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The volcano god of 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.

This is from an amazing, uplifting rehab story, told by Dr. Jerome Groopman in his book, The Anatomy of Hope: How people prevail in the face of illness, about his own experience with super severe chronic low back pain:

Dr. Rainville planted the MRI scan of my spine on a lighted box on the wall and systematically inspected the film, vertebra by vertebra. Seemingly satisfied that he had reviewed all the relevant data, he turned and stood before me. ‘You are worshiping the volcano god of pain,’ he declared. ‘The volcano god of pain is your master.’ I had been warned that Rainville was a brash, in-your-face clinician who held contrary views. But what on earth was he talking about?

The “volcano god worship” lecture Groopman gets from Rainville is really great: an intense, dramatic version of the simple idea that pain often gets completely disconnected from reality (pain without any apparent tissue trouble). Despite the artfulness of the explanation, Groopman struggles with the implications. This emphasizes again — as I did in my telescopes-not-brain-scanners post a couple days ago — that it is tricky to talk to patients about how pain works without them feeling like they are being told that it’s “all in their heads.”

And what was he really saying, in cold biological terms, not flamboyant metaphors of volcano gods? That changing my beliefs could dampen flaming circuits of pain? Was I some mystic or yogi who could walk barefoot over hot coals or lie down on a bed of nails?”

This story alone is worth the price of the book. Especially because it has a happy ending!

I’ve updated my article Pain is Weird with this story, and my Telescopes, not brain scanners post from earlier this week.

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