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Notes -
Is most chronic pain 'in our heads?'
I spent almost a decade dealing with chronic pain of various sorts. I had many diagnosis such as TMJ, Hypermobility, Repetitive strain injury, Carpal tunnel, Tennis elbow, Conversion disorder, etc. What finally ended my pain was close to 5 years of serious meditation, stretching, dance training, and most importantly yoga. Eventually I developed the ability to relax muscles at will even if they were tense from stress.
Right now 20.4 Americans experiences chronic pain(1), with more people in rural populations dealing with chronic pain than in urban populations. Early research shows that this rate has been rising over time. (2) My pet hypothesis is that over time Americans have become more stressed for a variety of factors, which has lead to an increase in chronic pain. This is also most likely linked to a lack of mobility and a sedentary lifestyle.
However, doctors are very wary of telling a patient something is 'in their head'. This isue has probably gotten worse due to the recent backlash against doctors for ignoring someone's personal experience or opinion. I'm afraid that with the current state of our culture this problem will not get better at any time soon.
The most common way to get chronic pain fixed is seems to be to look for non traditional sources of information, typically 'woo' stuff like crystal or energy healing. Unfortunately I have seen a number of chronic pain suffers fall to these types of outlooks, after 'getting in tune with the universe' seemingly healed their pain. In reality I believe that these people simply develop the ability to visualize and relax their muscles.
I think this is a highly neglected problem and something that many people do not realize because chronic pain is often not talked about, and if you do talk about it most of people will either ignore you, give trite and terrible advice, or stop wanting to listen to you. Perhaps most people innately have the ability to relax their muscles, or lose the skill over time for one or another reason.
Has anyone else experienced something similar or observed it among others?
Sources (Cant figure out how to link text from my mobile device)
1 - https://www.cdc.gov/nchs/products/databriefs/db390.htm#:~:text=Interview%20Survey%2C%202019.-,Summary,65%20and%20over%20(30.8%25).
2 -
https://read.dukeupress.edu/demography/article/58/2/711/168526/Pain-Trends-Among-American-Adults-2002-2018
Edit: fixed spelling/formatting errors.
I have a friend who recently went to pain clinic for therapy for like 3 months full time (no medication).
From what he described the pain doctors' conceptualisation of pain is fairly complex but for specifically chronic pain its often goes like this:
Some initial source of pain from an injury, often in the back or some kind of nerve damage.
This pain stays around long term and this fucks up the pain system in various ways.
First off, pain tends to naturally magnify and spread over time, as a sign that you need to be careful not to further injure or even move that area of the body. This is one way you can get pain in areas seemingly unconnected to the initial injury. Furthermore, the way pain is processed is through nerve signals sent to the spinal cord where they get converted into chemical signals that then get sent to the brain. The system is kind of segmented and when a signal gets sent long enough on layer gets overwhelmed and spills over to the next, that's how pain spreads. Now, this process can get self-reinforcing which means that you end up with pain completely unconnected to the original injury and that is unresponsive to traditional painkillers but responds to stuff like Gabapentin.
Secondly, and perhaps more interestingly, our nervous system is adaptive. The more we pay attention to something the better we get at it. Practice violin every day and you'll get better feeling and agility in your left hand. Unfortunately this works for pain as well. Get chronic pain from some injury and you'll pay attention to it all the time which trains your nervous system to be sensitive to that pain, which can be crippling.
For the second point there is an obvious solution, practice feeling other things even when you're in pain. Try to find some area in your body that doesn't hurt or feels less pain and focus on that.
Here various meditative practices and yoga can be very helpful. Relaxation is part of it but not the only aspect, luckily they often go hand in hand. This doesn't necessarily remove all pain but it has a very high success rate at decreasing it and making it manageble.
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Isn't by a strict definition, all pain in our heads?
Absolutely. I mainly used that phrase to get people interested. More specifically I am talking about the specific skill of mentally visualizing and/or controlling muscles intentionally. To put it another way, developing your kinesthetic sense.
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The very existence of the placebo effect (and the nocebo effect) and the fact it works even if you tell people it is a placebo, suggests that our mind plays a larger role than we give it credit for. And if our mind can make us believe that pain is worse than it is (or that pain exists where it does not), then our mind can do the opposite and alleviate 'real' pain. I think a lot of people want their pain to be recognized and validated, and that turns them away from 'simple' solutions they can do themselves. In the past, you needed to get through pain in order to survive. Today pain can be used as an excuse to not work, and not working isn't going to impact your survival. So the motivation to be pain free, especially for the lower class, has evaporated. Good times create weak men.
I think masturbation is a great example of how powerful the mind is. If you're not aroused or comfortable, masturbating can be a futile exercise, no matter how much physical effort you put in. And yet a dream can be so powerful as to cause an orgasm, with absolutely no physical stimulation. For the most part, people prefer masturbating with a particular thought in their mind, or looking at certain materials. Typically people masturbate in a comfortable area where they feel safe (and private). Imagine if we began to ignore this mental state with regards to masturbation, and instead replaced it with a pill (and not specifically viagra, but something that would make you ejaculate/orgasm; or maybe not even feel the need to). This is basically how we treat pain today, with no concern given to the mental state. Mental health is treated like this more and more everyday, it seems.
Wow, you made some great connections in this comment. I've relatively recently changed my mind on the importance of mental frameworks or attitudes when it comes to physical/mental pain. I also lament the fact that so many mental health 'disorders' are now seen as impossible to fix, or a result of a way the brain is structured. I think it's mostly hogwash.
Your link to the placebo effect is also excellent. It is strange that people can study something like the placebo effect, know its real, and yet not truly make any effort to utilize it's effects. Seems like the proverbial $20 bill left on the ground with regards to modern medicine.
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As
Doglatinecuwurious_strag_CA (mixed up posts) brought up, the Sarno Method sticks out to me as proving a psychogenic cause for some chronic pain. Whenever it’s mentioned online there are larger than expected people claiming to be cured thanks to it. Geraldo Rivera has video about it on YouTube. It’s vaguely similar to Carr’s Easy Way for smoking cessation, which also relies on a psychological approach.There’s also neurasthenia, historical neurasthenia which has similar symptoms to contemporary chronic pain. AZC hosted a book review on that. Most treatments had a psychological dimension, involving inherently pleasant places like the seaside or mountain, and a cessation from stressful reading and analysis.
I know Jordan Peterson says he suffered from varied symptoms and fatigue and pain before he went on an all steak diet. But his all steak diet corresponded with his rise to stardom, reduced obligations at work, enjoyable travel, etc. I doubt it was the eating of only steak that cured Peterson’s unusual pains. Instead he was probably suffering from a kind of psychogenic chronic pain, cured from the new (more enjoyable) lifestyle he developed, where instead of thinking up all his ideas he gets to talk about them to supportive people.
Does anyone have any experience with this? I've been suffering from some sort of mental burnout/exhaustion that I think is due to spending 10+ hours a day in front of screens while chronically ingesting information and over-analysing. Symptoms are eye strain, irritability/social awkwardness, anxiety etc. It's probably common sense that I need to dial things back and spend time relaxing away from technology. It's hard to change your habits though.
What worked for me was slowly learning how to relax my muscles, especially those around my jaw/mouth/throat, during meditation and yoga. As I got better I slowly started to work on relaxing those muscles while reading books, then watching shows, then browsing the web.
I do believe it's a skill you can train to relax your muscles while doing 'stressful' activity, but you have to take it slow.
Just wanted to comment on this (9 months later). I've had some success in physically relaxing muscles (and to a degree active thinking) while in a state of mindfulness. It really helps me relax and rest, particularly after a period of highly intensive stressful focus. Thanks for your advice on this.
Hah no worries. Glad to hear it was helpful for ya.
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Also where does Doglatine bring this up? Would love to see another similar discussion.
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Agreed! There are all sorts of diagnoses that make no real sense, such as Trigger Point issues, Chronic Fatigue Syndrome, Fibromyalgia, MS, Cluster Headaches, Hypersensitivity, the list goes on and on. As someone who's spent the better part of a decade in this space it boggles the mind how many potential options there are when you spent a lot of time going through them.
I didn't know about Jordan Peterson's issue - I also think a lot of 'diet sensitivities' can be explained by severe stress or anxiety as well. On another note I think this ability of training awareness and using it to relax muscles may be a large reason why meditation is so persistent as a practice, and so many claim it has extraordinary powers.
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The issue maddeningly confounded by reverse causality and feedback loops. As a running and biking enthusiast, I can say that approximately zero of my many friends that are into endurance sports suffer from chronic pain. Plenty of acute pain, even plenty of injuries that stick around and bug people for a long time, but none of fibromyalgia or long Covid or chronic Lyme style of diseases. All of the people that I know that suffer from the various mystery maladies that cause them suffering with no obvious cause or cure are thoroughly out of shape and have never put any real effort into improving their fitness. I can safely say that the circle of people that intentionally experience cardiovascular suffering from track intervals or hill sprints is completely non-overlapping with people that experience suffering while doing absolutely nothing.
Of course, the obvious retort is that the people with the chronic pain simply can't take up endurance sports, so it's a selective sample. This is pretty obviously at least part of what's going on, which makes it hard to draw any meaningful recommendation from the above other than the usual generic advice that you should avoid being fat and sedentary.
I think about this at least once a week. I think of myself as having average or better pain tolerance in the context of activities. I regularly climb or lift through serious pumps, I'll drag my ass through a marathon I haven't trained for, my hands and arms are covered in scabs and scars from bashing them on something climbing or futilely struggling on a stuck bolt on an old truck. When those things happen I'll barley notice them, I'll bash my elbow into a hold, scream fuck once, and finish the climb even after the blood starts dripping to the ground.
But take me out of an activity, and I'm SUCH a pussy. I'm going to give blood tomorrow, and I know I'm going to wince when they stick the needle in. I've done it every time I could for years, but I still wince when they stick me.
Hell last year I stabbed myself in the leg with a box cutter trying to work on something, barely noticed the pain of actually stabbing myself, calmly bandaged it and drove to urgent care, then had to grit my teeth to get through five stitches. You'd think I was getting civil war surgery if you looked at my face.
Mentality and context is everything for me.
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Regularly using your body helps but IMO it's not clean-cut; your comment is ambiguous enough that I'm going to elaborate.
I'm pushing 40 and still have chronic ~inexplicable back pain since my teens. I'm not a paragon of effort, but I'm not a slug either. I run a 5K every second day (for more than 4 years now!), alongside a variety of physical activities (think pilates, modern dance, HIIT, etc; Covid's response disrupted but didn't completely stop 'em). Sure, I could probably do more, but I could also do an awful lot less, so I claim I'm a relevant data point.
These help manage the pain, but it isn't as rosy a picture as your comment paints.
Physical activity is definitely a tool more people should try and should try more of with a plethora of benefits (mood! confidence! sunlight-if-you-do-it-outside! etc). However, I can read your comments as saying "if only the people with bad-brains-pain would move more, it'd go away". It sadly isn't universal or a fix; I'm living proof.
("ahah!", I imagine that you say, "I didn't mention chronic back pain, just chronic lyme; back pain is different!" Well, maybe. I dunno. I can't tell. Probably? Maybe that's the deal; 80%+ of chronic lyme is bad-brains, while only 25-75% of back pain is bad-brains and the remainder is the back pain of the gaps? Who knows!)
("that back situation sounds like it sucks, man; sorry", I go on to imagine from you, because that's the kind of forum this is going to be ;) )
I agree with your points actually, although not a fan of the pessimism about the sites future. Personally I believe many long time lurkers, like myself, will become posters now that the gaze of AEO is gone. I certainly hope the quality of comments and discourse remains around the same level, and I'm now galvanized to help achieve that.
You're right that I painted a far too rosy picture, I need practice anticipating arguments and I also need to think through this idea. I only became convinced recently and I'm still willing to toss it out if I find strong evidence against it. Part of why I'm posting it here.
My argument is more that a significant portion of chronic pain could be cured by incorporating this idea into treatment. To be clear, I know for a fact that many chronic pain illnesses have concrete causes, and are unfortunately much harder to fix.
Say there is a line between treatment styles of 'think your way out of the pain,' vs. 'all pain is caused by concrete factors that we know, and your mental attitude has no bearing'. Right now I think the line has move too far in favor of the latter, and we need to take a more diverse approach when treating chronic pain.
This will become increasingly relevant as more and more activity takes place on a computer, and we inevitably become even more sedentary than we are now. Figuring out the issue now could prevent a whole host of problems from cropping up in the future.
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The confounding factors seem to be infinite. This doesn't even bring sunlight exposure into the picture for example, which also has a large effect.
I can personally attest to the fact that it's difficult to force yourself to exercise when you have severe pain. However it doesn't help that so much of the medical establishment is incredibly scared of telling a chronic pain patient to be more active. Even physical therapists, chiropractors etc. told me I shouldn't 'push myself too hard' and to only do 30 minutes of light stretching a day.
You really do need to build up some sort of mental toughness to push through the pain. I'm afraid our traditional methods of healing people in those situations only make their condition worse.
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Can anybody else do the thing where you try to relax the all muscles in your body and you feel a buzzing, tingling sensation?
Yes, I've always been curious if there was a name or explanation for this phenomenon.
I see it discusses more frequently with regards to meditation/yoga than anywhere else. Zen Buddhism has a number of references to this if you dig hard enough.
I suspect this is not the same thing I'm describing. For me, this is not something that happens during meditation, it's something I can cause at will with no difficulty by consciously "letting go" of control of my muscles. I've been able to do this as long as I can remember. It's not a particularly pleasant feeling, a little like being electrocuted, and I can't maintain it for more than a few seconds without feeling like my muscles are going to involuntarily spasm.
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I can during moments of intense meditation or after a lot of physical activity, mainly yoga or dance. However I seem to be getting much more skilled at producing it more frequently.
Intense music that I really like can also help me get into that state.
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Isn't this just a thing one can do with muscles, like moving them?
Yoga is physical activity though, this doesn't distinguish between "more physical activity / stronger core / better integrated muscles / stretching muscles" helping the pain and it being mental
Claims that it works, from patrick collison's twitter - the "sarno method", fixing chronic pain just by intent, he claims it worked for 4/4 people he knows and many agree in the comments. Maybe ... the whole "people tense muscles when stressed for a long time, relaxing them fixes pain" is a component - the "stress = tense muscles" thing is certainly true in some sense, but the woo/therapy interpretations aren't quite right imo. And most woo-seeming things that work don't work for the reasons people think they do, and come with meaningless pacifying therapywoo! It just coming down to relaxing the muscles is plausible, but probably not the whole story, idk.
This may depend on the instructor, but I find yoga to also be a bit mental as well. There's a bit of meditation going on. Your breathing is regulated, you may be encouraged to clear your mind and focus solely on the pose you're holding. As TheDag describes, the instructor may tell you not just how to engage the appropriate muscles but disengage others, helping you "get in touch" with how your body works beyond mechanical movement. This meditation and bodily focus is why yoga attracts or creates the "woo" energy/spiritual types.
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I agree with all of your statements! To be a bit more nuanced, I certainly think strength/flexibility/mobility training is an important component of this, and helped me quite a bit. Perhaps to put it another way even though I spent 10+ years learning various types of strength training regimens and fitness programs, I never found a method that focused enough on the general idea of for instance, "when doing a crunch, make sure to relax your head/jaw/neck etc." Yoga was the first method that actually taught me to do that, eventually, after years of semi-regular practice and six months of daily practice.
I also made huge breakthroughs right after quitting a high stress job so I now think stress was an important factor in many of my physical issues. To be clear I don't believe in Sarno's stuff though I have read through it. I briefly used the Curable app, which is much more nuanced and focuses on body scan meditations and other ways to hone your awareness of your muscles.
Could you give an example of "And most woo-seeming things that work don't work for the reasons people think they do?" I find this topic very interesting.
As an aside, I'm very excited for the new site! The move was a good enough reason to motivate me to post this though I've been thinking about it for months. Thanks for your positivity and hope for this place, your comments were useful in convincing me to join.
Therapy/psychonalysis where you "get rid of negative thought patterns / childhood trauma / latent oedipal desire / condition your lizard mind / remove tensions between different sub-parts of your mind", but the practical outcome is just "the therapist becoming your friend / socially pressuring you to do the thing", with the explanation mostly serving as a distracting trick (although one all parties sincerely believe!). Meditation on chakras, even though the physical location of the chakra is basically random and it'd work if the chakra was just a vague concept instead of having a location. Spiritual claims about specific yoga poses. "The secret", the whole "visualize a thing and it'll come", when "visualize it" is either a "if you look for something you'll see it" trick or a way to get people to try just a little bit to actually accomplish it. These are all very different things, and are only all 'woo' in a broad sense, but there's a similarity!
So do you think the best way to avoid a lot of stress/chronic pain is having a stronger social net and not consciously doing the wrong thing?
I think I can agree with that basic concept, but the problem seems to lie in communicating what exactly is the right thing, how you figure out what you believe the right thing is, etc. This is notoriously difficult to communicate which is why so many specialized and esoteric systems have developed to attempt it.
What would you suggest as an alternative way to help rid people of 'negative thought patterns' etc?
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