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The myth of the back pain whisperer

 •  • 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.

Some musings excerpted from a recent update to my low back pain book, focusing on good and bad reasons for seeking professional help for chronic back pain …

It’s nearly impossible for most patients to tell the difference between a genuine expert and a charming bullshitter. (This is true in all areas of life, but it’s particularly problematic in healthcare.) When I worked as a massage therapist, people often said to me, “Wow, you’re so busy and expensive: you must be good!”

“Maybe,” I would reply. “Then again, I might also just be charming and a good businessman. You really have no way of knowing.”

I like to get people thinking.

The idea of the exceptional clinician, the “pain whisperer,” is mostly a pernicious myth. The superpowers of the truly knowledgeable and talented will mostly disappoint the desperate: restraint, humility, good communication, and doing no harm with bogus diagnoses and treatments.

Back pain is much too multifactorial and mysterious for any clinician to have consistently superior results. To the extent that they do, it is almost certainly because of charisma, empathy, and the ability to reassure … not their methods or savvy.

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