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Pain vs. brain: a follow-up

 •  • 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.

Yesterday I linked to Byron Selorme’s story of roofing his house with surprisingly little pain disturbance to his chronic pain. But that was a year ago, and while Byron got no worse, he also hasn’t gotten any better. I’ll try to extract an insight or two …

It was brave and wise to attempt the roofing as he did, and he got away with it, which is quite interesting and inspiring, and it strongly suggests that — in his case at least, but many others too — his pain has never been caused by anything “fragile” or “degenerating,” or the roofing would likely have been a disaster.

And yet he’s also still in pain!

This exasperating duality is common: on the one hand, pain is often less disabling and prone to exacerbation than people expect, particularly for those who are able to maintain confidence that they are not made of glass.

And yet all the positive mental attitude in the world often doesn’t put a dent in the problem either. In a case like Byron’s, there could be a source of tissue irritation, which the brain simply refuses to ignore and doggedly, perpetually interprets as a mild threat (at least, but probably partially controlled by careful conscious management of fears, as Byron did). But there could also be some more exotic, invincible sensitization — disturbed interpretation of tissue signals — which is a real neurological issue, as opposed to the psychological problem chronic pain patients are so often accused of (sometimes carelessly, sometimes almost maliciously, sometimes even by themselves).

But you can be sure of this: if chronic pain was “just” a psychological puzzle, then thoughtful, positive people like Byron would usually solve it.

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