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Masking Symptoms Is Under-Rated

Masking symptoms,” especially with medications, is often maligned. But sometimes symptoms need masking!

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

“Masking symptoms,” especially with medications, is often maligned because it doesn’t “treat the root cause.” But masking symptoms can be a good idea, and it should not be eschewed just because it doesn’t have a real healing effect … because there are very few real healing effects! “Healing” is mainly about removing impediments to natural recovery, like stress on tissues. It’s not dictated by some mythical power to speed healing, but by a strong understanding of the nature of the problem and what pisses it off and impedes recovery. Focus on facilitating natural recovery, and don’t knock a little “symptom relief” along the way.

full article 750 words

“Masking symptoms,” especially with medications, is often maligned because it doesn’t “aid healing” or “treat the root cause.” These are particularly common gripes in alternative medicine — usually right before claiming to be able to “aid healing” or “treat the root cause.” The insinuation is that treating symptoms is just for those silly doctors, and whatever they are offering is much better.

But masking symptoms can be a perfectly good idea, and it should not be eschewed just because it doesn’t have a real healing effect. There are very few real healing effects! Maybe none. There are few or no known ways to actually improve on the biological process of healing. Alas, we cannot tell the body, “Hey, heal better, will ya?”

“Healing” is mainly about removing impediments to natural recovery, such as continued overuse and excessive stress. It’s not dictated by some mythical power to speed healing, but by a strong understanding of the nature of the problem and what pisses it off and retards recovery.

Examples

Here’s the most idiotically simple example of how healing is often just about protecting injury from stresses: bad sprains need to be immobilized for a while, just like a fracture. No kidding, right? It might seem “obvious,” but it was actually common practice for decades to recommend excessive early mobilization.1

Here’s a classic-but-trickier example: patellofemoral syndrome is often misdiagnosed and over-treated with strength training that tends to stress the knee even more, and yet it often works to simply avoid sitting with bent knees, because that position is much more biomechanically “intense” than most patients realize.2 Removing that sneaky knee stress isn’t “healing,” per se, but it’s sure important!

Most importantly, pain is weird,3 and somewhat self-perpetuating — particularly to the extent that it’s exacerbated by stress, fear, and anxiety. Pain medication or any other temporary symptom relief, when it works, can help to break that vicious cycle simply by demonstrating that the problem is not so bad that the pain can’t be relieved.4 Such reassurance is more than just temporary relief: it can actually change the equation. This might be how pleasant massage could have a meaningful therapeutic effect, even if it has no biological impact on healing.

The risk of re-injury

The one worthwhile concern about masking symptoms is that it can make you too cocky. Pain killers and anti-inflammatories, when they are effective, can make you feel less vulnerable than you actually are.5 And re-injury — even minor re-injury6 — can really slow down rehab. So when you decide it’s time for some symptom relief, you must exercise more cautiously.

So, focus on facilitating natural recovery, and don’t knock a little “symptom relief” along the way — but be quite cautious while medicated!

Notes

  1. Lamb SE, Marsh JL, Hutton JL, Nakash R, Cooke MW. Mechanical supports for acute, severe ankle sprain: a pragmatic, multicentre, randomised controlled trial. Lancet. 2009 Feb 14;373(9663):575–581. PubMed #19217992. BACK TO TEXT
  2. Pressure under the kneecap skyrockets to hundreds of kilograms per square centimetre as the knee flexes. This is normal, and the knee is built to tolerate it — but only for so long. Sitting for a living is often too much. BACK TO TEXT
  3. Modern pain science shows that pain is an unpredictable sensation thoroughly tuned by the brain and not as closely related to tissue trouble as most people assume. So can we think pain away? Probably not, but we may be able to influence it. For more information, see Pain is Weird: Pain science reveals a volatile, misleading sensation that is often more than just a symptom, and sometimes worse than whatever started it. BACK TO TEXT
  4. Conversely and tragically, when symptom relief fails, it can have the opposite effect — discouraging and scary! This is why the false hope offered by many bogus treatments — like acupuncture, homeopathy, or craniosacral therapy — are actually a little dangerous: when they fail, patients often think it means that their problem must be really bad. And that’s bad for pain. BACK TO TEXT
  5. In fact, they can even do it when they aren’t effective: just the idea of symptom relief is all the excuse some people need to overdo it a little. “It’s okay, I can go a little harder and further — I’ve got some meds in me! BACK TO TEXT
  6. PS Ingraham. Collateral and Re-Injury Prevention: Don’t underestimate the importance of prevention … even after you’ve already been injured! PainScience.com. 1251 words. BACK TO TEXT

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.