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Minerva

PainSci » bibliography » Fisher et al 1995
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Tags: mind, case, chronic pain, odd, fun, nocebo, pain problems, harms

Four articles on PainSci cite Fisher 1995: 1. The Complete Guide to Patellofemoral Pain Syndrome 2. Complete Guide to Plantar Fasciitis 3. Pain is Weird 4. Mind Over Pain 

PainSci commentary on Fisher 1995: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This anecdote is widely cited, downright popular, because it’s a great story that supports a popular idea: that pain can occur without nociception. Is it for real? There is at least a somewhat credible source. If you are determined, you can verify the citation with a free trial membership for BMJ.com. But there is not much to verify: barely more than a photo with a caption, in the full text of the “Minerva” column (which is a compilation of snippets of interest). It is not a formal case study.

There is not much reason to doubt the overall veracity of the story, but every reason to doubt that it is exactly what it seems to be, or that it actually constitutes compelling evidence of pain-without-nociception.

Boot Nail Guy probably did have an unpleasant trip to the hospital, and yet wasn’t actually seriously injured. But it is also possible that the incident did not play out just exactly as described. Did Boot Nail Guy really need sedation? Was he actually in terrible pain, or was he just extremely anxious? And who wouldn’t be in that situation? Was he actually “entirely” uninjured, or could he have been just sightly injured, damage so minor that the story ignored it? A “seed” of nociception from minor is very different than none at all. We’ve all experienced how shockingly painful a paper cut be, despite being a nearly invisible injury. It seems plausible to me that the whole thing was not so much perfectly uninjured person experiences terrible pain and more like slightly injured person is really freaked out until proven safe.

Obviously this slightly formal anecdote is not compelling “evidence” of pain without nociception at all, though it can contribute minimally to that argument. But it can be a credible example of pain that was probably powerfully exaggerated by the mind — though I think we must still remain open to the possibility that it was more panic than pain. Indeed, it raises the interesting question of how to even tell the difference!

~ Paul Ingraham

original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

A builder aged 29 came to the accident and emergency department having jumped down on to a 15 cm nail. As the smallest movement of the nail was painful he was sedated with fentanyl and midazolam. The nail was then pulled out from below. When his boot was removed a miraculous cure appeared to have taken place. Despite entering proximal to the steel toecap the nail had penetrated between the toes: the foot was entirely uninjured.

This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights: