Detailed guides to painful problems, treatments & more

We can put a man on the moon, but we can’t fix most 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.

Lately I have finally been getting going on Instagram, so far mostly sharing simple but nicely typeset quotes. Because I am a programmer, I created a tool that spits these out “automatically” — I feed it an excerpt of text from one of my articles, and it produces quotes like so …

This one was particularly popular, and convinced me that this whole Instagram thing might just work out.

The quote is an excerpt-in-spirit from my article, A Historical Perspective On Aches ‘n’ Pains. But that exact text doesn’t actually appear: it’s just a summary. Here’s a bit of elaboration…

Healthcare for persistent pain and stubborn injuries is still rather primitive, not only because of its late arrival but because it has been too free to “wing it” for too long. For many topics, the bleeding edge consists not of good science, but the speculations of desperate patients and opportunistic cure purveyors. Vast numbers of professionals still work almost exclusively with obsolete conventional wisdom — ideas that predate the increasingly golden age of research in musculoskeletal health care that is finally underway. Ideas that can still be found in the textbooks, making progressive professionals who know better roll their eyes..

A reader wrote to me in the grips of justifiable outrage about a string of egregiously incompetent healthcare professionals he’d encountered while trying to rehab an injury. It was all routine nonsense from my perspective — unfortunately, I such stories frequently— but he was in a state of disbelief that so many so-called professionals could possibly be so amateurish. “Why is there so much ignorance in musculoskeletal medicine?” he asked.

So many factors! A sampling …

  • Professional pride and tribalism, ideological momentum, screwed up incentives.
  • The love of “advanced” and technological treatment methods, which has generated so much pseudo-quackery.
  • Near universal ignorance of the history of science, critical thinking skills, and the cognitive distortions and limitations that bind us all … like emotional reasoning, confirmation bias, the human weakness for oversimplification and “common sense,” and looking only “where the light is.”
  • The obscurity and difficulty of newer and better ideas, especially the major neurological and biological factors that we’re still learning about (but neglecting these is rapidly getting unforgivable).