Detailed guides to painful problems, treatments & more

What’s new on PainScience.com since September-ish? Lots!

 •  • 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 PainScience.com: a library of major articles and books about common painful problems and popular treatments. See the blog archives or updates for the whole site.

When I started the new PainSci newsletter last summer — delivering this blog by email — I figured it would feature frequent roundups of whatever’s new on PainScience.com. That is the whole idea, after all: my job is to constantly improve the books and articles that define the website, and then tell you about the most interesting bits here.

What actually happened: I wrote so much new material for the blog/newsletter itself that subscribers already knew what was new, because they were reading it as I produced it!

But I did do my job right some of the time, and it adds up. So see below for all the autumn highlights — some of which will be new to you even if you were subscribed the whole time. Scan for topics of interest.

Teaser for the next post: a vintage medical device with neon lights, a legacy of Nikola Tesla, and pumping gas into various body cavities. 🤔

The Updates…

Oops — major anticonvulsants correction

I made major corrections to the neuropathy chapters of my low back pain and trigger points books. I got busted by a knowledgeable reader for excessive demonization of gabepentin and pregabalin based on an oversimplification of their legal history and inadequate attention to the evidence on efficacy for neuropathy. In fact, these drugs are efficacious for some neuropathies. I will probably summarize this for subscribers soon — mea culpa posts are important.

Major magnesium medley

A few articles and books were supplemented with information about magnesium supplementation. The most detailed coverage of that topic can now be found in my Epsom salts article (because Epsom baths are a major way that people believe they can supplement magnesium). There are also summaries and other details in my guides to muscle strains, cramps and spasms, and trigger points.

Spice therapy (capsaicin)

This is another topic that got its start in the newsletter and then got integrated into several permanent articles, but chiefly the heating page. I probably spent more time on this than any other topic in the fall. As always, I am dazzled by how much there was to learn about something so humble and “simple” — and genuinely interesting science, too!

Blue light special

I rebooted all my content on light, blue light, gadget screens, and features like Night Shift and Night Light: new science and all new commentary. All coverage of that topic is in my guide to insomnia.

Jedi mind tricks for frozen shoulders

I added a substantive new chapter about the possible role of the mind and muscle guarding in frozen shoulder.

And the winner for Best New Red Flag for Scary Back Pain is…

Pain in both legs, especially combined with weakness, is the closest thing we have to a reliable red flag for cauda equina syndrome (CES): trouble with the lowest parts of the spinal cord. This was the focus of an important science update for my low back pain book and my when-to-worry guide to back pain.

And another red flag, this one for the neck

Neck pain also got a new red flag, too: “facial numbness.” See the neck pain book or the when-to-worry guide to neck pain.

Topical anti-inflammatory medication

What works? Topical diclofenac, for some: it has now been clearly established as effective and safe by a lots of good quality evidence, and that is about as close to “proven” as we get in this business. This made for a meaningful science update on Voltaren, and I added a key new citation to a dozen other articles.

Is modern living hard on backs?

Or is that just a cynical myth about the perils of modernity? The short answer: it’s probably a myth. The long answer is found in the back pain book, which got a whole new chapter about this.

Noci-what now? And the whatchamatrix?

My article Pain is Weird has long needed a definition and explanation of nociception. It finally has one. It’s “the conversion of noxious stimuli into nerve impulses.” But there are several more paragraphs of nuance.

Also new here, another definition/explanation: a short but key new section about the modern alternative to the “naive view” of pain, the “neuromatrix.”

The sense of position and movement

Some important PainScience.com articles get updates several times per year. Others go for years with nothing. Proprioception, the True Sixth Sense got updated last fall, which is probably the first time it has ever been updated since I wrote it in the mid-2000s.

For its age, it wasn’t in terrible shape. But I corrected some overconfident speculations, got a little more specific with some of the science, added a number of interesting details, especially a lot more information about Piezo1 and Piezo2 receptors… science that won a Nobel prize in 2021, but was done back when this was first written! The article doubled in size.

The never-ending debate about lactic acid

I substantially upgraded the debunking of the lactic acid myth in my delayed-onset muscle soreness article. Very satisfying! My previous effort was somewhat half-assed, and it had been bugging me for years.

But my update was then also followed up by important clarifications and corrections, because that topic is tough. It’s not just a slam-dunk debunk. It’s just too complicated.

Lactic acid molecule — three red oxygen atoms on a skeleton of black carbon, with some white hydrogen at the edges. But muscles make lactate, not an acid. This molecule would have to lose the white on the right to be lactate.

Orthopedic medicine reviewed

My “opinionated guide to the most popular sources of professional help for injuries and chronic pain” now has reviews of fifteen professions after adding orthopedic medicine.

Neck-o-genic headache

The headache book has a chapter on the idea that headaches can come from neck problems (cervicogenic headache). That chapter got a big science update, with a citation to an important new study showing that there are no obvious neck abnormalities in headache patients.

Tongue-o-genic headache?

Got a tight frenulum? That little flap of tissue under your tongue? Some people think this causes headaches, neck pain, and jaw pain — so those topic guides each got frenulum updates.

Soooo many typos got faxed

Literally hundreds of typos and other minor errors have been corrected over the last few months (major ongoing proofreading project), but one milestone stands out: the trigger points book, by far the longest of my books, has been scrubbed clean of most typos.

Better mind-over-pain information

One of the newest flagship articles on PainScience.com is Mind Over Pain, and it got a variety of upgrades. Most notably, there’s a new section about cognitive behavioural therapy. I also added clarifying examples to the “sensory novelty” section. The big idea was too abstract, so I added several concrete examples of exactly how you “change something about how a painful area feels” — much more practical now.

Is that all?

Nope. I updated 38 articles and books sixty-three times: 15 major updates, 27 medium, 20 minor. That’s a noteworthy update every 1.8 days. There have now been two thousand two hundred and eighty updates since comprehensive logging started in mid-2016. View the complete update archives.

1000 posts milestone

I published my thousandth blog post on Nov 30, 2021 — counting from Dec 14, 2010, when I published, “Bad science writer, bad! A major mea culpa.”