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Healing Time

Can healing be hurried? Would we even notice if it was?

updated (first published 2012)
by Paul Ingraham, Vancouver, Canadabio
I am a science writer and a former Registered Massage Therapist with a decade of experience treating tough pain cases. I was the Assistant Editor of ScienceBasedMedicine.org for several years. I’ve written hundreds of articles and several books, and I’m known for readable but heavily referenced analysis, with a touch of sass. I am a runner and ultimate player. • more about memore about PainScience.com

SUMMARY

Healing speed is of great interest, and people often believe that treatment X helped them to heal faster. It’s also a common marketing claim. Unfortunately, most patients aren’t the least bit knowledgeable about what constitutes a normal healing time, and should probably defer to clinicians who have seen hundreds or even thousands of examples — except that they don’t really know either, because they do know that healing time varies wildly depending on countless variables. People often recover faster or slower than expected for reasons no one can ever know. We also seem to recover faster or slower depending on which psychological “goggles” we have on (optimistic, pessimistic, etc).

The bottom line is that the natural variation in healing times tends to obscure the effects of treatments, and simply isn’t actually possible to know if any treatment helped us heal “faster,” because we can never know how long it would have taken without it. You also don’t know what will happen the next time. The only possible way to settle such questions and confirm a faster average recovery time — especially if it’s only a little bit faster — is with carefully designed scientific testing, and quite a bit of it.

full article 1000 words

Healing speed is of great interest, and people often believe that treatment X helped them to heal faster. It’s a common marketing claim, of course. A perfect current example is platelet-rich plasma (PRP) injections, which are often branded as a “regenerative” treatment that accelerates the return of injured tissues to a normal tissue state.

Unfortunately, most patients have no basis of comparison, no idea what constitutes a normal healing time — because there is no such thing. Experienced clinicians don’t really know what a normal healing time is either.1 People often recover faster or slower than expected for reasons no one can ever know. We also seem to recover faster or slower depending on which psychological “goggles” we have on (optimistic, pessimistic, etc).

Even if natural variation in healing times didn’t obscure the effects of treatments, it still wouldn’t be possible to know if any treatment helped us heal “faster,” because we can never know in any given case how long healing would have taken without the treatment. You also don’t know what will happen the next time (it could be completely different). The only possible way to settle such questions and confirm a faster average recovery time — especially if it’s only a little bit faster — is with carefully designed scientific testing, and quite a bit of it.

Biology (mostly) cannot be rushed

Healing mostly just takes what it takes. It usually starts slowly and then accelerates, as long as nothing gets in the way or goes wrong. A great deal of treatment and therapy are simply a matter of making sure nothing gets in the way or goes wrong — which can be worthwhile. They often get credit for that natural acceleration phase.

Healing in the broadest, subjective sense is recovery from any pathological state, which may have little or nothing to do with any tissue repair that can be sped up. For example, a patient with a tumour may be doomed but otherwise healthy. If the tumour is successfully surgically removed, the patient has “healed” — more less instantly, just by taking out the cancerous trash.2 It’s certainly “healing” from the perspective of the patient! But almost none of medicine’s greatest hits have anything to do with speeding up the biology of healing.

The main kind of healing that can in principle be accelerated is wound healing, the most literal sort of healing, which is a mix of regeneration and repair: either growing new cells where possible, or patching the damaged area with scar tissue. The more and faster the regeneration, the better, of course … but we’re kind of stuck, for now, with our biological destiny as mediocre regenerators.3

There are also a lot of common problems, especially in musculoskeletal medicine, where there is literally nothing to regrow or patch — and therefore no “healing” to accelerate even in principle. Here’s a couple simple, obvious examples…

And so on. The longer you look at it, the more obvious it becomes: “healing” is not one thing, but a thousand different things … most of which cannot be hurried.

What if healing doesn’t happen?

You may not have much control over it, but most healing does progress steadily and even accelerate: the better you get, the faster you get better, a “delicious cycle.” But…what if it doesn’t? Continue reading with Healing Usually Accelerates.

About Paul Ingraham

Headshot of Paul Ingraham, short hair, neat beard, suit jacket.

I am a science writer, former massage therapist, and I was the assistant editor at ScienceBasedMedicine.org for several years. I have had my share of injuries and pain challenges as a runner and ultimate player. My wife and I live in downtown Vancouver, Canada. See my full bio and qualifications, or my blog, Writerly. You might run into me on Facebook or Twitter.

Notes

  1. Witnessing hundreds or even thousands of cases of the effect of some treatments only confirms that healing time varies wildly depending on countless variables. BACK TO TEXT
  2. Other good examples are killing infections with antibiotics, curing scurvy with vitamin C, surgically closing a large wound to facilitate healing, or even just putting a bandaid on a cut — destroying invaders, stocking up on vital chemicals, facilitating normal-speed wound healing and protecting it from interference, and so on and on. BACK TO TEXT
  3. There are many critters that are better at regeneration in one way or another, so we know it’s probably possible to improve. However, there are still almost no examples of genuinely upgraded regeneration in medicine, and they are mostly rather exotic. BACK TO TEXT
  4. Although there are plenty of heavily marketed supplements that claim to be able to stimulate recovery from osteoarthritis, it’s all bollocks. BACK TO TEXT
  5. In worse cases, the connective tissue does begin to rot and crumble. In this context, “accelerated” healing might be more meaningful: giving a boost to cells, helping them do their job, so that they can catch up on their maintenance schedule without being so exhausted. But no one knows how to do this. BACK TO TEXT