Pain catastrophizing: More profound stupidity

[Woolie]

... and on that point, I'm still wound up by alkt's post...

This kind of approach to a patient is the exact opposite of empathy. Instead of placing one's self in the patient's position, imagining what it would be like to experience that level of disability and discomfort, the doctor distances themselves from the patient, seeing them as alien or crazy or just "other".

Once we are seen that way, we can be written off completely. Our experiences and views are seen as distorted, invalid, dysfunctional, a product of our "denial" of our fundamental psychopathology. No "patient empowerment" for us, we aren't proper autonomous individuals, just crazies with dysfunctional ideas.

 

[alkt]

too wooly i guess it wound me up for longer than two weeks. it was nearly 16 years ago but i was recently reminded after having to pay for a copy of my medical notes going back 25 years to help with an appeal brought back some appalling memories of so called doctors attitudes to patients with the letters cfs on their medical notes.it seems there was a great deal of stigma attached thanks to lazy journalism in the eigties.

 

[user9876]

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.

Shouldn't you also take account of reporting error. Do young men really report pain experience accurately or are they likely to down play it in a survey to look strong. This may also be a function of how the survey is done (in person, posted forms etc).

Also if they are talking of worrying about pain I would have thought that there is a difference between a one off pain incident (that you don't believe will be repeated) and one that you believe will be repeated (menstrual pain) or that is on going (chronic pain). These feel like different concept categories and to merge them seems over simplistic.

 

[user9876]

... and on that point, I'm still wound up by alkt's post...

This kind of approach to a patient is the exact opposite of empathy. Instead of placing one's self in the patient's position, imagining what it would be like to experience that level of disability and discomfort, the doctor distances themselves from the patient, seeing them as alien or crazy or just "other".

Once we are seen that way, we can be written off completely. Our experiences and views are seen as distorted, invalid, dysfunctional, a product of our "denial" of our fundamental psychopathology. No "patient empowerment" for us, we aren't proper autonomous individuals, just crazies with dysfunctional ideas.

Its something I have noticed about psychiatrists who treat ME they don't seem to have a real understanding of the symptoms and not only appear to have no empathy but they have used this distance and lack of understanding to form strange theories.

 

[Woolie]

Also if they are talking of worrying about pain I would have thought that there is a difference between a one off pain incident (that you don't believe will be repeated) and one that you believe will be repeated (menstrual pain) or that is on going (chronic pain). These feel like different concept categories and to merge them seems over simplistic.

Me too, user9876. Also very different when it comes to feelings of helplessness, which is one of the three major "factors" that are supposed to make up pain catastrophizing (the others are rumination and use of exaggerated terms).

Shouldn't you also take account of reporting error. Do young men really report pain experience accurately or are they likely to down play it in a survey to look strong. This may also be a function of how the survey is done (in person, posted forms etc).

The article argued that their principal components analysis demonstrated that the gender differences can't be explained by reporting biases. I don't know enough about this method to comment on whether their argument here is valid (which is why I didn't mention it). Perhaps you might know more?

 

[A.B.]

The article argued that their principal components analysis demonstrated that the gender differences can't be explained by reporting biases. I don't know enough about this method to comment on whether their argument here is valid (which is why I didn't mention it). Perhaps you might know more?

Sounds like they claim to have a tool to remove biases from answers to questionnaires. And the tool is so complicated only a few experts can understand it.

That sounds like bullshit.

 

[SOC]

Sounds like they claim to have a tool to remove biases from answers to questionnaires. And the tool is so complicated only a few experts can understand it.

That sounds like bullshit.

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.

 

[alex3619]

Do young men really report pain experience accurately or are they likely to down play it in a survey to look strong.

Case in point:

 

[alex3619]

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

I have commented recently that I do not think the age of enlightenment has really arrived. We are still working on it.

 

[alex3619]

Sounds like they claim to have a tool to remove biases from answers to questionnaires. And the tool is so complicated only a few experts can understand it.

If its that complicated, how do you validate it? Properly test it? I think there is no way at all to completely remove biases. A tool might help reduce biases, but that is the best case. The scientific process is in part about dealing with biases at so many different levels.

 

[A.B.]

If its that complicated, how do you validate it? Properly test it? I think there is no way at all to completely remove biases. A tool might help reduce biases, but that is the best case. The scientific process is in part about dealing with biases at so many different levels.

I think I need to be more clear.

Suppose we have a black box which produces a potentially distorted signal. We can measure the signal but there is no math in the world that can correct the distortion if we don't know how the signal should look like, or if we don't know how it is being distorted. We're simply missing essential information. Math is not magic and doesn't create information out of nothing.

To me it looks like these researchers are using tools they don't understand.

 

[leela]

That's it! I've had it! I hereby declare that, no matter how many degrees you have, or what kind of scientist you are, you are not allowed to write or express opinions about pain, especially chronic pain, unless you have experienced it yourself.

A friend recently told me that she only once had multi-day migraine but it was worse than childbirth. *blink*
She volunteered that part of that was because at least with childbirth you knew there would be an end.

I think people who do not live day in/day out with pain, whether intractable or waxing and waning, are not qualified to have an opinion on what living
under the random rule of such a cruel dictator is like.

 

[Snowdrop]

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.

Thank you for that. Very clear and worth repeating. I get so frustrated when I see bullshit like that and not just on behalf of ME or related studies. How do people come to think such garbage. My cats not that deluded.

 

[Snowdrop]

I agree Leela. I was also thinking that there is such a big problem with others ability to really understand this disease.

All the experts who want to apply inappropriate therapies on us just really can never grasp what it is to experience chronic pain or this illness (to expand on the topic). Even as someone with ME I have had trouble believing at times. And my family believe and support me nevertheless I know that they really don't understand my experience either.

So at the end of the day, this is what they need to come to grips with. The fact the something they can in no way 'enter into' or apprehend is real. They will never understand it from an experience point of view but if they are going to treat it they had better start listening to the experts, the patients. Thankfully, there are a few of those brave souls out there who do listen.

 

[Hip]

I wonder if aches and pains feel more severe than they normally would in conditions like ME/CFS as a result of sickness behavior. As many people know, Michael VanElzakker has proposed that ME/CFS may in fact be due to chronic activation of the sickness behavior response, this activation arising from a chronic infection.

The symptoms of sickness behavior are numerous, and include fatigue, malaise, cognitive impairment, depression; but in particular, sickness behavior involves increased hyperalgesia — that is, abnormally heightened sensitivity to pain. Ref: here.

So if ME/CFS does indeed involve chronic sickness behavior, then you might expect not only to have real pain (from say an enteroviral muscle infection or joint inflammation), but also at the same time, a heightened sensitivity to that pain.

In other words, there may be a double-whammy effect in ME/CFS, with this disease not only creating actual physical pain, but on top of that, this disease may turn up the "pain volume control" in the brain, such that physical pain feels worse than it would normally be.

In hyperalgesia, the pain signals from the body are not altered, but these signals are amplified much more than normal when they reach the brain.

Many conditions of medically unexplained symptoms, like ME/CFS, IBS and interstitial cystitis, have been linked to chronic infections, and these infections could be triggering the sickness behavior response, and thus hyperalgesia.

So this sickness behavior mechanism of increased hyperalgesia might actually play a role in pain catastrophizing.



Wikipedia describes pain catastrophizing thusly:

Pain catastrophizing is the tendency to describe a pain experience in more exaggerated terms than the average person, to ruminate on it more (e.g., "I kept thinking 'this is terrible'"), and/or to feel more helpless about the experience

If due to chronic sickness behavior, someone has increased hyperalgesia, with their brain's "pain volume control" turned right up, you might well expect them to describe a pain experience in more exaggerated terms than the average person — because with the hyperalgesia, that's exactly how they are feeling the pain.

An analogy for hyperalgesia might be putting a powerful hearing aid into the ears of someone with normal hearing. Now that person will experience any sounds from the environment in a greatly amplified way. Naturally, when that person talks about their experience of environmental sounds, they are certainly going to comment about how damn loud they are. And they may well ruminate of how damn loud the world is.

Likewise if your pain amplifier is turned to full volume, you are certainly going to comment about how damn bad the pain is, and may well ruminate on how bad pain can be.

 

[Woolie]

@Hip, that's in interesting idea. Although I do think the mechanism might be more peripheral than the brain. I do worry that these brain-based pain sensitization models that are going around at the moment create another means of claiming that we are not actually as sick as we think we are, and that the pain is "all in our heads". Not saying its wrong, just saying it requires very strong supporting evidence.

(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.)

 

[Hip]

To tell you the truth, @Woolie, I don't know much about the mechanisms of hyperalgesia. I just know it is involved in the sickness behavior response, and so while I was reading this thread, it occurred to me that sickness behavior-induced hyperalgesia might conceivably explain pain catastrophizing in diseases with medically unexplained symptoms.

In fact, a quick look at this Wikipedia article reveals that hyperalgesia does have peripheral causes.

I guess, though, for our purposes here, it may not matter so much where the pain amplification of hyperalgesia occurs; just the fact that hyperalgesia can and does occur may well provide a physical basis for explaining pain catastrophizing.

I am not sure why those researching pain catastrophizing have not considered hyperalgesia as a likely explanation for how pain catastrophizing arises in people.



In addition to sickness behavior, there is also central sensitization, which causes changes in the nervous system such that pain (as well as other sensory input, like touch) is greatly amplified. So central sensitization is another route to hyperalgesia.

 

[Hip]

I do worry that these brain-based pain sensitization models that are going around at the moment create another means of claiming that we are not actually as sick as we think we are, and that the pain is "all in our heads".

I can certainly see how the general public might misinterpret any research indicating that ME/CFS patients are amplifying their pain levels to mean the pain is "all in the mind", and that ME/CFS patients are just exaggerating things. But that's the none-too-bright general public for you, and I guess there's not much that can be done about them.


Glad you were able to edit Wikipedia and add some notes of caution. All my attempts to add notes of caution about CBT/GET in Wikipedia's CFS page were unfortunately always met by censorship from other editors.

 

[beaker]

Its something I have noticed about psychiatrists who treat ME they don't seem to have a real understanding of the symptoms and not only appear to have no empathy but they have used this distance and lack of understanding to form strange theories.

Interestingly enough, when I first got sick back in the 80's. It was a psychiatrist and a psychologist who told me not to believe anyone who said I wasn't really sick and warned me away from what the dr. I was seeing was treating me with. I had super severe spinal pain and severe pain in general. 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) She said if she in anyway thought it would help my pain she would say take it, but it will not and it will make you sicker. I was lucky to have them.

Of course, I must note the the psychiatrist (MD) herself was sick .
The psychologist I think might of had a mild case, not sure,I do not know for sure, but she kept her feet up when I saw her. She was also recommended to me by a nurse in a support group
I saw her to help me navigate the crazy world of medicine.
Most all the MDs at that time either didn't believe or if they did had no understanding of the severity of disease and certainly not of the pain .

 

[duncan]

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?

eta: I'm not sure why anyone would feel a need to explain either pain catastrophizing or central sensitization other than as pair of unconvincing constructs, i.e., cop-outs, that demonstrate little more than ignorance, compounded by an unwillingness to embrace commonly-practiced scientific principles.