Detailed guides to painful problems, treatments & more

Painful Lessons

What I’ve learned from twenty-five years of studying pain and injury

Paul Ingraham • 7m read

This is a repository of some of the major lessons acquired in my 25 career trying to help people — and myself — with chronic pain and stubborn injury rehab challenges. It is quite conservative.

I cringe when I think back on my first several years as a massage therapist, selling myself to patients as a chronic pain troubleshooter. I knew less than John Snow, less than nothing — my mind was cluttered with simplistic misconceptions that I had to actively clean up over the years.

I started in 1997. I didn’t know most of what's described here until at least 2010 — when I retired from massage therapy (somewhat dramatically) after a decade of clinical practice.

Everything listed here today is something that I am now fairly sure of, the major concepts I now more or less take for granted after twenty years of constantly investigating the legitimacy of popular ideas about treating painful problems. The highest certainty, and the greatest importance.

Some disclaimers

I will not defend any of these points in any detail here (though I do link to more information in many cases). There are, of course, lots of caveats. The devil is always in the details. For now, this list is incomplete and relatively glib. Just how confident am I in these things? Not extremely — but that's because the single most important lesson I’ve ever learned about pain is that it’s too complicated to ever be really sure of anything. All knowledge is provisional, and knowledge about pain is especially provisional! But what confidence I do have about each of these things has fairly deep roots. The sun will probably come up tomorrow, and I am just as likely to believe these things in five years. (And if I’m wrong about that, I can’t wait to find out how.)

The lessons

About Paul Ingraham

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

I am a science writer in Vancouver, Canada. I was a Registered Massage Therapist for a decade and the assistant editor of 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:


linking guide

1,600 words