Detailed guides to painful problems, treatments & more

We’re not just missing some pieces from a puzzle 

 •  • 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.

Elisa Arnaudo:

Medically unexplained symptoms (MUS) represent a major challenge for healthcare systems in industrialised countries. These symptoms are so prevalent that they are assessed in up to 50% of consultations in primary care.

And how many of those involve chronic pain? Probably almost all. Fibromyalgia is certainly featured prominently here. It’s an interesting little post, though perhaps unnecessarily dense in service of a simple point: that MUS patients are a stumper because of “an inadequate explanatory framework of disease.” In other words, we’re not just missing some pieces from a puzzle; it’s that we probably don’t even know what kind of puzzle we’re looking at.

And … not necessarily. Sure, one perspective is that a lot of medically unexplained symptoms may actually be extremely difficult to explain and won’t ever be explained without a paradigm shift. But it is also possible that many of the explanations we need are really hovering just out of our current reach, and really not so tricky after all — just too subtle to be easy. A good example, fresh in my mind from recent work, is vitamin D deficiency: a likely cause of a lot of pain, a common problem even by conservative estimates, and yet often misdiagnosed and often confused with fibromyalgia. Why? Not because it’s really hard thing to explain, diagnose, or treat!