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In late 2014 I moved all of the articles I’d ever written about pain from the old domain “SaveYourself.ca” to the shiny new “PainScience.com,” and I knew that I would have to write even more articles to be worthy of that name — more articles about pain science. I’d always stuck to writing mostly about injury, manual therapy, and rehab (stuff that was clearly in the scope of practice in my old job as a massage therapist). Vast regions of the science of painful things were neglected (the Neurology Ocean, the Rheumatology Continent, and so on).
Since then I have definitely started to spread out, with new articles and major updates about opioids for musculoskeletal pain and over-the-counter pain-killers, the effect of smoking on pain, unusual sources of pain, transcutaneous electrical stimulation (TENS), the ugly details of the controversy about trigger points, a much broader look at morning back pain, plus pain conditions that are much more about “software” than “hardware,” like tension headaches and frozen shoulder and (a really weird one) globus pharyngis.
Many moons ago I started trying to understand and explain pain, gradually producing an article: Pain is Weird.
I was only dimly aware as I worked that I was re-producing some much more mature ideas. I knew that modern pain science and treatment has deep roots, insights and research going back to the 1960s and Melzack, gate control theory and cognitive behavioural therapy, but my explaining was eerily similar to a recent and popular “packaging” of pain science known as Explain Pain (EP), from Drs. Lorimer Moseley and David Butler: “a range of educational interventions that aim to change one’s understanding of the biological processes that are thought to underpin pain as a mechanism to reduce pain itself” (Moseley). There’s a book of that name — Explain Pain — and many other interpretions and riffs on the key ideas (like my own). It’s not that I invented my own version of Explain Pain independently, I was just trying to explain pain, you know? Lowercase!
Explaining Pain according to Dr. Moseley is about “wanting people to actually understand how and why they can be in horrible pain yet not in horrible danger.” According to me, explaining pain (might) help to reduce it, and it’s inherently fascinating even if it doesn’t do a lick of good.
There have also been a lot of misunderstandings. Because explaining pain is tricky. (There are still plenty of unanswered scientific questions, too.) And because Explain Pain as a “brand” might be a little bit of an over-hyped upstart, maybe given too much credit by too many people too soon — especially the idea that it actually reduces pain, which remains highly speculative. Nevertheless, for the record, here are some key misconceptions about EP…
But the mother of all misunderstandings is the popular idea that if pain is an output of the brain, then we must be able to think our way out of it. It’s such an important and difficult topic that most of the rest of the article is devoted to it.
Official (IASP) definitions of pain terminology: reading so dry it’s like eating a bale of hay! But a valuable reference nevertheless. For example, here’s the formal definition of pain:
An unpleasant sensory & emotional experience associated with actual or potential tissue damage, or described in terms of such damage.
And now less formally, my translation:
A shitty, freaky feeling which may or may not have anything to do with fucked up tissues (but it sure seems like it!)
I should do a complete translation of the entire IASP taxonomy page like that.
Dr. Fred Wolfe is about as expert as a fibromyalgia expert gets: he’s largely responsible for the official diagnostic criteria for fibromyalgia (the original in 1990 and then the important revisions in 2010/11, which ditched “tender points” and factored in symptom severity, in a nutshell).
Since 2013, Dr. Wolfe has been blogging erratically, and in this short post he explains (with snark!) how fibromyalgia is being buried by an avalanche of crappy, useless research. (And you could substitute nearly any other difficult or controversial condition, like “trigger points” for instance.)
PubMed reports 659 publications in the last 12 months relating to fibromyalgia. For those who are interested, there are 9,366 articles listed in the all the years that data are available. For 1990, the year the American College of Rheumatology 1990 fibromyalgia criteria were published, PubMed cites 95 articles. If you think that after all these years of research you and your patients are much better off, think again. A kind, conscientious physician treating a fibromyalgia patient in 1980 or 1990 will have done as well as the 2016 health workers with access to all of these new publications and expensive if not very efficacious medications.
Reader question: Could you possible share a few ideas about how to stay current on relevant literature? What is your system?
I use a lot of RSS feeds from journals, and scan those daily for relevant headlines, using good power tools, Reeder for Mac (an RSS reader) and Feedbin (a paid RSS subscription/syncing service and online reader). If you don’t know about RSS, see RSS in Plain English 5:00.
I also subscribe to the NEJM’s JournalWatch service which gives me good quality summaries.
But weirdly, social media is now probably the most important source of sources for me these days. I have a strong network of really smart colleagues who are also trying to stay current, and our collective efforts are extremely effective. As a group, we don’t miss much, and it’s often super clear what the most interesting recent papers are based on who shares what how often with how much enthusiasm. When a particularly intriguing and good quality paper is published, I’m going to find out!
So, cultivate virtual friendships with colleagues and mentors, and join Facebook discussion groups and fan pages where research gets discussed! They aren’t hard to find.