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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.
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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