How to Simplify Chronic Pain Puzzles
Use Occam’s razor to clean up a mess of theories about your stubborn injury or pain problem
Occam’s razor is the logical principle that explanations based on fewer assumptions are usually better. It’s a “razor” because it cuts away useless extra ideas. It’s one of the sharpest and most versatile tools in my mental shed. I can hardly imagine life without it, let alone troubleshooting pain problems without it.
But I constantly encounter people in pain who haven’t even heard of it. Even though chronic pain treatment is chock-a-block with useless, overly complicated ideas.
Why does chronic pain need Occam’s razor?
Healthcare in general requires as much mental rigour as we can muster — especially for patients with unexplained chronic pain and illness.1 Patients with stubborn pain have often seen many health care professionals and read a lot of articles. They struggle to make sense of a whole mess of ideas, many of them incompatible, that they’ve gotten from different health care professionals telling them different things.
Or scary diagnoses found on the Internet. (We’ve all done it!)
Most people can easily use Occam’s razor to “cut away” most of this mess, simplifying the challenge significantly. You could be left with only the theories and therapies that offer the best bang for buck — and cause less anxiety, and less wasted time and money.
What would Carl Sagan do? He would probably use Occam’s razor.
Occam’s razor defined more
Occam’s Razor is a method or style of thinking simply about complex problems. (And few problems are more complicated than health problems, especially chronic pain and injury rehabilitation.) When trying to explain or understand anything, we should prefer simpler explanations to unnecessarily complicated ones. All other things being equal, the smart money is on that simpler explanation. The simplest possible translation of the Latin it comes from:2
Occam’s Razor = prefer simpler explanations
But “simple” is itself an oversimplification, ironically. It’s just a shorthand for the trickier idea that we should prefer explanations that require fewer assumptions… and that is definitely not necessarily conceptually simple. The truth might be complicated! Nature is definitely complicated! All other things being equal, the better hypothesis is the one that requires less speculation, less filling in of holes with guesses, all other things being equal.3
Here are some other common formulations of Occam’s razor:
- The KISS principle: keep is simple, stupid!
- Don’t add any more ideas to an explanation than necessary.
- A fun, famous maxim of medical diagnosis: “when you hear hoofbeats in texas, think horses, not zebras.” Like hoofbeats in Texas, most symptoms have common, familiar causes … not rare ones.
Fighting fear with Occam’s razor
Anything that increases fear and anxiety will directly aggravate pain4 — a “nocebo,” the opposite of the more familiar placebo.5
Occam’s razor can be a great antidote to hypochondria: the answers we fear are usually too complicated. The theories that freak us out are not the simplest and most likely theories. And the number one source of freaky theories is, of course, that great nocebo generator, the place you are: the bloody Internet, the ultimate source of mis/information.6
Doctor Grumpy, an anonymous neurologist with a great grumpy blog, writes7 (emphasis mine):
Is it okay for patients to learn about their health issues on the internet? Of course! As in everything else, though, it depends on the source of the info, the person reading it, and what they do with it.
And what they do with it should be to apply Occam’s razor: ignore or reject almost all of it as too complicated or unlikely.8
Unnecessarily complicated ideas about pain
Health care for musculoskeletal pain and injury are cluttered with unnecessarily complicated theories badly in need of pruning with Occam’s razor. The most common are the complex biomechanical theories that chiropractors and massage therapists cook up, and many physical therapists too (sometimes to rationalize expensive treatment plans). This is why I had a continuous stream of clients in my massage therapy pratice asking questions like:
- My chiropractor said I have a short leg. Could that be why my neck is hurting?
- My physiotherapist said my hips are tilted. Could that be why my foot is hurting?
- My other massage therapist said that my shoulders are rolled forward. Could that be why I feel dizzy?
And on and on. 90% of the time, Occam can answer these questions with no difficulty at all: probably not. Oh, anything’s possible … but therapy isn’t cheap, and you’ve got to be practical. A lot of biomechanical root causes are extremely difficult (i.e. expensive) to confirm or treat, and many are just pure bullshit.9
“Just treating the symptoms” is a simpler alternative to wild goose chases for root causes, but it gets bad press. And yet there’s actually a lot to be said for it: chronic pain often involves a vicious cycle, where the pain is effectively causing itself.10 So “temporarily” reducing the pain can actually disrupt that cycle.
For chronic pain patients, Occam’s razor is a vital tool to cut to the chase, separate the wheat from the chaff, KISS, and other “no bull” clichés. Use it today!
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:
- The Not-So-Humble Healer — Cocky theories about the cause of pain are waaaay too common in massage, chiropractic, and physical therapy. The consequences of not using Occam’s Razor.
- Studying the Studies — Tips and musings about how to understand (and write about) pain and musculoskeletal health science
- 13 Kinds of Bogus Citations — Classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable”
- Occam’s razor is about assumptions, not simplicity, by Fallacy Man, on TheLogicOfScience.com
What’s new in this article?
2020 — Added an important clarification, distinguishing between “simpler” and “fewer assumptions.”
2007 — Publication.
Consider the perilous situation with Long Covid:
Many of the country’s top medical centers have set up multidisciplinary clinics to see long-haul patients, but advocates say there aren’t nearly enough to handle the millions of Americans expected to be dealing with lingering issues from covid-19 in coming years, leaving most of them struggling to navigate a maze of doctors and diagnoses on their own.
How qualified are those millions of patients to “navigate a maze of doctors and diagnoses on their own”? The answer is probably depressing.
- The idea of Occam’s Razor is an elaboration on the law of succinctness or parsimony from the Latin (lex parsimoniae), most often stated as “entities should not be multiplied beyond necessity” (Non sunt multiplicanda entia sine necessitate).
In short, Occam’s razor does not state that the simplest solution is more likely to be correct. Rather, it says that the solution that makes the fewest assumptions is more likely to be correct; therefore, you should restrict your assumptions to only the ones that are absolutely necessary to explain the phenomena in question. A solution can be very complicated and still likely be correct if it is based on facts, not assumptions. Indeed, the answers science produces tend to be conceptually complex, and the history of science is a graveyard of simple ideas that were replaced with more complex ones.
The Logic of Science [anonymously authored blog], “Occam’s razor is about assumptions, not simplicity”
- Ingraham. Pain is Weird: Pain science reveals a volatile, misleading sensation that comes entirely from an overprotective brain, not our tissues. ❐ PainScience.com. 16191 words. Modern pain science shows that pain is as hard to predict or control as the weather, a function of countless chaotic variables, surprisingly disconnected from seemingly “obvious” causes of pain. Pain is jostled by many systemic variables, but especially by the brain’s filters, which thoroughly “tune” pain and often even overprotectively exaggerate it — so much so that sensitization can get more serious and chronic than the original problem. This has complicated all-in-your-head implications: if the brain controls all pain, does that mean that we can think pain away? Probably not, but we do have some neurological leverage — maybe we can influence pain, if we understand it.
- NewYorker.com [Internet]. Cook G. The Nocebo Effect: How We Worry Ourselves Sick; 2015 May 13 [cited 15 May 13]. PainSci Bibliography 54175 ❐
Placebo is belief-powered relief from symptoms, while nocebo is belief-powered symptoms, or “the placebo effect’s malevolent Mr. Hyde.” And: “The Internet has become a powerful … nocebo dosing machine.” Agreed: nocebo is a genuine hazard when writing about medical problems.
- In 2010, the Journal of Bone & Joint Surgery reported that “the quality and content of health information on the internet is highly variable for common sports medicine topics” — a bit of an understatement, really. Expert reviewers examined about 75 top-ranked commercial websites and another 30 academic sites. They gave each a quality score on a scale of 100. The average score? Barely over 50! For more detail, see Starman et al. This reference is getting old, but nothing has really changed. 😜
- Drgrumpyinthehouse.blogspot.com [Internet]. Grumpy D. Dr. Grumpy and Dr. Google; 2011 Jun 22 [cited 13 Dec 4]. PainSci Bibliography 55240 ❐
Dr. Grumpy writes with his customary articulate grumpiness, about patients seeking health care information online. (From websites like this one.) Much has been written about the phenomenon of online health care information. This is the funniest.
- Dr. Grumpy again: “For neurology purposes, I’d estimate that 90% of search engines lead to a self-diagnosis of MS.” For example, don’t be a chump and decide that you probably have multiple sclerosis just because your legs ache and feel unusually tired. Simple muscle pain is a much more likely candidate. MS is a much-too-complicated and exotic explanation for that (and many other symptoms that almost certainly have simpler explanations).
- “Structuralism” is the excessive focus on crookedness and “mechanical” problems as causes of pain. It has been the dominant way of thinking about how pain works for decades, and yet it is a source of much bogus diagnosis. Structuralism has been criticized by several experts, and many studies confirmed there are no clear connections between biomechanical problems and pain. Many fit, symmetrical people have severe pain problems! And many crooked people have little pain. Certainly there are some structural factors in pain, but they are generally much less important than messy physiology, neurology, psychology. Structuralism remains dominant because it offers comforting, marketable simplicity. For instance, “alignment” is the dubious goal of many major therapy methods, especially chiropractic adjustment and Rolfing. See Your Back Is Not Out of Alignment: Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain.
- Pain itself can change how pain works, so that patients with pain actually become more sensitive and get more pain with less provocation. For more information, see Sensitization in Chronic Pain: Pain itself can change how pain works, resulting in more pain with less provocation.