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How to Simplify Chronic Pain Puzzles

Use Occam’s razor clean up a mess of theories about your stubborn injury or pain problem

updated (first published 2007)ARCHIVEDArchived pages are rarely or never updated. Most featured articles on PainScience.com are updated regularly over the years, but not archived pages.
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

Occam’s razor is the logical principle that simpler explanations are usually better. It’s a “razor” because it cuts away useless extra ideas. It’s the sharpest tool 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 ideas.

Not Occam’s razor specifically, just a cool one: the $895 Bison + Max Sprecher Signature Straight Razor. Occam’s razor is much cheaper.

Why does chronic pain need Occam’s razor?

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 could easily use Occam’s razor to “cut away” most of this mess. 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.

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 translation of the Latin it comes from:1

Occam’s Razor = prefer simpler explanations

Here are some other forms of Occam’s razor:

Fighting fear with Occam’s razor

Anything that increases fear and anxiety will directly aggravate pain2 — a “nocebo,” the opposite of the more familiar placebo.3

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.4

Doctor Grumpy, an anonymous neurologist with a great grumpy blog, writes5 (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.6

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:

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.7

“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.8 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!

For more about the problem with therapists who try to come up with overly complex explanations, see The Not-So-Humble Healer. For a simpler explanation for an awful lot of pain problems and slow-healing injuries, see   Advanced Tutorial: Trigger Points & Myofascial Pain Syndrome For more about how to navigate differences of medical opinion, see Battle of the Experts.


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. 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). BACK TO TEXT
  2. PS Ingraham. 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. PainScience.com. 11108 words. Modern pain science shows that pain is a volatile, complex sensation that is completely tuned by the brain and often overprotectively exaggerated, so much so that sensitization often becomes more serious and chronic than the original problem. All of 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” of great value — we can influence pain, if we understand it. BACK TO TEXT
  3. NewYorker.com [Internet]. Cook G. The Nocebo Effect: How We Worry Ourselves Sick; 2015 May 13 [cited 15 May 13].

    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.

    BACK TO TEXT
  4. 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,” such as knee pain and low back pain — 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. BACK TO TEXT
  5. Drgrumpyinthehouse.blogspot.com [Internet]. Grumpy D. Dr. Grumpy and Dr. Google; 2011 Jun 22 [cited 13 Dec 4].

    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.

    BACK TO TEXT
  6. 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). BACK TO TEXT
  7. “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 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 and neurology. 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. BACK TO TEXT
  8. 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 Central Sensitization in Chronic Pain: Pain itself can change how pain works, resulting in more pain with less provocation. BACK TO TEXT