wording on my part.)
Edited 2010-11-10 02:03 (UTC)

[identity profile] vom-marlowe.livejournal.com 2010-11-10 02:10 am (UTC)(link)
It's OK. I really shouldn't be thinking or talking about this at all today, because I know better than to do it when I've been on a bad run of pain days. A lot of the chronic pain stuff that's bad (IMO) sounds reasonable at first read(and IS emminently reasonable if it's relegated to one's own intimate personal decisions, like, whatever works for herself is cool, but it's different if she's broadening that out), I think, but the way it plays out is ugly, and not always obvious unless you've done a lot of reading on the chronic pain/disability politics. Does that make sense? I don't know. I'm sorry I snapped.
ext_7025: (she's okay)

[identity profile] buymeaclue.livejournal.com 2010-11-10 12:29 pm (UTC)(link)
No worries; that's totally fair, and I apologize again for the thoughtless comment!

[identity profile] fmanalyst.livejournal.com 2010-11-10 03:14 pm (UTC)(link)
Plus a lot of the pain politics turns into blaming the victim for being disabled. "If you only did this, this, and that, I</> wouldn't have to listen to you complain about how much pain you're in." And that's alongside, "You're overestimating your pain because you just want to get high."

I've been a pain sufferer for over 20 years now. I've had it up to here with the 'power of positive thinking' crowd.

[identity profile] telophase.livejournal.com 2010-11-10 02:24 am (UTC)(link)
But it makes you more spiritual/closer to God/beautiful/whatever!

Gah, yes, I remember reading on a Usenet group a few years back a long exchange in which one person (who did not have, nor ever had, chronic pain/health issues) was arguing that she thought yes, suffering made you somehow more ... I forgot exactly what, but it was something like wise/holy/whatever. In the face of and directly contradicting a number of people who *had* chronic pain and health issues who were arguing back that all it made them was bitchy, tired, and in pain!

It's a good thing I was reading Usenet through something that I hadn't worked out how to post with, otherwise I'd probably have attempted to punch them through the internet.

[identity profile] awamiba.livejournal.com 2010-11-10 08:26 pm (UTC)(link)
I actually did have a person in real life tell me that "you are so much more wise and thoughtful now. God has really improved your life through this pain." In person. In a room full of people nodding along with her. *sigh* I managed not to kill her, but it took a lot of deep breaths.


I've had some sort of chronic pain or other all of my life. I do agree that at times I am my own worst enemy and move around in ways that would avoid pain when I'm not actually experiencing that pain. I've had to work hard to pay attention to make sure that I'm walking the right way rather than the avoiding-knee-pain walk that I'd started doing the last year or so.

But I've also noticed that some things cause me pain that don't cause others pain. For years I've heard people talk about this special gel that all the other RA sufferers love, but hadn't tried it because it was hard to get. Finally got some and guess what: it makes me hurt worse. Terrifically painful stuff for me, but works wonders in others.

[identity profile] telophase.livejournal.com 2010-11-10 09:51 pm (UTC)(link)
I managed not to kill her, but it took a lot of deep breaths.

Well, that just proves her point! *ducks and runs*

I pulled a ligament in my ankle in 6th grade and because it didn't heal for six years* I ended up walking with my right foot turned inwards to avoid the pain, and it became such a habit that I didn't notice it until people pointed it out to me. It's mostly gone now - it still doesn't feel weird to walk that way - but it cannot have done me any good.


* My parents refused to take me to the doctor for something they thought could be cured with exercise, which the doctor said was bad for it when I finally got to one in college. Nooooo, I'm not bitter about that...