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Filed under “Pain is Weird.”
The Salt Spring Island terrain in the video is gorgeous, and in my backyard. (I’ve spent a bunch of time on that island.) You can’t beat yoga under an arbutus tree!
Contrary to everything scientists might have feared exposing their irrationality, their humanity, even their craftiness and hot tempers, makes the public more receptive to the revelations of science, not less. People can not only take the truth about science, they actually prefer it.
~Michael Brooks, The Secret Anarchy of Science
I’ve know some crafty, hot-tempered scientists. Hell, it seems to go with the territory!
Harriet Hall translated a French article on placebo by Jean Brissonnet for ScienceBasedMedicine.org, calling it “the best explanation of placebo that I had ever read.” (I was quite involved editorially, and in particular spent a bunch of time on producing shinier, translated diagrams.) I’m not quite sure it’s the best placebo explanation I’ve ever read, but on the other hand I can’t point to a better one, and it is certainly chock-a-block with historical context, effectively cited science, and little gems of clarity on this tricky topic. For example:
There are many arguments against its use in healthcare practice. Do we have the right to fool the patient? Do we have the right to act without his consent? Can we risk permanently damaging the doctor/patient relationship if the patient finds out that he has been deceived? A better understanding of the phenomenon makes such questions obsolete. To the extent that the “placebo effect” is only a contextual effect that doesn’t depend on the use of an inactive object, it can and should be used in healthcare practice. It can probably be used instead of a prescription in certain functional diseases, and it certainly can potentiate the effect of prescribed drugs in many cases.
The gist of the article is that what we usually refer to as “the” placebo effect is a category of phenomena, many of them clinically meaningless, and we truly need to learn and use more precise terminology. It’s not just word-nerd nitpickery! Speaking only of “placebo” is about as useful as saying only “furniture” when you mean “chaise longue” or “credenza” or “futon.”Placebo, Are You There?
Does swearing reduce pain? @^#@%, yeah! And so does saying “ow!” according to a new study. And of course it’s not really surprising, given what we know about pain (it’s weird and thoroughly brain-tuned). It probably doesn’t have much relevance to chronic pain. But it’s interesting, and fun.
In our study, saying “ow” increased pain tolerance by about 20%. One may speculate that benefits in real life may, perhaps, even be larger. There, vocalisations are typically less measured. That is, people are likely to say “ow” and other things more forcefully and can do so continuously without the somewhat unnatural breaks that were introduced for standardisation in our study.
Less measured and more forceful indeed.
Naturopathic doctor training does not hold a candle to medical training, as I’ve explained before (see Chiropractor, Naturopath Training Way Less Than Doctors). It’s nice to have some insider confirmation of that now. Britt Marie Hermes is a naturopathy apostate, and she’s telling her story on her own new blog, NaturopathicDiaries.com and in a new series of guest posts on ScienceBasedMedicine.org, starting with an exposé of her training (which I was particularly proud to help publish). It’s cringe-inducing.
Given my journey through naturopathic medical school, I can provide strong evidence and testimony of the quality and quantity of training at Bastyr University. I base what follows on my academic transcript, course syllabi, course catalog, and the student clinician’s handbook in addition to my personal experiences. It should come as no surprise to readers of ScienceBasedMedicine.org that naturopathic training is not as the profession presents. I’ll say it anyway: naturopathic education is riddled with pseudoscience, debunked medical theories, and experimental medical practices.
~Britt Marie Hermes, ND Confession, Part 1: Clinical training inside and out
Alice Sanvito, massage therapist, in a new article about the difference between nociception and pain:
When we live with chronic pain, it can dominate our lives and dramatically alter the way we live, like an obnoxious cab driver who insists on taking us where HE wants to go rather than where WE want to go.
Googling your symptoms is as unavoidable as it is unwise. We almost literally cannot help ourselves. I imagine there is a modern epidemic of reckless, panicky self-treatment based on really bad Internet-powered self-diagnosis — something I am acutely aware of every time I hit my magic “publish” button. (With great power…)
The Flemish government is acutely aware of it too, which is why they commissioned a couple of (hilarious) public service announcements about it, one that’s pure sketch comedy, and one about their clever delivery method: the clever monkeys used Google’s own advertising program to target people searching for common symptoms!
Confession: reading about many kinds of symptoms actually makes me swoon. I get dizzy and queasy. It’s not really a hypochondriac effect — I don’t really start worrying about having the symptoms. It’s more like the way some people can’t handle the sight of blood. I just can’t handle the idea of many symptoms.
Laura Allen’s book is unique. As far as I know, she is the first massage therapist to ever write one like it: a scathing and sassy denunciation of her profession’s love affair with crystals, chakras, and fringe science. Addressing her colleagues throughout, she tells them, “Our profession has turned into the snake oil medicine show.”
The book takes the reader on a tour of most of the weird practices that seem to cling to massage therapy like parasites, and asks again and again, “Excuse me, exactly how does that work?” In most cases, of course, the point is that they don’t.
And she describes her own “reformation” from believer to skeptic. She once believed everything she’s rolling her eyes at today. All her snark has a self-depractory poignancy to it, and I hope it makes her sharp criticisms palatable and funny to many people who wouldn’t be able to hear it from anyone else. Allen used to believe it all! “I could not possibly even name all the things I went through,” she writes, but her effort is impressive, and it puts my own substantial New Age dabblings in the 90s to shame. Here’s a sample of how far down the rabbit hole Laura Allen went:
I had a lot of psychic readings. I tried Aura Soma, which is described as “color healing.” I got tuned up with tuning forks, and crystal bowls. I participated in one workshop called Matterspeak, which consisted of sitting around chanting random words, letters, and numbers for 8 hours, as in “1263supercalifragilisti789.” I don’t remember what the purpose of that was and frankly doubt that it had any purpose, other than to enrich the teacher’s pocketbook. If memory serves, she had “channeled” that information from the Atlanteans. I also used the chi machines, the detox foot baths and pads, biofeedback and all kinds of computer programs designed to balance your body, mind and spirit, and most New Agey-sounding things in existence at the time. If it was out there, I tried it.
I collected some buffalo dung…for cermonial purposes. Since it had come from a buffalo on the reservation I figured it was more powerful than your average cow dung.
While we were on a road trip out west, I collected some buffalo dung—I actually witnessed the buffalo relieving himself, waited until he ambled off, and I jumped out of the car with a zip-lock bag to harvest it for future ceremonial purposes. Since it had come from a buffalo on the reservation I figured it was more powerful than your average cow dung.
Allen’s book is all about a different sort of powerful bullshit:
People like to have something to believe in, don’t they? Whether it’s religion, the tooth fairy, or the efficacy of something they have bought—and bought into—people get attached to their BS. I like to say that BS can stand for “belief system” or “bullshit”—your call.
Massage therapists, and others in the holistic arts, are no exception. We seem to be a particularly gullible bunch. And there are a lot of people who have seized upon that, and marketed their products, their classes, their modalities, and their wild claims to us...and many of us have fallen for it, hook, line and sinker...and unfortunately, gone on to convince our clients to buy into it, as well.
Fortunately, not all beliefs are firmly held. Many massage therapists come into them rather carelessly (as I did) — they just seem to go with the territory. Laura Allen’s book is a friendly kick in the rump for any massage therapist teetering on the brink of coming to her senses.
I’ve harvested several quotes from Laura’s book, and they will appear here and there around PainScience.com from now on. It is invaluable to cite her irreverent voice and vast experience with the massage profession — of which she is still a vital member. You’ll find her quoted in the following articles for now:
Sexy question from a back pain patient:
I seem to be able to handle more exercise when the exercise is sex, as opposed to working out. Is there any research on why this might be so? Happy chemicals canceling out the pain chemicals?
No research that I know of. (It’s hard to compare sex to a placebo.) I wouldn’t say so much happy “chemicals” specifically cancelling out pain as just the happy cancelling out the pain. Sex is absurdly uplifting, and mood is a well-known mediator of pain (plenty of research about that).
Pain is a motivator. It exists to get us to act. We hurt when our brains think we need to do something differently for safety, if possible. Our brains are willing to “mute” many danger signals for the sake of sex… because it’s worth it, baby. “Muting” is technically called descending inhibition, which Todd Hargrove describes like this in his excellent book, A Guide to Better Movement:
…the brain does not want to discourage the activity that is creating the nociception, and therefore decides to simply block the danger signals. Descending inhibition may be the mechanism that explains why many people do not feel pain from degenerative changes in joints, bulging discs, or torn rotator cuffs. It also likely explains why pain is often not felt during an emergency.