Trying to answer the question “what works for pain?”

Here’s what people think I do for a living, as the publisher of a website about the science of pain:

Tell them what works for pain … with a citation!

What I actually do for a living:

Endlessly explain that almost nothing really “works” for pain, that 80% of everything they have ever heard is pseudoscientific bullshit with potential harms they never imagined … that stubborn pain is not just difficult but impossible in principle to relieve reliably, because it is super “weird,” because it is aggressively multifactorial and entangled with consciousness itself … and so the only viable general strategy is a tedious process of experimentation with a list of deeply flawed and woefully under-studied options that are roughly prioritized by plausibility, costs, and risks … all of which requires an insane amount of knowledge to get passably good at… etc etc blah blah, please see several books-worth of details. 🙂

It doesn’t matter how much I bang that drum, people just keeping asking “so what works?” Like I might be holding something back! So I finally relented, and created an article devoted to trying to answer that nearly impossible question: What Works for Chronic Pain? A skeptical roundup of all the disappointingly small selection of effective chronic pain treatments (or the least bad ineffective ones).

This new article probably cannot actually scratch the what-works itch, but it is an earnest effort to focus on the positive, to highlight and explain the best options that exist. From the introduction:

Since 2001, I have been debunking the pseudoscience and quackery that dominates the options for pain patients. I have been very “negative” Since 2015, I have ironically been a chronic pain patient myself, seeking answers as desperately as any of my readers over the years. This page is a long overdue optimistic collection of what definitely works for pain.

It’s not a long enough list, obviously — especially because it excludes many experimental therapies and speculative strategies that are genuinely “worth a shot” due to their lower costs and risks and somewhat higher plausibility. This article is not about what might work for a some people, it’s about what definitely works for quite a few of us.

“Promising” treatments weren’t good enough to make the cut, because they never actually are. In fact, it’s usually the opposite: just a weak signal p-hacked out of a bunch of noise & spun into something worthy of a press release.

But never everyone, and always with caveats.

It’s also not a complete list. Even constrained by my picky criterion and annoying dedication to the science, I am sure I missed something. When this post goes out, I will get many suggestions, and most are doomed to be politely rejected. But a couple are bound to cause a why-didn’t-I-think-of-that forehead smack. So please send your suggestions. But please bear in mind the criteria…

If you made a list of every treatment that has ever seemed to work for someone, it would never end. I have constrained this list to treatments that have better-than-lame supporting evidence for relatively large and well-defined types of patients. Nothing here is merely “promising” or half-baked. Nothing is obscure and applicable only to some tiny sliver of the population.

I have notably left out complex interventions that suffer from theory-versus-practice problems, like cognitive behavioural therapy or massage therapy, which probably are extremely valuable when done well, but it’s next to impossible for patients to know if they are getting “the good stuff.”