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The overdiagnosis of pain as a “false alarm” [premium]

 •  • 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.

A woman walked into a physical therapist’s office, her first visit for a “new” problem, about two months old and still worsening — back pain, but a bit strange, a bit lateral, almost more ribs than back. The PT was some kind of fancy pain troubleshooter, her doctor told her: “He’s really great with this kind of thing.”

She was optimistic. Like most people, she reasonably assumed that “this kind of thing” is pretty manageable. It’s the 21st Century. Medicine is “advanced,” right? Especially relatively simple, body mechanic stuff!

“The fancy therapist told me it was a ‘false alarm’,” she said.

“My brain was over-reacting to some minor tissue insult that was probably over, and it would calm down about it in time. He explained the neurology to me in detail, which I liked at the time. Looking back on it now, it was more of a pedantic lecture, a one-size-fits-all speech. We talked a lot about how stressed and run-down I was, how I could work on the pain indirectly by improving my overall health and fitness. We joked at the end about how physical therapy wasn’t anything like I expected, more like counselling.

“Now I cringe thinking about how nice that all seemed.”

Is that pain alarm for real? It can be very hard to tell. Photo by Timothy-r.coakley, CC BY-SA 4.0, via Wikimedia Commons.

The predictable punchline

The pain was not a false alarm, of course. A serious medical problem was brewing. I’ll reveal the rest of the story at the end of the post, for premium subscribers only.

But the real attraction, what this post is all about, is an exasperated, detailed rant about the overdiagnosis of “false alarms.” If you’re a chronic pain patient who has been frustrated with ineffective care, you may appreciate the wrist-slap this post gives to some professionals for this poor behaviour.

If you’re a professional, you may feel vindicated… or defensive. 😉 Or both! It’s complicated. Still ahead in this post (a 9-minute read):

  • Telling too many patients their pain is a “false alarm”
  • Two problems with excessive “false alarm” diagnosis: misdiagnosis and insult!
  • The pendulum pushers who are encouraging “false alarm” diagnoses… like yours truly
  • Pushing the pendulum where? The alternatives to structuralism
  • Integrating psychological and social factors into pain care is hard!
  • Ham-handed psychosocialism: the psychosocialists
  • Dangerous distractions
  • My personal example: “well there’s your problem”
  • Paying lip service to both new and old paradigms
  • Revolutions seem to be impossible without some zealotry
  • How did we get into this mess?
  • Where does the pendulum belong? In the middle, duh
  • And the diagnosis is…