Many people think that pain can yield to psychology — an idea that gives them a lot of hope, and has spawned industries and empires and millions of hours of people sitting in the lotus position.
But not everyone is a fan. The paradox of mind-over-pain treatments is that they inspire just as much outrage and disdain as hope and enthusiasm — because most psychological cures can only work if there's a psychological cause for pain, a hypothesis that seems offensively simplistic, speculative, and dismissive to many chronic pain patients … and they get really tired of being told that they just need to stop working so hard, relax, and meditate.
Last week I listed the many kinds of mind-over-pain treatment, and (for members) I dug into how to classify them into four major ways that they theoretically get the job done. Today I continue hammering on the theme of psychology in pain treatment with another another list: the six main reasons why people hope that pain might yield to a shift in perspective or attitude. It’s a list of what people believe and why — not what is true.
- Cognitive behavioural therapy and other mainstream psychological therapies are routinely and loudly touted as good evidence-based medicine, whether they actually are or not.
- Placebo is widely believed to be potent. And anyone can see that if placebo is potent, then clearly the mind does have power over pain. But the potency of placebo is probably overstated. Hypochondria is the other side of the placebo coin, which also convinces people that the mind must have great power. But it’s unclear how much pain (specifically, as opposed to illness), we can actually “create.” Like private detectives and cops, there may be more hypochondriacs on television than in real life.
- Psychological stress and anxiety are implicated as major factors in almost every imaginable kind of health problem, but especially unexplained illness and chronic pain — and, once again, it’s not really clear how well that actually holds up to scrutiny. We still just don’t know how many chronic pain patients ended up in that predicament because they were stressed. The actual number is somewhere between “zero” and “many.”
- Reducing suffering and disability caused by pain is a legitimate and valuable goal in itself, but many people hope that it will also — via spinoff effects that are rarely clearly articulated — actually treat pain. People are hoping that better coping will ultimately reduce how much pain you have to cope with. Unfortunately, although this cope-hope is reasonable, it’s not at all clear that it works.
- Meditation has massive “mindshare” — it is one of the most popular self-help options in the history of self-help. Exactly what people think it’s capable of is unclear and suspiciously flexible, but its popularity has an immense “there must be something to it” effect: it is widely believed to kill pain directly through obscure and exotic physiologic mechanisms — “there’s so much we don’t know, you know?” — or indirectly via the more boring mechanisms of relaxation and stress relief.
- Gurus of “mindbody” medicine have trained generations of people to believe that illness and pain are ultimately powered by psychological factors with their aggressively advertised methods. This tradition continues uninterrupted from the patent medicine era to the present day. More generally, pop psychology has infected millions of us with generally raised hopes for better-living through life hacks that can be crammed into a magazine or talk-show. Even if we don’t think it can be done so easily, it insidiously persuades us that it probably is possible with greater effort.
- “Pain is an opinion” is a somewhat notorious tenet of modern pain neuroscience, much more obscure than hypochondria, but somewhat fashionable among professionals and a few patients. There is little doubt that pain is modulated by perceptual factors to some extent — but it’s also not at all clear how clinically useful that is. Do we have any significant more conscious control over this than we do over, say, phobias? No one really knows yet.
All of these ideas contribute to the faith that pain relief might come from between our ears. Can you think of more?