Detailed guides to painful problems, treatments & more

What works for pain (with many asterisks)

 •  • 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.

Hell hath frozen over: I have finally published an article about what works for pain. With many asterisks!

This wasn’t easy. It was about twenty years in the making. As overdue as it is, I don’t think I could have written it much sooner in my career than this. I just wasn’t ready! I didn’t really have good answers to the question “What works for pain?” I had to figure out how to write it without good answers. I had to cook up several genuinely nice things to say about a field that is a bit of a dumpster fire of quackery, bullshit, fraud, wishful thinking, self-serving delusions, and even extreme ignorance and irrationality.

So it was a tall order, and quite a departure for me.

I have been delivering the bad news for a long time. I have been infamously “negative.” had a strong focus on debunking in the early days. The funk of curmudgeonry was overwhelming for many readers. Why so negative? The annoying reality is that musculoskeletal and pain medicine are surprisingly primitive, and the huge gaps in our knowledge are mostly filled with pseudoscience, much of which actually passes for “mainstream.” There’s an army of well-intentioned hacks and quacks out there selling their wares to chronic pain patients, eager to tell them exactly what’s wrong with them and how to fix it.

And so I have told readers what’s not worth their time, their money, or the risk to their health. And I like to think I have saved tens of thousand of people from unnecessary expenses, false hope, and side effects.

But clearly I have been a disappointment to many more, millions of website visitors over the years who couldn’t get past being offended by the mean things I say about stretching, acupuncture, platelet-rich plasma, or therapy taping. I could have sold so many more books if I just hadn’t been such a buzz-killing skeptic.

Finally putting out an article about what does work is not going to turn this grumpy ship around. My good news is too heavily qualified, too obviously diplomatic. But it is sincere. This is what I actually believe. For whatever it’s worth, this is the best news that I can ethically deliver. Read the What Works article.

I look forward to your comments (mainly on the Facebook post, I imagine).