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Pain catastrophizing: More profound stupidity

Hip

Senior Member
Messages
17,824
How so??????

The ME/CFS community had a bad experience with the Wessely school psychiatrists, who put forward the idea that ME/CFS was an "all in the mind" psychosomatic condition. They said that your belief that you are ill is what keeps you ill. This led to a situation where many doctors became dismissive of ME/CFS, and worse still, offered inappropriate psychological interventions.

As a result of this bad experience with the Wessely school, now whenever any psychological research is done on ME/CFS, ME/CFS patients may assume the worst, and think the research is deliberately trying to portray ME/CFS as "all in the mind".

That's might be thought of as catastrophizing, ie, interpreting something as much worse than it is.

To an extent I can understand this stance that some ME/CFS patients take: if you have had a very bad experience with a certain group of people like the Wessely school psychiatrists, naturally you may become wary of any psychiatrists / psychologists, and suspicious of their motives.

However, I do think there is often a sort of knee jerk reaction against any psychological perspective taken on ME/CFS. As soon as the "psy" word is seen, people assume it's a ruse to cast ME/CFS in a psychosomatic light.

So for example, I don't think the pain catastrophizing research is aiming to make doctors dismissive of pain, as far as I am aware.


But this is not to say that ME/CFS patients should stop fighting against ME/CFS being labeled as a somatoform, psychosomatic or psychogenic; I very much support this continued fight.

Although I should add the proviso that in some cases of ME/CFS, there may be a psychological element such as a learned stress response which may be helping to maintain the disease. ME/CFS is a multifaceted disease which seems to have many causal inputs.

So what I am saying is that I support this fight against ME/CFS being generally labeled as a psychogenic condition, but remain open minded about the possibility that in some minority patients, a psychogenic causal factor may play a role in their disease.



When my CFS symptoms are bad my anxiety is high

Have you seen my thread: Completely eliminated my severe anxiety symptoms with three supplements!

A lot of people with significant anxiety disorder symptoms have found these supplement very effective at reducing or eliminating their anxiety, especially the N-acetyl-glucosamine supplement.
 
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duncan

Senior Member
Messages
2,240
@Hip , did you just use an artificial psych construct - pain catastrophizing - to criticize a learned response against psychs for employing a second artificial construct - somatoform disorders - against an entire patient community, and then try to justify a third artificial psych construct - the idea that psychogenic factors cause and help maintain ME/CFS in some patients?
 

Snowdrop

Rebel without a biscuit
Messages
2,933
We can make the misguided into our
enemies or can guide them. It is our responsibility. It is our choice

That ship has sailed.

They have made it abundantly clear that they are not going to budge from their POV. Do not want our 'help' or 'guidance' and indeed they resort to labelling us with mental health issues should we try to speak up. The labelling is to have the effect of ensuring that everything we say can be easily invalidated and dismissed.

This is not about science.

It is about power and control over a vulnerable and marginalised group. One that up until recently did not have much of a voice. And now that we speak more collectively we are now attacked as a group. Anything to keep us shut up. We have a right to speak up against bad science that is abusive and outright prejudice disguised as science.
 
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Hip

Senior Member
Messages
17,824
@Hip , did you just use an artificial psych construct - pain catastrophizing - to criticize a learned response against psychs for employing a second artificial construct - somatoform disorders - against an entire patient community, and then try to justify a third artificial psych construct - the idea that psychogenic factors cause and help maintain ME/CFS in some patients?

Indeed I did. Thought you might like it.

Though your use of the word "artificial" is a bit redundant, since all constructs are by definition artificial (artificial = produced by human beings rather than occurring naturally).
 
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panckage

Senior Member
Messages
777
Location
Vancouver, BC
I have. People keep misquoting me on this though lol. I don't have anxiety in general. I get something which I refer to as a 'fatigue attack.' It starts, say in the morning and then usually gets better by about 8pm at night. Anxiety and pain are just 2 of the many symptoms in this 'attack. ' I've tried many things but the effects are usually pretty minor when I'm in this state
 

alkt

Senior Member
Messages
339
Location
uk
There is quite a nuanced review of pain catastrophizing in this paper: Pain Catastrophizing: An Updated Review
it says something when other pyschologist can pull apart all the previous documented trials and say the results are confounded.a polite way of saying that the research is flawed or that their methodology is subjected to the bias of the researcher . which most people on this thread would agree with . after all future income depends on finding the evidence wanted by those who fund the research. also who would take the writings of a long dead chinese herbalist and obvious misogynist bad enough with western male doctors putting all medical problems of women down to hysteria from the 1800 s to the 19 60 s.
 

Hip

Senior Member
Messages
17,824
it says something when other pyschologist can pull apart all the previous documented trials and say the results are confounded

Yes, what it says is that the paper is a review.

That's what they do in reviews: appraise all the major studies conducted in the field. You expect reviewers to point out inconsistencies, contradictory results, methodological flaws, and so forth. Nothing unusual there.



also who would take the writings of a long dead chinese herbalist and obvious misogynist

Er, anyone who was surveying the history of the field, as they did in that paper.


And how did you ascertain that this Chinese herbalist was an "obvious misogynist" from the single sentence that mentions him in that review paper? Talk about drawing conclusions on almost no evidence.
 
Messages
3,263
I began this thread, not to criticize any psychological approach (for heaven's sake, I'm a psychologist myself!), but to evaluate this concept (pain catastrophizing). In my view, it is based on poor logic, that leads to conclusions that may prevent people with MECFS from getting proper treatment, directly or indirectly.

This is my responsibility, as I see it, I have the skill set - and no-one else's gonna do it - but I really do value the feedback I get from sharing my thoughts on PR. You guys are great. I'm interested in hearing from those who disagree as much as those who agree.

@panckage, criticism is how research works. Its part of the way that we prevent bad science from doing harm (good thing someone criticised those lobotomies in the 40s and 50s!). I receive criticism for my work, and expect other researchers to be able to take it. Some subfields, though, have little critical debate within them - just believers - and this leads to poor quality research. Those subfields include psychosomatic/psychogenic illness.

I never criticise the people, you'll notice, just the ideas.

I put this thread under "Other news" (not ME), because some folks here are interested in psychogenic/psychosomatic models of illness in general.

But if you want to link it to MECFS, here are some articles you might enjoy:

Nijs, J., Van de Putte, K., Louckx, F., Truijen, S., & De Meirleir, K. (2008). Exercise performance and chronic pain in chronic fatigue syndrome: the role of pain catastrophizing. Pain Medicine, 9(8), 1164-1172. It is hypothesized that both the aggravated painful experience during exercise [7] and pain catastrophizing limit exercise performance in patients with CFS. (read on for results, which were not as supportive of their hypothesis as they might have hoped).

Meeus, M., Nijs, J., Van Oosterwijck, J., Van Alsenoy, V., & Truijen, S. (2010). Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Archives of physical medicine and rehabilitation, 91(8), 1153-1159.
 
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alkt

Senior Member
Messages
339
Location
uk
Yes, what it says is that the paper is a review.

That's what they do in reviews: appraise all the major studies conducted in the field. You expect reviewers to point out inconsistencies, contradictory results, methodological flaws, and so forth. Nothing unusual there.





Er, anyone who was surveying the history of the field, as they did in that paper.


And how did you ascertain that this Chinese herbalist was an "obvious misogynist" from the single sentence that mentions him in that review paper? Talk about drawing conclusions on almost no evidence.
the quote mentioned in the article pointed out that the herbalist only referenced women as recognized by the author. the article did not state whether the herbalist was a psychoscocial observer or just a herbalist.
 
Messages
3,263
PS @panckage, I think this is where the misunderstanding is coming from as regards your anxiety and catastrophizing:
panckage said:
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.
You might want to go back and edit that out if you feel its not expressing your situation accurately.
 

alkt

Senior Member
Messages
339
Location
uk
I began this thread, not to criticize any psychological approach (for heaven's sake, I'm a psychologist myself!), but to evaluate this concept (pain catastrophizing). In my view, it is based on poor logic, that leads to conclusions that may help prevent people with MECFS from getting proper treatment, directly or indirectly.

This is my responsibility, as I see it, I have the skill set - and no-one else's gonna do it - but I really do value the feedback I get from sharing my thoughts on PR. You guys are great. I'm interested in hearing from those who disagree as much as those who agree.

@panckage, criticism is how research works. Its part of the way that we prevent bad science from doing harm (good thing someone criticised those lobotomies in the 40s and 50s!). I receive criticism for my work, and expect other researchers to be able to take it. Some subfields, though, have little critical debate within them - just believers - and this leads to poor quality research. Those subfields include psychosomatic/psychogenic illness.

I never criticise the people, you'll notice, just the ideas.

I put this thread under "Other news" (not ME), because some folks here are interested in psychogenic/psychosomatic models of illness in general.

But if you want to link it to MECFS, here are some articles you might enjoy:

Nijs, J., Van de Putte, K., Louckx, F., Truijen, S., & De Meirleir, K. (2008). Exercise performance and chronic pain in chronic fatigue syndrome: the role of pain catastrophizing. Pain Medicine, 9(8), 1164-1172. It is hypothesized that both the aggravated painful experience during exercise [7] and pain catastrophizing limit exercise performance in patients with CFS. (read on for results, which were not as supportive of their hypothesis as they might have hoped).

Meeus, M., Nijs, J., Van Oosterwijck, J., Van Alsenoy, V., & Truijen, S. (2010). Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial. Archives of physical medicine and rehabilitation, 91(8), 1153-1159.
sorry if i have dragged the conversations of track and it is all very interesting to try and fathom how different people think( from those with open minds to those with a predisposition to holding on to only one position) ie i am right because the four papers i have shown you agree with my way of thinking. as in i cannot be wrong if other people agree with me.therefore telling the reader not to think for yourself because i have done your thinking for you. a kind of peer group bullying.
 
Messages
3,263
sorry if i have dragged the conversations of track and it is all very interesting to try and fathom how different people think( from those with open minds to those with a predisposition to holding on to only one position) ie i am right because the four papers i have shown you agree with my way of thinking. as in i cannot be wrong if other people agree with me.therefore telling the reader not to think for yourself because i have done your thinking for you. a kind of peer group bullying.

Very interesting @alkt, and I think not easy for any of us to change our view, even when the evidence is strong. Usually, I can only do it after a cooling-off period first. If my work gets criticised by a journal reviewer, my first reaction is usually %$@## You!

It sometimes takes weeks before I can grudgingly accept they might have had a valid point.
 

Chrisb

Senior Member
Messages
1,051
Is there not a problem with the concept of pain catastrophisation per se? The term is pejorative. Sufferers have been judged and found wanting before any investigation is made. Just need a bit more stiff upper lip. Try and be a bit
more like the researchers. Probably try and be a bit less female. (For the avoidance of doubt this is not a reflection of my views.)

Why would any competent researchers interested in an objective measure use such terminology? I have probably answered my own question there.

If there were people out there with an abnormal neural or physiological disorder at the opposite end of the spectrum to those incapable of feeling pain what would their likely response be to an offer to participate in research under this name?
 

DeGenesis

Senior Member
Messages
172
I think my pain is and should be viewed as a catastrophe, both to myself and to those I share my experience with who are born with empathy. Pain is a catastrophe and that's why doctors are supposed to treat it aggressively. I guess you could say that I catastrophize, but I don't think that it's a narcissistic, maladaptive or in any way a self-harming behaviour. On the contrary it's a natural response to intolerable suffering.

As I saw in the recent Peter Rowe webinar, ME/CFS patients have a lower pain threshold which could be partly explained by elevated levels of certain mRNA during PEM.
 

SOC

Senior Member
Messages
7,849
I think my pain is and should be viewed as a catastrophe, both to myself and to those I share my experience with who have empathy. I guess you could say that I catastrophize, but I don't think that it's a narcissistic, maladaptive or in any way a self-harming behaviour. On the contrary it's a natural response to intolerable suffering.

As I saw in the recent Peter Rowe webinar, ME/CFS patients have a lower pain threshold which could be partly explained by elevated levels of certain mRNA during PEM.
"Catastrophizing" in the psychological sense used in this paper means having an excessive response to the situation. When the response is natural, it's not (supposed to be) considered catastrophizing. Claiming you are going to die from a headache would be catastrophizing. Being miserable and not socializing because of extreme pain is in a sense a catastrophe, but it's not catastrophizing in the psychological sense, nor is talking about your pain.

The problem with these idiots and their ilk, is that they assume we have little or no pain, so any response to the (in their minds) nonexistent pain is excessive. If only we could make them walk a mile in our shoes....