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If we’re genetically programmed to hurt, why bother trying to control anything?

 •  • by Paul Ingraham
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Weekly nuggets of pain science news and insight, usually 100-300 words, with the occasional longer post. The blog is the “director’s commentary” on the core content of a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

There are many genetic contributions to chronic pain, large and small. A lot of stubborn pain is biological destiny.

Zorina-Lichtenwalter et al reviewed genetic factors implicated in chronic pain conditions, reporting that there are “several strong-effect mutations” — mutations that directly cause painful pathologies, the more obvious genetic factors in pain. But they also reported “minor contributions from a large number” of minor genetic typos (single nucleotide polymorphisms). For instance, in migraine and musculoskeletal pain patients, “nearly half” of what makes them genetically distinct from healthy people is … fishy. The difference “alters neurotransmission pathways.” That is, those people are biologically different in ways that affect how nerves do their thing — and that’s probably not a coincidence.

Nearly half! That’s a lot of subtle genetic contribution to how we feel. Interesting. But now I’m going to take this in an odd direction…

The original plan for this post, inspired by that genetic evidence, was to write something a bit snarky about the futility of obsessing over trivial modifiable risk factors. I almost used it as an excuse for taking another shot — from a new angle — at things like posture, core weakness, low vitamin D, and many more that range in credibility from “maybe a bit of a thing, but overhyped” to “just silly bullshit.”

But then I backed off. I remembered how my own chronic pain has driven me to fight like hell to control whatever risk factors I possibly can — because the only thing worse than mysterious chronic pain is … mysterious chronic pain complicated by factors that might be preventable. Even if they are minor.

If there’s any reasonable hope that a chronic pain patient can do anything to avoid making a bad situation worse — even if it’s a long shot — it’s not just an understandable choice, it’s a rational one. Many of those efforts are doomed to be inefficient or even wasted. But so what? There are worse things than inefficiency.

And so I controlled my impulse to snark. We certainly should be aware that there are many truly uncontrollable factors in pain, but that doesn’t mean we shouldn’t also be keen on doing whatever we can do to avoid making a bad situation even worse.

This is an excellent example of the kind of insight I might never have had if I hadn’t become a chronic pain patient myself.

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