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A Systems Perspective on Chronic 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.

Todd Hargrove recently published a terrific new article exploring chronic pain as an emergent property of complex biological systems. In this view, unusually stubborn or bizarre pain is the tip of an iceberg of stress-induced meltdown, rather than the result of any one problem (or in addition to it). Making fancy ideas useful is a great strength of Todd’s writing, and he wraps up with some superb practical ideas that I heartily endorse:

Pains associated with these conditions will probably NOT be effectively treated by focusing sole attention on the locally painful areas. The problem doesn’t live there. As Peter O’Sullivan has stated, we should give up looking for a “magic bullet theory” of non-specific low back pain. Instead, because the problem is more about supersystems than subsystems, it should be addressed by interventions that target this more complex and global level. These might include working on diet, sleep, exercise or mindfulness-based stress reduction. These are the “big rocks” that we should make sure have been put in the jar before we start reaching for tiny grains of sand like improving posture or strengthening the core.

Many people have huge room for improvement in the way they eat, sleep, exercise or handle stress. They might be more motivated to make those improvements if they better understood the connectivity of all the different systems in the body, and their potential relationship to chronic pain.

If this is actually how serious chronic pain works, then we should see relatively weak ties between chronic pain and any particular sign of generally poor health (such as obesity, or insomnia), and much stronger correlations between chronic pain and any of several signs of poor health. In other words, we should see a pattern of people who were a bit of a mess before the pain even started. But … do we see that? It’s hard to tell. I am aware of many contrary examples, cases of severe chronic pain in robust people, and they are all the more tragic because of it. But those examples can’t tell us much, unfortunately. In fact, if the systems perspective is valid, I expect it to produce all kinds of surprising cases, and be maddeningly difficult to prove — like trying figure out what kind of atmospheric conditions cause the worst storms.

Chronic pain has indeed been one of the toughest puzzles in the history of medicine. Whatever we know about it in 50 years, I bet the systems perspective will be involved in some way.

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