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So sorry about my last post (about trusting pain)

 •  • 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.

I apologize: my last post, You can trust your pain (mostly), was a head-scratcher for many of you. My error? I just didn’t explain enough. “I had one job…” and I didn’t do it: I forgot to write for ordinary people as well as professionals.

But even many pain nerds were also a bit puzzled or annoyed by the lack of context.

I’ve written reams about the great debate about pain’s reliability as a signal. I cannot, of course, repeat it all every time I bring this up, or every post would be a book. But there’s a balance, and I want every single post to be clear to anyone. In that spirit, here’s what I should have said to make my point that “you can trust your pain.”

Let’s do this bullet-point style to make sure each key idea is (literally) punctuated…

  • It is undeniably true, for many reasons, that “pain is weird.” That is, it often seems disconnected from any obvious cause: an alarm that is too loud, long, or maybe even false.
  • There are several reasons for the weirdness, and exactly why pain is weird, and how weird it can get, is quite controversial.
  • Some people believe the brain can produce pain without tissue damage, and some of them believe it only or mostly does so.
  • That idea is a great relief to many people. It can help both patients and professionals worry less about “what’s wrong in there,” which has some spin-off benefits, such as not wasting time/money trying to diagnose an injury/pathology. Liberating, amiright? It can be!
  • But others believe that's wrong or exaggerated, and it amounts to a high-falutin' way to say “it’s all in your head.” Many of us have had disturbing experiences with having our pain badly diagnosed as pure “pain weirdness” (especially “sensitization”), only to eventually find a much more conventional cause.
  • These views exist on a spectrum, of course, but they are surprisingly polarized, with some vigorous Team Spirit in each direction.

That’s still all greatly oversimplified, of course, but I’m not going to try to fully explain today, let alone “re-litigate” the debate. But I have now set the stage to repeat the point of my last post more clearly and more specifically:

  • I encountered a reader who was in pain, and frustrated by her conflicted understanding of it.
  • Being a pro, she was aware of the points above, and she thought I would — as Mr. Pain Science — endorse the idea that her pain was “just” a brain thing. Indeed, that might what she wanted.
  • But I could not deliver! I saw clues (as she did) that there might well be something wrong in her tissues.
  • And so I wanted to clarify for her — and for you — that I am not actually a champion of the idea that pain is a seriously unreliable perception.
  • I do think that pain is indeed often somewhat weird for many reasons, but I have never believed that pain is routinely a false alarm.
  • My position is that even chronic pain is often a meaningful, biologically relevant and correct signal — even if we don’t understand it.

I thought this would be reassuring — for her, and for many of you! And so I wrote a post to emphasize that “the truth is in the middle.” But the middle of what? Many of you just didn’t know what I was talking about, while some of you who did were irritated that I wasn’t clearly coming down on your side! 😜

Once again, I apologize — for the lack of clarity and context. Not for the opinion that the truth is probably in the middle!

PainSci Member Login » Submit your email to unlock member content. If you can’t remember/access your registration email, please contact me. ~ Paul Ingraham, PainSci Publisher