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[telophase]

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.

Comments

[telophase.livejournal.com]

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!)

[vom-marlowe.livejournal.com]

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.

[fmanalyst.livejournal.com]

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.