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Pain catastrophizing: More profound stupidity

duncan

Senior Member
Messages
2,240
I'd wager not "all psychological research" is considered bad by PWME - just a lot. Those areas that involve any degree of divining, for example.

Also, it is unacceptable to have not only our disease hijacked by psychs, but our qualifying characteristics.
 
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Effi

Senior Member
Messages
1,496
Location
Europe
I'd wager not "all psychological research" is considered bad by PWME - just a lot.
If their approach worked, we'd all be doing it! I mean, it would even be kinda fun: some gentle exercise a couple of times a week, a friendly therapist to encourage you whenever you need, some positive affirmation techniques to keep you going, ... All the while seeing slow but steady progress.

I really think that's how they see it. What they fail to realize is that we aren't just against it for the sake of it. Most of us have tried it, to the best of our abilites. And most of us have failed miserably. What they think is gentle exercise to us feels like torture during, and even more torture after. What they think is a friendly therapist is actually someone who doesn't listen and encourages us to ignore all our body's signals. What they see as positive affirmation just drags us straight down into crash mode. It is wrong on almost every level, but still we did try it. We tried it all the way through. And it didn't work.

We gave it our best. Enough is enough.
 

A.B.

Senior Member
Messages
3,780
If their approach worked, we'd all be doing it! I mean, it would even be kinda fun: some gentle exercise a couple of times a week, a friendly therapist to encourage you whenever you need, some positive affirmation techniques to keep you going, ... All the while seeing slow but steady progress.

I really think that's how they see it. What they fail to realize is that we aren't just against it for the sake of it. Most of us have tried it, to the best of our abilites. And most of us have failed miserably. What they think is gentle exercise to us feels like torture during, and even more torture after. What they think is a friendly therapist is actually someone who doesn't listen and encourages us to ignore all our body's signals. What they see as positive affirmation just drags us straight down into crash mode. It is wrong on almost every level, but still we did try it. We tried it all the way through. And it didn't work.

A normal person would eventually accept patient reports that this doesn't work and adjust accordingly, but not so the psychs. They think we are suffering from a distorted perception of reality - therefore our experiences that their advice isn't working must be ignored. Instead they come up with many strange ideas on why it's our fault their therapy isn't working.

A system where the possibility of failure is excluded is a system that is unable to correct itself.
 

SOC

Senior Member
Messages
7,849
I personally "pain catashrophize." I'm not sure why people find this so controversial.
What is controversial is the absurd assumption that because a small minority of people catastrophize, that many (or even most, according to some psychs) pain reports are catastrophizing.

If you catastrophize, you should get quality psychotherapy for that problem. That doesn't mean other people with pain are catastrophizing and need psychotherapy as well. Treatment for catastrophic thinking is NOT treatment for pain. It's a separate issue. One (catastrophizing) is psychological and extends into other aspects of life. The other (pain) is medical and needs medical treatment, not psychotherapy. The existence of unexplained pain does not imply the mental illness that results in catastrophizing.

Catastrophic thinking can be identified in the absence of pain. People who catastrophize do so about all kinds of things. Diagnosis of catastrophizing should be made by looking at many aspects of the patient's life, not one small corner. Patients who do not exhibit catastrophic thinking in other areas of life are highly unlikely to be catastrophizing in this one specific area (pain) only. What is far more likely is that they are experiencing very real, just unexplained, pain.

I think it's odd that psychologists and psychiatrists, of all people, have so much difficulty in dealing with ambiguity. There are a lot of things in life we don't yet understand, or can't yet clearly identify. Deal with it already.
 
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alkt

Senior Member
Messages
339
Location
uk
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.
 

alkt

Senior Member
Messages
339
Location
uk
does pain catastrophizing exist.considering their only evidence is from forms that ask you to think about and describe your pain. nobody from any culture is taught to report pain in any specific way. so how are you supposed to report pain/describe it without having to think about it .also since pain is subjective how the hell do they decide if someone is exaggerating. this is answering ? the above post. im trying to get used to how the buttons work.
 
Messages
3,263
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.
Nicely put, @duncan !
 
Messages
3,263
@panckage, I think the problem is that these ideas perpetuate the view that MECFS - and many other illnesses - are psychological.

Every time I come onto PR, I hear examples of how this view has caused further pain to already sick people - from the contempt they have been shown by doctors, right through to their struggles to get treatment and living assistance. This happens to a lot of other ill people too - not just those with MECFS. The problem is huge, and goes way beyond MECFS.

Did you know that if a person with a rare disease is initially misdiagnosed with a "psychological" disorder, it can take them up to five years longer to get a correct diagnosis, when compared with those who received a "non-psychological" misdiagnosis? Link here. This stuff does real harm when used incorrectly.

If you believe you catastrophize when anxious, that may be so. But could it be that you are just an ordinary person, coping with high levels of pain and malaise, who isn't always perfect in your attitude to that pain? And who is? So, not a "dysfunction" on your part, just not a super human? Wouldn't you prefer to be offered positive ways to even further improve your ability to cope with these challenges - rather than being labelled a dysfunctional "catastrophizer" and offered "correction"?

Oh, and once you've been labelled a catastrophizer, do you really think a doctor'll ever be interested in ever hearing about your symptoms again? Whatever their origin? Your testimony will be considered unreliable for ever more.

There is only a small step between ideas like catastrophizing and the idea that MECFS is merely a psychological condition. And I think those working in this area don't even notice that step.
 

panckage

Senior Member
Messages
777
Location
Vancouver, BC
@panckage, I think the problem is that these ideas perpetuate the view that MECFS - and many other illnesses - are psychological.
This is how research works. Every researcher views it through their own paradigm. Is it surprising that psychologists view our problems as psychological? That's how they see everything! Not sure why people taking this so personally.
Like all researchers they chose their target group as the one most likely to benefit from the intervention. If this causes them to fudge the lines and recruit people that have illnesses not representative of people on this forum then so be it. That's the state of our illness. Scientists can't even agree on a classification. What do we have CFS? ME? Lyme? SEID??

This leads usto the 2 main issues
1) There are no known universal bio-markers for ME. (although PEM might be but even that is not yet universally accepted)
That's why we are listed as having a syndrome. Science can't even classify what exactly our problem is. Its like when people had AIDS and nobody knew what caused it. How can doctors treat us when they can't classify what we have?

2) There are no real treatments yet. If there were an efficacious treatment for our disease we could expect that treatment. There is none however. Medical professionals just have to make guesses. Its very common to guess that a disease that science does not understand to be psychological. Its the default trashbin diagnosis

Every time I come onto PR, I hear examples of how this view has caused further pain to already sick people - from the contempt they have been shown by doctors
Yes this is awful. Taking into account the 2 main issues above, what are the doctors supposed to do? Can you diagnose a patient with something you don't understand?


If you believe you catastrophize when anxious, that may be so.
Those are your words, not mine The research had nothing to do with ME.

Related
i)Research found race was correlated with IQ
ii)Research was able to further clarify the real underlying correlation was between IQ and socio-economic status.

We can get pissed and insult researchers for i) or we can help researches move to ii). This is our responsibility. This is our choice

Wouldn't you prefer to be offered positive ways to even further improve your ability to cope with these challenges - rather than being labelled a dysfunctional "catastrophizer" and offered "correction"?
They are exactly the same thing. There is no boogie man in science :p. We can make the misguided into our enemies or can guide them. It is our responsibility. It is our choice
 
Messages
15,786
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.
Well, I don't get anxiety, so I can't relate to that aspect. But I find that paying attention to my pain, and even actively looking for it and monitoring it, is quite helpful.

For example, I might feel out of sorts, but if I stop what I'm doing and pay attention to my body, I might realize that I'm tensing my muscles too much, which is causing me some pain and making me cranky. And often when I'm tensing my muscles it's because my body is trying to compensate for low pulse pressure, and I need to lie down a bit and give my body a break. Or I might realize I forgot to take a B12 shot a couple days ago, and that's likely contributing to body-wide aches. So I take the B12 and the pain recedes.

Paying attention to my pain and other symptoms allows me to resolve or mitigate them, and get on with my life. Ignoring those symptoms would be the real catastrophe :D
 
Messages
15,786
This is how research works. Every researcher views it through their own paradigm. Is it surprising that psychologists view our problems as psychological? That's how they see everything! Not sure why people taking this so personally.
The psychobabblers are not just investigating the disease through their own paradigm. They spin results to support their hypothesis, they engage in misleading media campaigns to support it, they ignore contrary evidence, they never question the validity of their hypothesis, and they attack competing hypotheses by employing various logical fallacies. They use their hypothesis to suggest that emotional, financial, physical, and medical support be withheld.

Other psychologists are able to objectively examine their own hypotheses, and present them honestly. I can respect that research, even if I find it to be of limited use when there is a much more urgent need to address the biomedical gaps in the research.

Like all researchers they chose their target group as the one most likely to benefit from the intervention. If this causes them to fudge the lines and recruit people that have illnesses not representative of people on this forum then so be it. That's the state of our illness. Scientists can't even agree on a classification. What do we have CFS? ME? Lyme? SEID??
I also don't particularly object to chronic fatigue research. I don't find it useful personally, since I don't have chronic fatigue, but I respect that it might help someone with something. However this mix-and-match approach to recruiting patients for studies is not done honestly. Chronic fatigue patients are recruited, and labeled with CFS. The results are then touted as applying to ME/CFS, even if there few or no ME patients involved at all. If they wish to investigate something which is not ME or even CFS, they should not label it as ME or CFS, nor try to apply their findings to ME/CFS patients.

1) There are no known universal bio-markers for ME. (although PEM might be but even that is not yet universally accepted)
Universal acceptance is not required for any disease. And in the case of fringe psychologists, it is unlikely they will ever accept a competing model, even when pathology has been proven.

That's why we are listed as having a syndrome. Science can't even classify what exactly our problem is. Its like when people had AIDS and nobody knew what caused it. How can doctors treat us when they can't classify what we have?
It can get a preliminary definition based on a set of symptoms and the exclusion of known alternative explanations for those symptoms. PEM is actually pretty unique, and as a symptom is much more useful in diagnosing ME than most symptoms are in diagnosing other diseases. But that requires understanding the experience of PEM, and many doctors seem to prefer taking the "fatigue" shortcut in making a diagnosis.

There are no real treatments yet. If there were an efficacious treatment for our disease we could expect that treatment. There is none however. Medical professionals just have to make guesses. Its very common to guess that a disease that science does not understand to be psychological. Its the default trash bin diagnosis
There are many treatments for ME symptoms which can improve quality of life. And when Orthostatic Intolerance is tested and treated, disability itself can be reduced. Treatment does not have to be curative, nor even result in substantial improvement in functioning, in order to be beneficial. Yet the psychobabbler approach is to limit even palliative treatments, and go straight for the completely hypothetical, unproven, and even disproven "cure" of CBT and GET.
 
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