Masking Pain is Under-Rated

“Masking symptoms,” especially with drugs, is often scorned because it doesn’t “aid healing” or “treat the root cause.” These are common anti-medical gripes in alternative medicine — usually a setup for the claim that alt-med can “aid healing” or “treat the root cause” much more effectively than those silly doctors.

But a little symptom relief is often a great deal better than nothing — as everyone has ever had any serious pain knows all too well1 — and it’s the only realistic option in any case. Symptom relief, especially some analgesia, should not be eschewed just because it doesn’t have true healing effect (altering the course of the disease). Actually improving on the biological process of healing, to make it faster or more thorough, is difficult and rare — especially for pain and injury.

Alas, we mostly just cannot tell the body, “Hey, heal better, will ya?” Even masking symptoms is difficult, which is why it’s usually only partial and temporary.

“Healing” in the context of pain and injury rehab is mainly about removing impediments to natural recovery, such as continued overuse (“load management”), and reducing underlying vulnerability due to things like poor fitness or sleep. It’s mostly not about some extravagant power to speed healing.

Examples of “healing” in pain and injury rehab

Here’s an absurdly 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.2

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.3 Removing that sneaky knee stress isn’t “healing,” per se, but it’s sure important!

Most importantly, pain is weird,4 and somewhat self-perpetuating, perhaps exacerbated by stress, fear, and anxiety. Pain medication or any other temporary symptom relief, when it works, might help to break that vicious cycle simply by demonstrating that the pain isn’t invincible.5 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. Even if it’s fleeting, hope is powerful, an can inspire more confident exploration ways to cope and adapt — especially movement, activity, and exercise. This is the concept of “windows of (rehab) opportunity” in rehab and pain medicine.

The risk of re-injury is a legitimate concern about “masking” symptoms

The one worthwhile concern about masking symptoms is that it can make you overconfident with your exercise and activity choices. Pain killers and anti-inflammatories, when they are effective, can make you feel less vulnerable than you actually are.6 And re-injury — even minor re-injury7 — can really slow down rehab. So when you decide it’s time for some symptom relief, you must exercise more cautiously.

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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. Anyone who demonizes medications for “just” relieving symptoms probably hasn’t yet had symptoms nasty enough to develop an appreciation for the value of taking the edge off.

   In the words of the Borg queen, they “haven’t been properly … stimulated yet.” (Hat tip to salamander friend K.M. for the nerdy framing.)

2. 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 ❐
3. 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.
4. Modern pain science shows that pain is an extremely unpredictable sensation, heavily tuned by the brain and jostled by complex variables — not the relatively simple response to tissue insult that we tend to assume, and that most treatment is based on. For more information, see Pain is Weird: Pain science reveals a volatile, misleading sensation that comes entirely from an overprotective brain, not our tissues.
5. 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.
6. 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!
7. Ingraham. Sports Injury Prevention Tips: A few evidence-based ways to reduce your risk of injury. PainScience.com. 3832 words.

About Paul Ingraham

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of ScienceBasedMedicine.org for several years. I’ve had many injuries as a runner and ultimate player, and I’ve been a chronic pain patient myself since 2015. Full bio. See you on Facebook or Twitter., or subscribe:

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