Detailed guides to painful problems, treatments & more

Regressing to Hell

 •  • 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.

A reader describes an all-too familiar experience for chronic pain patients, riding the therapy merry-go-round:

It was extremely demoralizing! She’d worked with me for a couple of months and we only had one success where, for a period of about a week, my average pain was at about a 3, down from a daily average of 6–8. But that’s always been my pattern: a new treatment seems like it miraculously works (chiropractic; exercise/stretching; trigger point massage combined with other things (the jaw, then some spots right around my shoulder blades were like a miracle cure for a short time), and then I have a pain flare-up and I’m back at square one.

This is how it usually goes. Seems like at least 80% of the time someone is swearing by the efficacy of some treatment, they are just in that honeymoon phase before the next flare up.

Regression to the mean” cuts both ways. In health care, it mainly refers to the statistical inevitability of healing, the way people tend to return to an average state of health, regardless of treatment. And yet treatment often gets credit for that movement back towards normalcy, because treatment is often sought in the later stages when recovery is finally just around the corner (this is the darkest-before-dawn effect).

But returning to a healthy state is exactly what is (tragically) not happening for people with chronic pain. For the chronic pain patients, the “mean” (typical state) that we regress to is often an unrelenting pattern of erratic flare-ups. 😱