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Counterstimulation as an obscure seed of truth powering quackery

 •  • 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.

Counterstimulation is a basic neurological mechanism for minor temporary pain relief, a sensory “distraction” from pain. Despite being a modest effect, it’s probably a legitimate obscure reason why we love massage and other hands-on therapies.

It may also be more potent in some situations. Some therapists almost certainly do a particularly good job of optimizing for counterstimulation potency in a variety of subtle ways.

Regardless, it rarely gets any credit. Instead, it quietly props up many bogus narratives about how those treatments work … which in turn fuels a lot of false hope. Here is how I think this works:

  • You go for a session of Deep Unwinding Meridian Balancing™.
  • By the time you’re done, the charismatic and compassionate therapist has filled your head with polished sound bites about how DUMB supposedly works and why it’s worth $150. It’s obviously dubious, but there’s juuust enough Actual Science thrown into the explanation that you’re willing to keep an open mind. Besides, who are you to judge? You’re a copyright lawyer, not a healthcare professional!
  • But counterstimulation? Never even comes up. The DUMB practitioner barely knows the term. And you don’t know it either. But counterstimulation doesn’t care if either of you know it — it will still do its thing.
  • And so you actually feel better afterwards, mostly because of counterstimulation — and that genuine benefit boosts your placebo, pushing the benefits to last longer, maybe a few hours, maybe even a day or two…
  • Long enough for you to get to this thought: “There must be something to this DUMB stuff!” Which is also long enough for you to decide to spend three grand on a series of treatments, praying that it will solve your nightmarish problems. And then you are invested, literally and figuratively, and quite incapable of being objective about it, and you spend the rest of your life telling people that DUMB works for you.

Hopefully that doesn’t strike too close to home for most of you. Alas, it will for some.

Quackery thrives on seeds of truth and nuggets of scientific plausibility or legitimately helpful components, and all the best placebos are boosted by something that actually works — like a supplement adulterated with an actual drug. And the most consistent “active ingredient” in the hands-on therapies, the most reliable seed of truth, is probably counterstimulation.

Counterstimulation is there almost no matter what is actually done to patients, blunting pain, even masking actual harm. It may be mostly minor, but it is a lot more real than the many bullshit pet theories that get the credit, everything from “we released your trigger points” to “we aligned your spine” to “we balanced your chakras.”

If the only consequence of all this was people getting a little actual relief, it would be no big deal. But people really do invest heavily in these therapies, convinced by that legit-but-trivial active ingredient that they might do more than just take the edge off. The effect is being used to sell people much more than just a bogus narrative about how manual therapy works, but expensive red herrings.

This post is an excerpt from a recent addition to an article I published last summer and then forgot to ever officially announce, so let me do that now: I wrote a new article about counterstimulation, counterirritants, gate control theory, and “rubbing the pain away.”

Counterstimulation — Minor but reliable, counterstimulation is one of the most basic pain-killing mechanisms in biology… and maybe there’s a fancier version that’s more useful. (2,750 words, 11-min read)

Addendum: At the same time I was publishing this, the Massage Therapist Development Centre was publishing this, which is highly relevant and adds two more points about what actually generates the benefits of manual therapy.

“Analgesic touch” is basically counterstimulation.