site banner
8nbVq8oVakvAp6SX  28d ago (text post)   613 thread views

What experimental evidence is there that chronic pain is psychosomatic?

There have been claims of this by commenters, but only anecdotal evidence given. Last I checked, the accepted/preferred scientific explanation was "central sensitization," though I couldn't find an experiment showing chronic sensitization exists. (Lots with decerebrated mice who were immediately euthanized, though, going back to the 1980s, if I remember correctly.) Psychosomatization, to the best of my knowledge, is non-falsifiable and conditions have been misattributed to it in the past. It hasn't yet been replicated, so far as I know, but there was a clever experiment published 18 months ago that may prove fibromyalgia (one of the chronic pain conditions most commonly regarded as psychosomatic) is actually an auto-immune disorder, which would be a big blow to "psychosomatization of the gaps" proponents. (E.G., The "Unlearn Your Pain" author.)

Is this just a case of Scott making an off-hand comment and others running with it beyond what the evidence can support?

7
Top Bottom Old Controversial Comments
Jump in the discussion.

No email address required.

No new evidence, but an anecdote.

I hurt my right ring finger badly (A2 pulley- climbing) last October, and it has been a long recovery process. Lately however, I have started noticing pain in that exact same location on my left finger, and nowhere else.

Now, I haven't climbed in months, and have been resting all my fingers since. If anything, this is the most relaxed my fingers have been in years. It's almost like my brain can't tell which side the pain signal is coming front, mixed it up, and instead perceives phantom pain signals from the wrong side of the body, but that exact same location - mirrored. When I try to use my 'phantom hurting' right finger, I can still load it up to full capacity and have full mobility in it. Funnily enough, this is also the least pain my actually hurt finger has been in, but that's to be expected given the careful recovery process.

From my datapoint of 1, I have to conclude that some pain is indeed, psychosomatic.

disclaimer - it could also be carpal tunnel / RSI due to overuse. I have been doing 70+ hr work weeks. But, I'd expect it to affect my other fingers too.

There’s also some evidence that stress can significantly increase risk of autoimmune disease which can make this whole argument a bit circular. We don’t have great categories yet for discerning between “real” and “psychosomatic” pain.

Even pain as a concept is poorly labeled and understood.

Well, why did you list chronic pain as a possible culture bound illness?

Personal experience with it has convinced me that’s the case.

How confident are you that your experience applies to the general population and why?

Not positive of course, but I’ve also spent a decade looking into chronic pain and at first was strongly against the idea it could be psychological. I was wrong and accepting that has helped me get better.

Some other sources are Unlearn your pain by Sarno, and a bunch of other books.

Also there’s a lesswrong post I can’t paste for some reason but it’s called “The mind-body vicious cycle of RSI and back pain.”

I’ve got a few more bookmarks I’ve collected over the years I can dig up if you’re curious. No solid RCTs as far as I have studied but lots of personal and anecdotal evidence.

I definitely wouldn’t die on the hill that most or even 50% of chronic pain is psychological, but I do think it is a large component. I’m a fan of the bio-psycho-social model of pain myself.

Having had some recurring back spine/nerve related pain after an accident, I'm a bit dubious on the psychosomatic front.

Maybe my pain was just entirely biological because pain killers surely fixed my shit up for a few hours. While not medicated I could "choose" to ignore the pain and it would go away for a while but it would return basically any time I moved "the wrong way" or was "reminded" of my problem spots by a sharp stabbing of pain when rotating my upper torso in a specific way.

I think the idea is more like this:

You have an injury, brain tightens certain muscles to protect them --> The muscles heal over time, but you have a trapped prior around constricting that area --> If you can't get muscles to release, constant muscular tension begins to cascade into other muscles and areas of the body.

Which implies that painkillers and muscle relaxants can relieve pain for far longer than they're supposed to last in such cases by helping to break the cycle.

Which conforms to my personal experience as well. Though I'd expect cases of chronic pain to be filtered a bit against cases where that works.

There’s this, specifically for back pain: https://www.bidmc.org/about-bidmc/news/2021/09/researchers-mind-body-program-outperforms-other-chronic-back-pain-treatment

2.5.2. Usual care (control)

Participants randomized to the usual care arm continued their prescribed treatment regimens under guidance of their physicians and without influence from the study team.

The way the study was designed, perhaps the usual care underperformed usual care+placebo. Also, the exclusion criteria included "had diagnosed organic disease as cause of pain."

Surgery and steroid injections for back pain strike me as one of those "when all you have is a hammer" type problems.

Has there ever been a study of the obvious solution involving a shoulder harness, block and tackle, and a tall tree?

No but inversion tables have been shown to be helpful

What is this place?

This website is a place for people who want to move past shady thinking and test their ideas in a court of people who don't all share the same biases. Our goal is to optimize for light, not heat; this is a group effort, and all commentators are asked to do their part.

The weekly Culture War threads host the most controversial topics and are the most visible aspect of The Motte. However, many other topics are appropriate here. We encourage people to post anything related to science, politics, or philosophy; if in doubt, post!

Check out The Vault for an archive of old quality posts. You are encouraged to crosspost these elsewhere.


Why are you called The Motte?

A motte is a stone keep on a raised earthwork common in early medieval fortifications. More pertinently, it's an element in a rhetorical move called a "Motte-and-Bailey", originally identified by philosopher Nicholas Shackel. It describes the tendency in discourse for people to move from a controversial but high value claim to a defensible but less exciting one upon any resistance to the former. He likens this to the medieval fortification, where a desirable land (the bailey) is abandoned when in danger for the more easily defended motte. In Shackel's words, "The Motte represents the defensible but undesired propositions to which one retreats when hard pressed."

On The Motte, always attempt to remain inside your defensible territory, even if you are not being pressed.


New post guidelines

If you're posting something that isn't related to the culture war, we encourage you to post a thread for it. A submission statement is highly appreciated, but isn't necessary for text posts or links to largely-text posts such as blogs or news articles; if we're unsure of the value of your post, we might remove it until you add a submission statement. A submission statement is required for non-text sources (videos, podcasts, images).

Culture war posts go in the culture war thread; all links must either include a submission statement or significant commentary. Bare links without those will be removed.

If in doubt, please post it!


Rules


Recommended Posts And Communities

Recommended Realtime Chats