Pain Science Reading Guide for Skeptics

A tour of PainScience.com for readers who have doubts and concerns about the validity and efficacy of popular treatments for injuries and chronic pain

Paul Ingraham • Mar 20, 2019 • 5m read

I hope that skeptics, critical thinkers, and scientists will feel right at home on PainScience.com, and come to think of it as a valuable resource in combatting pseudo-scientific nonsense and old wives’ tales about aches, pains, and injuries. Of course I debunk classic quackeries like subluxation theory, acupuncture, and homeopathy, but that’s the tip of the iceberg — the stuff every skeptic knows about.

There’s so much more. I’ve seen countless people who scoff at homeopathy fall uncritically swallow whatever nonsense their physical therapist tells them. They don’t even know there's controversy about it. But basically everything in the treatment of pain and injury is controversial, and the pseudoscience is rampant.

Most people who call themselves “skeptics” are critical-thinking generalists. Specialized skeptics, with deep knowledge of a bullshit in one field, are relatively rare. I am a definitely a specialist skeptic, studying one very particular kind of bullshit since the early 2000s years now. And I want all skeptics to understand this: it is not just the chiropractors and osteopaths that are churning out the nonsense about pain and injury. You need to start asking whether your physical therapist is actually practicing evidence-based medicine! Because the answer is “probably not.”

There is a great deal of obscure and underestimated nonsense pseudoscience in the world of pain and musculoskeletal medicine. You can find many deep dives here on all kinds of topics that receive surprisingly little critical analysis elsewhere, like ultrasound, electrical stimulation, stretching, arnica, posture, trigger points, t’ai chi, fascia, orthotics, and many, many, many more.

This page lists articles with a particularly strong skeptical angle; see also the complete index of treatment reviews.

What skeptics should read on PainScience.com

• Pseudo-Quackery in Physical Therapy — The large, dangerous grey zone between evidence-based care and overt quackery in rehab and pain treatments. There are many intellectually immature and pre-scientific ideas in musculoskeletal health care and not just in alternative medicine — treatments and therapies that skeptics aren’t generally aware of … but should be.
• Does Epsom Salt Work? — The science and mythology of Epsom salt bathing for recovery from muscle pain, soreness, or injury. A perennially popular article, attracting thousands of readers per month for more than a decade.
• Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be. The most annoying trend in alternative medicine is the exaggeration of “the power of placebo” as a justification for therapy that can’t beat a placebo. Therapies that perform no better than placebo are now predictably spun as being “as good as placebo,” as though placebo is the new gold standard to meet. Oh my.
• Quite a Stretch — Stretching science has shown that this extremely popular form of exercise has almost no measurable benefits This is PainScience.com’s original controversial article. Stretching was one of the issues that got me writing.
• The Chiropractic Controversies — An introduction to chiropractic controversies like aggressive billing, treating kids, and neck manipulation risks. The original version of this article was a polemic, and it sparked the fight that inspired my own departure from alternative medicine. The current version is a much more diplomatic and mature summary of issues, and probably more useful and effective.
• Does Fascia Matter? — A detailed critical analysis of the clinical relevance of fascia science and fascia properties. The epidemic of pseudoscientic fascination with fascia looks quite silly by the end of this article.
• Alternative Medicine’s Choice — What should alternative medicine be the alternative to? The alternative to cold and impersonal medicine? Or the alternative to science and reason?. This article contains the highest concentration of criticism of CAM found on PainScience.com, and also talks about what alternative medicine could have been in an alternate universe — what it could and should have been, as opposed to being an not-so-complementary anti-scientific substitute for medical care.
• Does Massage Therapy Work? — A review of the science of massage therapy … such as it is. As both a skeptic and a former massage therapist, I’ve spent more energy on this topic than any other. Massage itself is not quackery … but the profession is badly polluted with it. (Skeptics will particularly enjoy my compilation of 💩 Massage Therapists Say.)
• Quackery Red Flags — Beware the 3 D’s of quackery: Dubious, Dangerous and Distracting treatments for aches and pains (or anything else). A short article built around a highly condensed caveat emptor infographic, a Venn diagram — shareable and social media friendly. Grab the full-size image and pass it around.show
• Why “Science”-Based Instead of “Evidence”-Based? — The rationale for making medicine based more on science and not just evidence… which is kinda weird.
• Homeopathy Schmomeopathy — Homeopathy is not a natural or herbal remedy: it’s a magical idea with no possible basis in reality. This is my terse, almost obligatory dismissal of homeopathy. For a much deeper dive…
• Does Arnica Gel Work for Pain? — A detailed review of popular homeopathic (diluted) herbal creams and gels like Traumeel, used for muscle pain, joint pain, sports injuries, bruising, and post-surgical inflammation. While the Traumeel brand survived, it was the most popular of all homeopathic products.
• Ioannidis: Making Medical Science Look Bad Since 2005 — A famous and excellent scientific paper … with an alarmingly misleading title. (One of the nerdiest articles on the site … with one of the strongest skeptical points.)
• Popular but Weird & Dangerous Cures — The most dangerous, strange, and yet popular snake oils and “treatments” in history (and why anecdotes and testimonials cannot be trusted).
• 13 Kinds of Bogus Citations — Classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable”. Fine link bait, this one! Share it!
• Does Acupuncture Work for Pain? — A review of modern acupuncture evidence and myths, focused on treatment of back pain & other common chronic pains. More than any other topic in pain medicine, acupuncture gets a pass it doesn’t deserve from otherwise skeptical people. But acupuncture is just as scientifically bankrupt as homeopathy.
• Extraordinary Health Claims — A guide to critical thinking, skepticism, and smart Internet reading about health care.
• Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. This is my thesis, the “big idea” of my career from before it got all popular.
• The Not-So-Humble Healer — Cocky theories about the cause of pain are waaaay too common in massage, chiropractic, and physical therapy. This article criticizes alt-med practitioners for not actually being humble, and includes a great story about an encounter I had with a therapist with an amusingly specific theory about the origin of “all pain.”
• Water Fever and the Fear of Chronic Dehydration — Do we really need eight glasses of water per day? A profile of one of the most irritating and persistent bits of unscientific health advice under the sun. Closely related: the obnoxious habit massage therapists have of recommending hydration after massage to help “flush out liberated toxins.”
• Therapy Babble — Hyperbolic, messy, pseudoscientific ideas about manual therapy for pain and injury rehab are all too common. More curmudgeonly skeptics will enjoy this ranty little article … plus the fantastic comic strips from Cectic, and the classic example of the butt-reflexology hoax.
• Applied Kinesiology is Bunk — The skeptical position on applied kinesiology, a bizarre and extreme alternative medicine method of diagnosis practiced mainly by chiropractors and naturopaths

Other Recommended Resources for Skeptics

With a bit of an emphasis on skepticism about health care in particular…

• Science-Based Medicine: Exploring issues and controversies in the relationship between science and medicine (sciencebasedmedicine.org). Science-Based Medicine is now the single best source of critical thinking about health care available anywhere. Founded by Yale neurologist Dr. Steve Novella of the Skeptic’s Guide to the Universe, it’s written by several physicians who are alarmed by the soaring popularity of dangerous and pointless alternative health care. The title of the post expresses the elegant idea that the value of health care ideas must not only be based on evidence, but must also be reasonably consistent with a well-established body of scientific knowledge of how the human body works.
• What’s the Harm? (WhatsTheHarm.net). Alternative health care has an undeserved reputation for being harmless and wholesome. In fact alternative medicines and treatments are just as full of hazards and risks as medical care, yet with virtually no proof of efficacy or regulation. While many other skeptical websites focus on the question of efficacy, WhatsTheHarm.net is devoted to cataloguing the costs of alternative health care: the many lives ruined and even lost.
• QuackWatch: Your Guide to Quackery, Health Fraud, and Intelligent Decisions (QuackWatch.org). Quackwatch fights health-related frauds, myths, fads, fallacies, and misconduct. Its primary focus is on health consumer information that is difficult or impossible to get elsewhere. Dr. Stephen Barrett, the founder of QuackWatch and author of most of the articles, is one of the great figures of anti-quackery activism. For many years now, I’ve been watching his work and the controversies and legal battles that swirl around QuackWatch, and I have been consistently impressed by Dr. Barrett’s integrity and intelligence — and unimpressed by the tactics and quality of his critics. He is also providing a vital service and a sorely neglected perspective on health care.
• Respectful Insolence (respectfulinsolence.com). One of the oldest and best skeptical blogs on the internet, written relentlessly since forever by Orac, the no-so-secret blogging identity of Dr. David Gorski, best known for his writings on cancer and vaccines, among much else. He was also my boss at ScienceBasedMedicine.org for several years.
• EBM-First.com (ebm-first.com). A well-curated and thorough directory of reading recommendations and references for a couple dozen alternative medicine topics. It’s hard to find good reading lists, but it’s not hard here! The most relevant to PainScience.com are craniosacral therapy, energy therapies and reiki, homeopathy, magnetic therapy, reflexology, therapeutic “touch.” As you can see there’s a strong focus on alternative medicine’s flakier side.
• Bad Science (badscience.net). Blog of Ben Goldacre, best-selling author, broadcaster, medical doctor, academic, and tough critic of bad science wherever it happens, in both mainstream and alternative medicine … Could Ben be any more my kind of guy?

And a few notable blogs about aches and pains and related topics by authors who “get it”:

• BetterMovement.org: Practical Science On Movement And Pain: Practical Science On Movement and Pain (BetterMovement.org). Todd Hargrove is a Seattle Rolfer with a refreshingly clear, precise, and rational style. He has an uncanny ability to tackle controversial subject matter in a way that doesn’t seem to bother anyone.
• The New York Times, Well Blog (well.blogs.nytimes.com/author/gretchen-reynolds). Gretchen Reynolds has written hundreds of articles for The New York Times “Well” blog … and they’re basically all good. She’s the most reliable mainstream journalist writing in this field that I’m aware of.
• Sweat Science: Fitness myths, training truths, and other surprising discoveries from the science of exercise (outsideonline.com/1745511/alex-hutchinson). Alex Hutchinson's "Sweat Science" column has been hosted by Outside magazine for years now, with weekly posts, usually focusing on a study about training and performance in outdoor sports.
• TheSportsPhysio: Simple, practical, honest advice (thesportsphysio.wordpress.com). I have marketed myself as a “sassy” rationalist, but truthfully Adam Meakins is much sassier and feistier than I am. An entertaining and very skeptical physiotherapist blogger.
• GregLehman.ca (greglehman.ca/blog). Greg Lehman is a Canadian physiotherapist and chiropractor with incredible mastery of the subject matter, good writing skills, and real talent for seeing all sides of an issue.
• Massage & Fitness Magazine (massagefitnessmag.com/whats-the-news). The man behind Massage & Fitness Magazine, Nick Ng, used to be grumpy about PainScience.com, but has since become a skeptic and one of the most tireless writers and advocates for rationality in the field.