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Pain catastrophizing: More profound stupidity

Discussion in 'Other Health News and Research' started by Woolie, Aug 12, 2015.

  1. Woolie

    Woolie Senior Member

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    I can't get over this one.

    Its called "pain catastrophizing". The basic idea is that patients - especially of course those with medically unexplained symptoms - can work themselves into a frenzy of mad, catastrophic thinking which causes their pain to feel much worse than it really is.

    The evidence for "pain catastrophizing"? Self report studies show that people who ruminate about their pain, or express their feelings about it in exaggerated terms, or feel more helpless when in pain, are more likely to rate their pain as more intense.

    How circular is that? If your pain is more intense, you're likely to feel worse about it, and find it intrudes more into your thoughts... it doesn't take a genius to predict that. But of course, the claim being made here is the exact opposite: that your maladaptive, dysfunctional thinking makes the pain more intense. The tail actually wags the dog, as it were.

    Now get this one: Females are more likely to "catastrophize" about their pain than males. How do we know? Because someone asked a large bunch of undergrads to think of an intense pain experience they can recall then rate their thoughts and feelings about it - how helpless they felt, how much they ruminated on the pain, etc. The females tended to rate feeling more helpless, and to think about their pain more (although not necessarily describe it in more exaggerated terms):

    Testing Factorial Validity and Gender Invariance of the Pain Catastrophizing Scale
    Joyce L. D'Eon, Cheryl A. Harris, Jacqueline A. Ellis


    None of these researchers bothered to report what pain experiences the two genders were actually responding about, let alone ensure the pain experiences were of comparable objective intensity. I'm guessing the female undergrads were reporting a lot more menstrual pain - perhaps the odd miscarriage - and maybe a few less football injuries.

    I don't know whether to laugh or cry.

    Why is this so outrageous? Because this kind of thinking is not only lazy but extremely dangerous. It can be used to justify why "medically unexplained symptoms" are really in all our heads...
     
    Last edited: Aug 13, 2015
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  2. Cheshire

    Cheshire Senior Member

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    It reminds me of that stupid study: Brief report: Writing about chronic fatigue increases somatic complaints

    They asked healthy people to imagine they had CFS and write about it, and then noticed they had higher scores on the Somatization subscale of the SCL-90 than controls who wrote about anything they wanted. No need to have a control group writing about having cancer or MS to compare...

    http://forums.phoenixrising.me/inde...writing-about-cfs-symptoms-causes-harm.27106/
     
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  3. A.B.

    A.B. Senior Member

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    These people don't live in reality. It's all about selling an idea to the research grant office or desperate patients.
     
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  4. lansbergen

    lansbergen Senior Member

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    :rofl::rofl::rofl::rofl:
     
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  5. Forbin

    Forbin Senior Member

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    As someone of Norwegian descent, I can tell you that over-emotionalism
    is not the problem. :)

    [​IMG]
     
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  6. Simon

    Simon

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    Slight digression but in the early years of my illness my pain was very severe and I belonged to a chronic pain group (run by a woman, of course, no doubt ruminating away about nothing but imaginary symptoms from a serious spinal injury).

    Two things struck me about the similarities between chronic pain and mecfs.
    1. PEM was common, along with relapses. Do a bit too much and pay for it for months
    2. CBT was prescribed as the answer, based on remarkably similar theories to those for mecfs. Pushed with remarkable passion too. Though received with less enthusiasm by patients who often found it wasn't nearly as effective as claimed.
     
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  7. sarah darwins

    sarah darwins I told you I was ill

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    Thank you :) Made my day
     
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  8. Snowdrop

    Snowdrop Rebel without a biscuit

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    @Woolie

    Thanks for the accompanying commentary.
    I haven't even had my morning coffee yet but your pain catastrophe satire has cheered me up.
    Yes, I suppose it does have the possibility of dire consequences but for now I'll just :rofl:.

    If you spend all your professional life studying how patients are deluded does that tend to make you more delusional?
     
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  9. Woolie

    Woolie Senior Member

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    Ha, thanks @Snowdrop!

    Actually "Tail wags dog" pretty much sums up psychosomatic explanations of MECFS, don't you think? I think this calls for an illustration:
    [​IMG]
     
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  10. Woolie

    Woolie Senior Member

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    @Simon, that's interesting about the PEM in the chronic pain group! I suppose it coudl be a very different mechanism, though.

    Why am I not surprised that the CBT didn't seem to live up to its promises?
     
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  11. Woolie

    Woolie Senior Member

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    If you spend your life studying patients' false illness beliefs, do you begin to acquire your own false beliefs about illness? I think we all know the answer to that one...:meh:
     
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  12. Cheshire

    Cheshire Senior Member

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    Part of psychology is built on sand, is a denial of reality (see the supposed illness maintaining factors (deconditioning, kinesiphobia, depression) that have been demonstrated to be irrelevant but at different times by the very same psychologists that say they are core issues of the ongoing process of our illness).

    But in these two studies (Testing Factorial Validity and Gender Invariance of the Pain Catastrophizing Scale and Brief report: Writing about chronic fatigue increases somatic complaints ) they go a step further: no need to have patients to study their "psychopathology", just get students and make them imagine they're ill. What a great idea: no need to gather patients cohorts, you save time and money. Without going out of the university, you can study the whole world! (Imagine, you just have to make students pretend they are ants to study their social structure!) :confused:
     
    Last edited: Aug 12, 2015
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  13. Simon

    Simon

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    Could be, but I was really struck by the similarity. Also, I think it's fair to say that pain can be disproportionate to the injury (at least according to our current understanding). That intrigued me, and I did wonder if common mechanisms were involved. And I wasn't assuming psychosocial.

    Apart from anything, these dramatic (PEM/relapse) effects don't seem to fit with simply having the 'wrong' thought patterns. Take the placebo effect - sometimes people strongly believe a medication they think they are on will cure them, yet it turns out that true placebo effects are really rather small, where they exist at all. So I'm afraid that despite whatever dramatic case studies people can come up with for the power of the mind, I don't think that in general the mind can create things like PEM out of thin air (and we now know the deconditioning hypothesis is blown for mecfs).
     
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  14. alex3619

    alex3619 Senior Member

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  15. alex3619

    alex3619 Senior Member

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  16. alkt

    alkt Senior Member

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  17. Woolie

    Woolie Senior Member

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    Sorry guys, I think I wasn't entirely clear on what those undergrads were supposed to do in the pain catastrophizing study.

    They were supposed to recall an actual pain experience from their past. Not just imagine one out of thin air. I've edited the top post, and added that in in bold.

    So the study's maybe not quite as stupid as some of you were thinking... but its still pretty stupid. Think of some of the common pain experiences of females... they will commonly include menstrual pain, which is often quite uncontrollable in its onset and duration (feelings of helplessness?).. those of male undergrads might include more acute pain episodes, for example, resulting from injury. Others, of course, will be pretty common to both genders.
     
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  18. alkt

    alkt Senior Member

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    i also attended a pain clinic a cbt therapest i know its misspelled that makes it more accurate also put down that i catastrophized something or other didnt say in my medical notes what exactly but i had been ill for nine years by this time and im guessing my mentiong severe nausea from travelling for an hour to get there was their idea of catastrophizing. i strongly doubt they would erroniously think that if they had spent even a fraction of that time suffering the levels of pain and other symptoms that we are left to endure. being stubborn is a good survival trait with m e. still existing after 25 years.
     
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  19. Woolie

    Woolie Senior Member

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    Thanks for posting the link, @alex3619. I agree, a pretty dodgy study. Small groups, a between-subject design and only one manipulation. Yet another study claiming to show profound and astonishing and dramatic changes in behaviour and thinking as a result of some very trivial, artificial and temporary manipulation. (brings to mind your signature line: "I can't believe its not science!)

    But the main problem seems to be that there were no before scores on the Symptom Checklist against which to compare the after scores. I guess that's why it ended up appearing in such an obscure journal.

    This stuff would just be written off as trivial if it wasn't so dangerous to people that are actually ill.
     
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  20. Woolie

    Woolie Senior Member

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    How utterly aggravating and infuriating, @alkt! That would have wound me up for weeks! The choice of word itself, "catastrophizing", is so exaggerated it is demeaning in its own right. It conjures up mad, neurotic patients frantically whipping themselves up into a crazy lather about nothing.

    Thank god we can come here to PR and share these experiences, and receive a dose of sanity from time to time.
     
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