Pain catastrophizing: More profound stupidity

[Sean]

(You might notice an unusually cautious tone in the WP page on pain catastrophizing... I can tell you this is most unusual in this domain, where there generally complete belief and no dissent. The notes of caution on WP are part of my little contribution to help correct the misinformation.)

I think we have a subversive sheepens in the flock.

 

[PNR2008]

Neurology Now came out with a new issue that blew my mind with it's unrelenting BS on pain and exercise. The opium problem feeds into this. What propaganda. WWW.NUEROLOGYNOW.COMTHEWAITINGROOMRETHINKCHRONICPAIN.

I know they don't think exercise is good for concussion and look how long they came up with that, by their own admission the way they treat concussion is different than they treated it 5 years ago. Let see how long it takes them to review their attitudes on CBT and psychological feelings about acupuncture.

 

[Woolie]

The MD gave me an anti-psychotic and told me it was very strong pain med. The psychologist told me what it was and to stop it and that the dr. was violating law by not giving me informed consent. ( also possible severe SEs)

OMG, @beaker, never ceases to amaze me the hell people here on PR have gone through.

 

[Woolie]

Neurology Now came out with a new issue that blew my mind with it's unrelenting BS on pain and exercise. The opium problem feeds into this. What propaganda. WWW.NUEROLOGYNOW.COMTHEWAITINGROOMRETHINKCHRONICPAIN.

I know they don't think exercise is good for concussion and look how long they came up with that, by their own admission the way they treat concussion is different than they treated it 5 years ago. Let see how long it takes them to review their attitudes on CBT and psychological feelings about acupuncture.

Thanks, @PNR2008 Good point about concussion, at least this illness is being treated with a bit more respect now. I won't be holding my breath until enlightenment comes for us, though.

Took me a while to find the article (URL seems to have changed), but I think this might be it:

http://journals.lww.com/neurologyno...ronic_Pain__Opioid_painkillers_can_be.16.aspx

Some highlights from the article

People with low back pain who did not expect their acupuncture treatments to be effective had more pain-related disability than those who went into therapy with a positive attitude.

This is a statement we've all head before. Does it not occur to any of these intelligent neurologists that there is a huge confound here: the worse your pain in the first place, the less likely you are to have high expectations for treatment with acupuncture.

“Chronic pain is always a combination of behavioural and biological factors” (says Neurologist Dr. XXX Neurologist. “A lot of people have to deal with psychological barriers to recover, such as fear-avoidance (shunning exercise and activities based on fear of pain), catastrophisation (convincing yourself the pain is worse than it is), and low expectations of recovery”

Notice how the emphasis here is on the negative. The patient is doing stuff wrong, dysfunctional, maladaptive stuff. There's no recognition of the suffering they are enduring, and probably coping with much better than Dr. XXX could ever hope to do. I'm fine with them saying that there might be ways to teach even better skills - if its true - but please, don't make this about some dysfunction on the part of the patient.

“… sometimes people can’t accept their condition, and won’t do the physical and emotional work required to manage the pain” says Neurologist Dr., YYY

Oh, wait there it is! The universal get-out-of-jail free line: "if this 'programme' doesn't work, then its the patient's fault for not trying hard enough"

A type of physical theory program, called activity coaching, for instance, focuses on doing more everyday. Walking more, standing more. The goal is to get your life back.

Hmmm, this sounds familiar from somewhere...

 

[Woolie]

So, there are people outside of psychology/psychiatry circles that actually believe there are such things as pain catastrophizing and central sensitization?

Or are we speculating about individuals who stand to benefit from promoting ideas of this ilk?

I wish this were true, duncan! The article introducing the pain catastrophizing scale (the self-report scale they use to measure PC) has been cited in the literature more than 2,000 times! This is massive, mainstream stuff.

 

[Hip]

From a scientific standpoint, the main problem with pain catastrophizing is that psychologists have incorrectly labeled their observations that some people describe pain in more intensified or exaggerated terms with the name of a theory (ie, pain catastrophizing) that they have proposed to explain these observations.

This is fundamentally wrong.


The fact that some people describe their pain experience in more intensified or exaggerated terms, ruminate on pain more, and feel helpless about their pain is a phenomenon that psychologists observe. It is an empirical observation, but not as yet a theory.

With empirical observations, there can be many theories and hypotheses that might explain them. The idea that some people catastrophize pain is just one theory that might explain these observations.

However, what psychologists have done is incorrectly labeled these observations with the name "pain catastrophizing," which is actually the title of one particular theory on what might give rise to the phenomenon observed.

So psychologists are conflating theory with phenomenon, whereas these should always be kept separate.


This should be pointed out, because there is a real danger that by giving the observations, and a theory that tries to explain them, the same name of "pain catastrophizing", people may forget that this is only just one theory proposed to explain the observed phenomenon, and forget there may be other theories.

As I suggested in an earlier post, another theory that might explain why some people describe their pain in such intense terms is simply because their pain is much more intense. If someone has the condition of hyperalgesia or central sensitization (which cause an abnormally heightened sensitivity to pain), you would expect a given pain to be felt much more intensely, and perhaps more mentally intrusively, compared to people without heightened sensitivity to pain.

So this heightened sensitivity to pain theory I proposed is an alternative hypothesis to the pain catastrophizing theory.


The bottom line here is that psychologists should use a different name for the observed phenomenon that some people describing their pain in more exaggerated terms. They might call this phenomenon something like "intensified pain reporting" or some similar phrase. This is to distinguish the phenomenon from any theory that attempts to explain it.

Then if a psychologist wants to consider whether the theory of catastrophizing — the condition of believing that something is far worse than it is in reality — might possibly explain the observed phenomenon of intensified pain reporting, then he can do so without mixing up phenomenon with theory.

Or a psychologist might like to work on a different explanatory theory for intensified pain reporting, such as the hyperalgesia / central sensitization hypothesis I suggested.

In either case, at least you will have the clarity of mind to distinguish phenomenon from theory.

 

[alkt]

Bullshit indeed. This article is supposed to be aimed at scientists. You don't refuse to explain your technique because "It would be too hard for you to understand". As a scientist yourself, you shouldn't be using the technique if you can't explain it to a scientific audience. If you don't understand the technique well enough to explain it to other scientists, how do you know what you are doing or if you are even doing it correctly?

This is the old science = magic story. Pretend your "scientific" idea/treatment/tool is beyond the ken of mortal men and therefore cannot be explained. This is completely contrary to the basic principles of science which state that there are understandable, consistently explainable, non-magical explanations for physical phenomena.

Science = magic is often used in pseudoscience to "support" the proponent's inability to explain their theory/treatment in detail. Mumbo-jumbo, handwaving, throw around obscure words, the rest is too hard for you to understand -- there, I've explained it. If you don't agree it's because you have a closed mind.

Sometimes I fear that intellectually we are sliding back into the Dark Ages. Or at least before the Age of Enlightenment.

well put the arrogance of spseudo scientist is proven as soon as they say its to complex to explain to mere mortals outside of their so called speciality.

 

[Woolie]

@Hip, you're pretty accurate there. Another way of looking at it is confusion between cause and effect. Does the catastrophizing cause the pain to be more intense, or is it the other way around?

@SOC, yea, its true I don't have a good grip on factor analysis/principal components analysis (or at least don't work with it enough to evaluate it in another study), even though I'm a research psychologist too. But its a vast discipline, and not everyone knows every methodology off pat. To be fair to the authors, if we all had to write our papers so that everything was explained to everyone, they'd get pretty long. Not that I'm trying to defend the lazy thinking that goes into some of these ideas, that's really bad, I'm totally with you there and every bit as angry as you!

 

[Effi]

However, what psychologists have done is incorrectly labeled these observations with the name "pain catastrophizing," which is actually the title of one particular theory on what might give rise to the phenomenon observed.

If someone has the condition of hyperalgesia or central sensitization (which cause an abnormally heightened sensitivity to pain), you would expect a given pain to be felt much more intensely, and perhaps more mentally intrusively, compared to people without heightened sensitivity to pain.

I had a doctor explain to me the following: "There is no real pain without tissue damage. People with let's say fibromyalgia don't have tissue damage, therefore their pain is perceived pain, due to something going wrong in the pain signalisation system in their brain (central sensitization). They perceive pain, without actual pain being really there." Pain catastrophizing IMO is just the missing puzzle piece that makes that theory look like it makes sense - cause why would you feel pain when there is no pain? If it's caused by something in the brain, you can surely think it away! Just get your act together and you'll be fine, right?

What baffles me is that this entire idea is based solely upon observations and one-sided interpretations, with no place for the actual reality of the patient. Doctors/therapists who use this theory mold patients symptoms so that they fit into the theory. They switch around cause and effect however they feel it will best fit their purpose. Whatever biomedical evidence science finds out along the way is pushed to the side, all in the name of make-believe...

 

[Cheshire]

There is no real pain without tissue damage. People with let's say fibromyalgia don't have tissue damage, therefore their pain is perceived pain

Pain is a sympton, not a sign, we can't measure it with any objective tool. Whatever the cause of pain might be (broken bone, neuropathic, wound, inflamation or "central sensitization"), it remains a subjective phenomena. Talking about real pain (implying there's an "unreal" one) is just nonsense. Pain is an unpleasant sensation felt by someone. One can't say your pain is imaginary, it's nonsense, if you feel it, it exists. Period.

 

[duncan]

Yeah, I think the entire concept of central sensitization may be so much pooh.

 

[Effi]

One can't say your pain is imaginary, it's nonsense, if you feel it, it exists. Period.

Exactly! When there's pain, there's pain. That thing that doctor said to me about 'the only real pain is when there's tissue damage' sounds like utter BS. Problem is it sounds logical to an unexperienced person, and that's where the danger lies. So many people (incl. doctors) believe it! But it is baseless, and even harmful, nonsense.

 

[Woolie]

I had a doctor explain to me the following: "There is no real pain without tissue damage. People with let's say fibromyalgia don't have tissue damage, therefore their pain is perceived pain, due to something going wrong in the pain signalisation system in their brain (central sensitization). They perceive pain, without actual pain being really there."

Still astounded at the BS people here have been subject to! Makes my blood boil!

 

[Hip]

@Hip, you're pretty accurate there. Another way of looking at it is confusion between cause and effect. Does the catastrophizing cause the pain to be more intense, or is it the other way around?

Indeed. Though before we even address that question, we would want to know whether pain catastrophizing exists at all. We know what I called "intensified pain reporting" exists, where people describe the pain that they feel in more intense and exaggerated terms, and ruminate on it more.

However, the question is whether intensified pain reporting is caused by pain catastrophizing, or whether intensified pain reporting is caused by something else, such as the patient suffering from hyperalgesia or central sensitization.

In fact, there could even be more that one cause of intensified pain reporting: in some people it might be due to pain catastrophizing, in others, intensified pain reporting might be due to hyperalgesia or central sensitization.

I don't think psychologists should be assuming that their theory of pain catastrophizing is the only possible explanation of intensified pain reporting.


If pain catastrophizing were the cause of intensified pain reporting in some patients, you might expect that those patients would also display other manifestations of catastrophizing. I have one acquaintance who is always catastrophizing about world events: every time something bad appears in the news, he seems to think it signals the end of civilization, rather than just being a temporary bad state of affairs that will pass in time. That's catastrophizing unfortunate events that happen.

I wonder if psychologists have checked whether patients displaying intensified pain reporting, who the psychologists think might be pain catastrophizing, are also catastrophizing in other areas of their life. If so, that might provide some support for the pain catastrophizing theory.

 

[duncan]

Oh, I don't know. Seems pretty intuitive. Assuming they are not lying, people report more pain because they a) are experiencing that pain, and b) feel less cultural constraints in expressing that pain.

Pain is pain. The degree of pain is subjective, just as the perception of pain is. But both are equally real. Psychs or clinicians that second-guess the source or validity or degree of the pain seem to me to be indulging in little more than hubris.

Similar to taste. If I say something tastes bad, ok. If I say something tastes terrible, again, ok. Who second guesses the degree of distaste??

 

[Hip]

If we look at central sensitization as a possible explanatory theory of intensified pain reporting, it's interesting to note that central sensitization has been linked to multiple chemical sensitivity (MCS).

 

[panckage]

I personally "pain catashrophize." I'm not sure why people find this so controversial. When my CFS symptoms are bad my anxiety is high and all I do is focus on my pain and it makes things 10 times worse. This research can lead to other ways to treat pain. In my case doing something for anxiety or getting me up and moving about would probably work better than pain killers. This is a GOOD thing.

I really wish people here could be more positive and point out the positives in research. There are other statements in the OP that are uncontroversial and have been duplicated in research. The world is not against us. They are here to help us, even if sometimes misguided.

I wish we could be more diplomatic here. Let's help the people trying to help us. Let's not tell them to f#^# off every time we read something that makes us mad. We can build a bridge to the community that is trying to help us or or we can ridicule them. This is our decision. Which do you think will have a better outcome for people with PWME?

 

[lansbergen]

I personally "pain catashrophize."

I do not.

 

[Hip]

I personally "pain catashrophize." I'm not sure why people find this so controversial. When my CFS symptoms are bad my anxiety is high and all I do is focus on my pain and it makes things 10 times worse.

That is interesting, @panckage.

I don't normally get joint or muscle pain in my ME/CFS symptoms, so I have not had much experience of constant pain.

However, I was wondering whether pain catastrophizing might be connected to the "mental firewall" problems that appear to be present in ME/CFS, problems which seem to allow sensory input to overload consciousness.

By mental firewall problems, I mean things like sound sensitivity, where environmental sounds seem to penetrate right through your mental firewall, getting far too deep into the mind, overloading consciousness and becoming very unpleasant. I certainly experience sound sensitivity.

If there were also a mental firewall problem with the sensory input of pain, perhaps this might lead to an analogous condition were pain overloads consciousness, and thereby becomes the focus of your consciousness awareness.


Marco wrote a good article on sensory gating deficits (mental firewall problems) and ME/CFS.

I wish we could be more diplomatic here. Let's help the people trying to help us. Let's not tell them to f#^# off every time we read something that makes us mad.

I agree.

Possibly the negative response that many ME/CFS patients have to psychological research is an example of catastrophizing in action. Because of the bad experience the ME/CFS community has had with the Wessely school psychiatrists, who proposed that ME/CFS was a psychosomatic "all in the mind" condition, I think many ME/CFS patients now have tendency to view all psychological research as bad.

 

[Effi]

In my case doing something for anxiety or getting me up and moving about would probably work better than pain killers.

I think I understand where you're coming from, and I agree that we need to be open minded. Some PWME might pain catastrophize. If they do, it's probably because they live in constant agony, so it's pretty understandable they'd get upset sometimes.

I'll share some of my personal experience to show you where I'm coming from. What I've experienced, when I was trying to find a solution to my severe health problems, is that doctors/researchers in this psycho-field don't listen to us, they construct theories based on rational ideas and shove them down our throats. They told me I don't have the symptoms I have. They told me I do have symptoms that I don't even have. They told me I have certain character traits that I don't recognize, and that these traits are causative of my weak health. Just so I fit into their story. And although that is ludicrous, I did do everything they told me to do in order to get better. It didn't work, it even made me sicker. But they still wouldn't listen. They still would blame me personally.

I don't pain catastrophize. And I don't think most PWME do. But these people keep telling us we do and say that getting to grips with that is the answer to all of our problems. That makes me mad. And it makes me feel like they're not taking me seriously. I deserve to be taken seriously. Just like any other person who is this sick.