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Pain catastrophizing: More profound stupidity

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

  1. Mark

    Mark Former CEO

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    The 'pain catastrophizing' concept seems to be quite feasible to prove or disprove these days. I may be wrong, but I've got the impression, in general, that these days we have at least a half-decent handle on measurements of the level of pain experienced, using brain scans. So ME patients could potentially be compared to other groups on a questionnaire indicating the pain they subjectively experience, as compared with what the scan says. If what they say about their pain is consistently more extreme than what their brain scan says, and more so than other groups, then pain catastrophizing in ME patients would be proven.

    If the people who coined the phrase 'pain catastrophizing' were scientists, they would attempt to disprove their hypothesis with a rigorous test of their hypothesis, similar to what I've suggested. If they failed to disprove it, they could then begin using the phrase 'pain catastrophizing' with evidence to back them up.

    Does anyone know whether they have done this? Or are they not scientists?

    If they aren't, then it would be nice if a scientist would come along and disprove their insulting, demeaning, abusive babble.

    Perhaps they are more into 'evidence-based' than 'science'. A lot of evidence-based stuff is coming in at my workplace these days. Where I've been involved in it, the concept of 'evidence' typically amounts to me making the claim, in writing, that I have done something. I wonder whether this is the same standard of evidence that people who talk about 'pain catastrophizing' are using?
     
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  2. DeGenesis

    DeGenesis Senior Member

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  3. Woolie

    Woolie Senior Member

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    @Hip and everyone else,

    You prompted me to read more about central sensitiziaton as it relates to pain.

    This article gives a good overview of the concept as it relates to MECFS, and takes a fairly neutral perspective at least, not written by someone from the BPS/psychosomatic school of thinking.

    Some of the things they said seemed to make sense to me, but I was worried about how broad the concept was. I did also think it could be easily hijacked by the psychobabblers, and used as further support for a psychological approach.

    In fact, one section of the article suggests the central sensitization could be due to psychological factors like pain catastrophization:

    "... Forebrain centres are capable of exerting powerful influences on various nuclei of the brainstem, including the nuclei identified as the origin of the descending facilitatory pathway [75]. The activity in descending pathways is not constant but can be modulated, for example by the level of vigilance, attention and stress [76]. This has been referred to as ‘cognitive emotional sensitisation’ and can be a target for therapies [77]. Hence, forebrain products such as cognitions, emotions, attention, and motivation have influence on the clinical pain experience [75]. Catastrophising [21], problems with acceptance [22] and activity-avoidance [19] have been identified as factors perpetuating factors for CFS. These psychological factors may inhibit descending pathways in the central nervous system, resulting in sensitisation of dorsal horn spinal cord neurons [75]. Hence, cognitive and emotional factors could be contributing to and possibly sustaining the mechanism of central sensitisation in CFS. This notion is supported by the fact that cognitive behavioural therapy – a form of psychotherapy used to treat a variety of psychological impairments, but also used as a therapeutic adjunct for symptom management and coping in illnesses such as cardiac, cancer, diabetes and chronic pain – has been shown to be effective for the treatment of CFS [78–80]. Indeed, part of the effects observed with of cognitive behavioural therapy for CFS may be explained by its action on cognitive emotional sensitisation. Reducing the impact of perpetuating cognitive and emotional factors in patients with CFS might lead to desensitisation, as has been shown in patients with fibromyalgia [81].

    In their conclusions, the authors open with this:

    "... The finding that central sensitisation is present in a large proportion of CFS patients calls for treatment strategies that desensitise the central nervous system. First, cognitive behavioural therapy could be employed to addresses the cognitive emotional aspect of central sensitisation. Hence, a comprehensive treatment of central sensitisation should include cognitive behavioural therapy. This notion is in line with the current evidence-based practice guidelines for the management of CFS [85].

    Admittedly, these authors do consider other aspects. But it would be better to see a more well-specified concept, with its own proper mechanism, properly fleshed out. rather than this vague idea of "central sensitization" that might have many causes.
     
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  4. Woolie

    Woolie Senior Member

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    Alas, I don't think this is true, @Mark. Neuroimaging measures are just as complicated and hard to decipher as any behavioural measure. So for example, your brain will respond not just to the pain stimulus, but will also evaluate that pain, react to it emotionally, and even perhaps try to inhibit it or manage it in some other way. So you have a massive number of brain regions that could be activated, all for different reasons.

    To make matters worse, there are a whole bunch of brain structures that have been associated with pain, and lots of these structure do other things too - like process emotion. Its really hard to work backwards from a structure to what its actually contributing to our experience.

    I guess fMRI studies offer something slightly different from self-report, and that's got to be a good thing (because with self-report, you don't know how much people are responding to social expectations). But far from providing the answer we're all looking for.
     
    Last edited: Aug 21, 2015
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  5. Chrisb

    Chrisb Senior Member

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    "Claiming you are gong to die from a headache would be catastrophising." What if the headache is caused by an undiagnosed brain tumour? Still catastrophising? Or is there an ex post facto revision of the catastrophisation when diagnosis is made or the patient dies
     
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  6. SOC

    SOC Senior Member

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    I think most people know what I meant with that sentence. If it makes you feel better, I'll change it to
    Claiming you are going to die from a mild, common, everyday stress headache would be catastrophizing.

    Catastrophizing exists. That's what makes it possible for psychoquacks to expand the diagnosis far beyond the reality and get people to accept their ridiculous claim. I imagine we all know someone for whom every little setback is a major disaster. They break a nail and they're in tears. They get a chip in their car paint and now the car is worthless. They get a C on a test and now they're never going to get into college.

    The problem is that the psychoquacks take this condition which exists in a small number of people and apply the diagnosis willy-nilly to everything they don't understand. Their life situation and response to it is normal, and everything they don't experience or don't understand is pathological. In order to justify that line of thinking, they look for a pathology and apply it to a perfectly normal response and suddenly the label becomes the reality. In their minds, anyway. :rolleyes:
     
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  7. Tired of being sick

    Tired of being sick Senior Member

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  8. Chrisb

    Chrisb Senior Member

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    I'm just trying to find the limits of the idea with a view to testing the arguments, if such they can be called, of those who take an opposing view. I realise that we are of the same view. I suspect the problem here is that we all have a similar outlook.

    I'm sure there are people who in ones own perception seem to over-react to apparently minor stimuli. However one cannot judge the importance of any particular matter to another person or their capacity to cope with the particular situation in which they find themselves. Often with such people their recovery seems immediate and spontaneous, until the next time. Is there any evidence that all such people when suffering pain go on to develop abnormal pain responses if confronted by circumstances which might be expected to cause minor inconvenience.? Has there been any attempt to falsify any hypothesis ? I suspect that the answer to both is "no".

    In such cases as the car and the nail, mentioned above, one can see for oneself the stimulus causing the reaction and therefore assess for oneself what one thinks an appropriate response would be. With another person's pain one just cannot know. Even when one sees the stimulus there is not much to go on. The language of pain is very difficult. I seem to remember that Wittgenstein expended considerable thought provoking effort on the subject. But my memory is not up to much. One of the difficulties is to overcome the metaphysical idea that there is something called pain. All we have is the shared use of language.

    I find interesting the comparison of this idea of catastrophisation with other apparently abnormal pain responses. One might look at referred pain or phantom limb pain. In neither of these cases, so far as I know, are sufferers subject to implied denigration. Neural explanations are sought. Is it because catastrophisation is somehow seen as a quantative false response whilst the others are qualitative? One might think that false limb pain might be a more obvious case for denial-one could always point to the absence of the limb in question.

    I do also have another problem with catastrophisation, and its existence. I may be entirely wrong. It always seems to me that whatever is said about the end of mind /body duality being accepted, the language always seems to suggest that the ghost in the machine is still alive , if not always well. It seems to be suggested that rather than being merely a category error he is to blame for all the problems which beset the sufferer. Otherwise what is it that is doing the catastrophising. Could such a term, with all that it implies, reasonably be used merely to describe physical responses caused by activity within the brain.

    Probably experts will say they are using words in specialist ways. Words mean what I want them to mean said Humpty Dumpty. Once they do this even they often fail to distinguish between the different uses and specialist usage is overlain with the everyday usage. Even amongst themselves.
     
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  9. Woolie

    Woolie Senior Member

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    Nicely said, @Chrisb!
     
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  10. DeGenesis

    DeGenesis Senior Member

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    I can't agree more. It would seem to me that the end of the mind/body duality way of thinking also invalidates psychiatry as a whole, removes what remains of it to neurology, and the entire idea of "mental health" is also no longer valid. ("Mental health" is very vogue at the moment, promoted by mostly well-meaning people). Obviously this would not be advantageous for many vested interests.
     
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  11. Woolie

    Woolie Senior Member

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    Here's some hard evidence that psychosocial explanations of pain do real harm to patients in how they are perceived by carers. Its kind of scary to see this in actual print.

    Click on the title for a link to the paper.

    Health Care Professionals’ Reactions to Patient Pain: Impact of Knowledge About Medical Evidence and Psychosocial Influences


    De Ruddere et al.

     
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  12. Woolie

    Woolie Senior Member

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    Another, equally scary study by the same authors. This one looks at general observers, not health care practicitioners.

    Discounting pain in the absence of medical evidence is explained by negative
    evaluation of the patient

    De Ruddere et al.

     
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  13. Snow Leopard

    Snow Leopard Hibernating

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    I wonder whether physical fatigue itself leads to the things they mention (pain & pressure thresholds). They also seem to overlook the effect of pain tolerance on subjective reporting of pain and even pain thresholds. There is a bit of research on this in athletes. The conclusion is that athletes and especially elite athletes don't have increased pain thresholds, they simply have increased pain tolerance - and this leads to them subjectively reporting less pain than other people.

    Back to the athletes though, I wonder whether say, marathon runners have reduced pain thresholds after running a marathon than before?

    There is an interesting narrative review discussing the relationship between pain, fatigue and performance of athletes:
    http://journal.frontiersin.org/article/10.3389/fphys.2013.00104/full
    This might be interesting too, though I haven't read it yet:
    https://www.researchgate.net/public...Participants_of_the_TransEurope_FootRace_2009
    I'd love to see a study that monitored pain thresholds/tolerance, rated fatigue, pain and actual performance over time during a long multi-day race like that.
     
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  14. Chrisb

    Chrisb Senior Member

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    It's interesting that you raise this question on the day that Paula Radcliffe issued a statement about suggestions regarding three apparently abnormal blood test results. She said, I think, that two of the samples were taken immediately after races, and that rules were subsequently changed to prevent testing of samples taken within two hours of the finish of a race. The third unusual result was taken after a race in Portugal in the midday heat and there may have been other illness factors involved.

    I mention this not to cast aspersions but as an example of the possible extent of unsuspected variability, and the difficulties in testing and interpreting test results. Perhaps similar variability would arise with factors affecting pain thresholds.

    I am a strong believer in the fallacy of inductive reasoning. There often seems to be too little testing and too much extrapolation.
     
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  15. Woolie

    Woolie Senior Member

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    Really good suggestion, @Snow Leopard, I'm looking forward to looking at these!
     

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