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Painful word of the day: palliative

 •  • 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.

Palliative care is “relieving pain without dealing with the cause of the condition” (Oxford Dictionary of English). I’ve always thought of “palliative care” as being exclusively about relieving the suffering of people who are dying, but when I read that definition a couple day ago I realized that it’s broadly applicable to all pain medicine, even trivial pain medicine, like icing an ankle sprain with the intent of simply making it less unpleasant for a while, as opposed to trying to actually help it heal. When I had an almost unbelievable painful episode of calcific tendinitis in 2016, and my doctor prescribed a potent version of topical diclofenac, neither of us thought we were actually fixing anything — the only goal was to blunt the pain enough that I might be able to get an hour or two of sleep.

Most attempted treatments for severe and chronic pain are treating the symptom, not the disease, because either we flat out don’t know WTF the disease is, or we know but we don’t actually have a clue to how to truly treat it (like calcific tendinitis). In fact, it’s troubling how infrequently medicine has any capacity to “deal with the cause” of pain, whether it’s known or not. And when we don’t know, we really don't know: not just because there’s an undiscovered biological cause (which I fear is alarmingly common), but also because pain itself can be the disease (wonky calibration of the pain system, sensitization).

Known and treatable causes are quite rare, and so most pain relief is palliative.

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