Detailed guides to painful problems, treatments & more

What happened editorially on in 2018

 •  • 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.

I only produced two original new articles in 2018, about “core” strength for the neck and laser therapy, but I think it was a record-breaking year for updates, 227 of them for existing articles and books. Topics that got extra attention this year: fibromyalgia, headaches, frozen shoulder, Epsom salts, unwanted muscle contractions, trigger points (my rebooted review of treatment efficacy was extremely thorough), and more.

Here are a few things about the subject matter of that particularly stood out in 2018:

Speaking of trigger points

I am now officially sick of the careless dismissiveness of skeptics on this subject. I have spent years painstakingly and earnestly acknowledging skeptical concerns about “trigger points” — sore spots of unknown nature — but I still think it’s interesting and worthwhile topic. And yet I am just as appalled as ever by the amateurish overconfidence of the average trigger point therapist. While I remain on “Team Skeptic” on most subjects — homeopathy, vaccination, acupuncture, bigfoot, ancient aliens, etc — when it comes to trigger points, I am on no one’s “side” and don’t expect to be for a long time to come.

Just because it’s “medically unexplained” does mean there’s no explanation

My interest in difficult-to-diagnose causes of chronic pain exploded in 2018 for both personal and professional reasons. Contrary to what many critics seem to believe, I have never denied or avoided the “bio” in the biopsychosocial model of pain. But the emphasis has gotten much stronger this year! Many interesting examples are now covered in 38 Surprising Causes of Pain: Trying to understand pain when there is no obvious explanation, like facioscapulohumeral muscular dystrophy, a disease that is often subtle and can dodge diagnosis for ages, decades even, while causing chronic exercise intolerance and aches and pains all the while. This came to my attention when an old friend finally got his diagnosis, explaining a lot about his life to date (and his brother’s and father’s too). Fascinating, but only one of many similar examples.

No, sensitization is not “all in your head”

The esoteric phenomenon of neurological “sensitization” — feeling too much pain — seemed to become an almost mainstream concept this year, with lots of attention and interest… and a strong pattern of confusing it with psychological over-reaction to stimuli. In 2019, I’ll be working hard to combat that misunderstanding with a bunch of revisions.

Musculoskeletal medicine is a disappointing mess

I’ve been increasingly exasperated for years by the avalanche of crappy little studies and “garbage in, garbage out” reviews: more study is always needed and never comes, and I’m getting sick of and cynical about it. But my concern escalated dramatically this year when I finally noticed the seriousness of the trouble with predatory journals. This caused a serious morale problem for me. My enthusiasm for science is the basis for everything I do here, but I have to admit that it’s got really serious problems. I’m afraid that the best that “evidence-based” can possibly be (for the foreseeable future) is just rigorous critical analysis of plausibility and safety. Good direct evidence of efficacy is almost never actually available. It sucks, but that’s where we’re at.

My favourite update

Some science is still worth reading though, and my vote for the most interesting science-powered update of the year was a sprawling revision to the discussion of inflammation in my repetitive strain injury review, based on new evidence that RSIs may be inflamed after all — just not a classic, acute immune response. It wasn’t really a shock or anything, but it sure is interesting, and many changes had to be made to accommodate just a single key new citation (Dakin et al). This is why my work will never be done!