8 ms·

Over the next 20 or so years, expect a lot of syndromes/conditions to be reclassified, as Michael Sharpe puts in the article, as "biological condition[s] that c

Over the next 20 or so years, expect a lot of syndromes/conditions to be reclassified, as Michael Sharpe puts in the article, as "biological condition[s] that can be perpetuated by social and psychological factors.". I struggled with RSI for a couple of years until I read John Sarno's "The Mind-Body Connection" on the recommendation of someone from HN. Sarno's thesis is that many chronic pain conditions (those without a clear physical mechanism, such as RSI or chronic back pain) are psychosomatic. A lot of people struggle with this idea, and take it, as they did in the article, as "my pain isn't real". Sarno's book very clearly lays out that the pain is real, it's just caused by processes in your brain, not the rest of your body. Societally it's all very strange. We accept a "mind-body" connection for certain types of disorders, but, not for others. Anxiety sufferers can fool themselves into thinking they're having a heart attack and hyperventilate. Why is it crazy or anti-scientific to think that the same can cause other symptoms? We've searched for decades for body-based mechanisms for these chronic pain conditions, why not consider causes in the brain?

mcv 8y ago
> those without a clear physical mechanism, such as RSI or chronic back pain But RSI has a clear physical mechanism. I don't know as much about chronic back pain, but considering how much physical stuff there is in our back, I'd assume it's similar. Or does "physical mechanism" mean something other than it seems to mean?
- dwighttk 8y ago
  to be clear... RSI is repetitive stress injury, correct? Or strain?
  - __blockcipher__ 8y ago
    strain.
- hirundo 8y ago
  John Sarno's theory is that such pain is indeed caused by physical mechanisms ... which are triggered by psychological mechanisms. Such things are common, like a blush to the cheeks, hair on your arm raised by fright, erections and other sexual responses, etc. He was also clear that this is not always the case, and that direct physical causes should be looked for by a specialist before pursuing psychological remedies.
  - mcv 8y ago
    You mean that stress can play a factor in RSI? I don't think that's in any way controversial, but that doesn't make it in any way less real, or less physical. Although in the case of RSI, there are a lot more factors than that: bad posture, lack of exercise, and most importantly of course repetitive motions that very slowly build up strain on surrounding tissue, wrists, shoulders, back, etc.
    - Pimpus 8y ago
      It's not stress and it's not playing a factor. Unconscious, repressed emotions are the direct cause of RSI and many other ailments, including Chronic Fatigue Syndrome. I highly recommend reading the book.
    - SubiculumCode 8y ago
      Psychological IS physical. Full stop.
    - hisnameisjimmy 8y ago
      The implication by Sarno is that stress, or other psychological factors, is the whole reason for the physical pain. Not always, but in many (if not a majority) of cases. The idea is the pain is very, very real, and very, very painful. But that the cause is psychological. The reason why RSI and back pain type issues persist is because psychologically they are very easy to justify. Of course we put load on our backs! Of course we do repetitive things! So it's easy to draw the conclusion that this is the cause, especially for your brain. This prevents people from exploring a root cause. It's interesting material, but I think you have to be pretty open minded to consider it.
- pjc50 8y ago
  In practical terms, "physical mechanism" means something a GP can see or test for, rather than relying on asking the patient whether it hurts.
  - mcv 8y ago
    GPs aren't always sufficiently specialised to do a detailed diagnosis, but in my experience, a good physical therapist should be able to find the problem. (They have in my case, whereas the GP just asked some vague questions and decided it's probably some form of RSI.)
  - ryukafalz 8y ago
    That’s an ever-changing category, though, as medical technology improves. Bone fractures would have been more difficult to observe directly before the invention of x-ray machines, but that doesn’t change the underlying physical condition.
- bunderbunder 8y ago
  What is a person, if not a whole bunch of physical mechanisms under the control of a central nervous system that is itself another physical mechanism?
- jacobolus 8y ago
  Yes, there’s some physical mechanism, but triggered by emotional responses. Speaking for myself, I don’t have serious back pain, but when I occasionally experience momentary strong anxiety my back muscles get noticeably tight/strained, especially while sleep deprived. Drinking 1 beer typically alleviates that, or I’m sure some other anxiolytic medicine could. I would not be surprised at all if chronic severe anxiety (e.g. taking care of a chronically ill child, working a high-stakes short-deadlines job, living with an emotionally abusive person, experiencing trauma and then suffering PTSD, ...) might cause me to develop a real back pain problem.
- flatline 8y ago
  For example, everyone’s disks degenerate with old age. They squash, bulge, even herniate. But only some people experience notable pain from this. And back pain has been a growing epidemic for decades! Are there physiological differences between people that explain this? Probably. But I suspect in many cases Sarno is right, it’s not purely physical. Look into neuromatrix theory and non-proprioceptive pain for a somewhat more scientific attempt at an explanation.
- wpietri 8y ago
  Yeah, "clear physical mechanism" is a hole I could drive a truck through. Clear to whom? And what does "clear" have to do with "verified through rigorous scientific exploration of this and competing hypotheses"? As Mencken said, "Explanations exist; they have existed for all time; there is always a well-known solution to every human problem — neat, plausible, and wrong." My experience with most serious medical things is that doctors have a clear general-audience explanation, because part of their job is making patients feel like they understand what's going on. But if you get into the details, the good doctors will say, "Well, actually, the picture is much murkier, but here's what we know based on studies X, Y, and Z, but there's a lot yet to learn." Back pain in particular is an area of open dispute. Many people have many theories, all of them very hard to test. When I was dealing with back pain, a spine-center doctor recommended a book called "Treat Your Own Back" [1]. It was hugely helpful to me. And in it, the doctor explains that he hit upon his method because a patient came in, used a piece of equipment that was set up totally the wrong way, and said, "Gosh, doc, that was great!" It led him to reexamine what he had been taught about backs, coming up with a different "clear physical mechanism" to explain a common class of pain. That we are still figuring something out does not mean it's psychosomatic. It doesn't mean it's not, but a doctor suggesting otherwise is doing the medical equivalent of "god of the gaps" theology, where anything mysterious is attributed to your preferred cause. [1] https://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0959774661 https://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/095...
jimmy1 8y ago
> the pain is real, it's just caused by processes in your brain, I don't find this particular statement very revolutionary. We have known for a long time that physical pain is manufactured by the brain as an evolutionary tactic to help us prevent further harm to ourselves. If we didn't "feel pain" when we were on fire, we would burn to death.
- nateberkopec 8y ago
  I completely agree with you, but our society has such a stigma around mental illness that if you tell someone their back pain is caused by repressed emotions, you get what happens in the article.
  - mikojan 8y ago
    Maybe it's because you're not a doctor
    - ergothus 8y ago
      I felt plenty of resentment and disbelief when a doctor said it. (Not about RSI in my case, but the point that "it's in your head" does not come off well.)
      - kmundnic 8y ago
        I used to feel the same way, until I read Sarno’s book. The way he explained what psychosomatic means completely changed my perspective over it. I think the main problem with many doctors is the fact that the patient tends to feel blamed when told that their minds are causing the problem. This is not Sarno’s approach at all, since he states that chronic pain can be seen as a defense mechanism against deep negative emotions.
  - theli0nheart 8y ago
    > if you tell someone their back pain is caused by repressed emotions, you get what happens in the article. But...you would (or could?, or should?) never tell someone that, because how would you know? Maybe there is some link but to conclude that it could be the case is pretty silly. So it's not like that's a stigma, it's just a statement not based in fact that evokes a strong reaction because you're telling someone why they're feeling a certain way when in reality you have no idea at all.
gerbilly 8y ago
> that the pain is real, it's just caused by processes in your brain, not the rest of your body. I was also helped by Dr Sarno's book, and for me the news that it was "all in my head" was encouraging. I can control my mind[1], and if my mind is the source of the problem, it's a lot easier for me to fix it that if I required surgery or medicine. [1] At least partially, the mind is a slippery thing too.
- Delmania 8y ago
  The more I learned the more terrifying that statement has become. The mind exerts incredible power of the body (and vice versa) and it's much harder to get rid of pain caused by a something in your brain than a cut or a broken leg.
  - reitanqild 8y ago
    Agree. This is kind of embarrasing as a grown up, an engineer and a soldier, but the brain can really prank some of us. (Edit: I guess it might be even worse as a doctor or nurse. My point is only that I consider myself a reasonable adult, not too easily scared.) My brain used to have my body act up when I took a certain medication. I was lucky: Once it got a little ahead of itself and my body started acting funny before I'd even taken the medication. At that point I knew it was all in my head and never had any more problems with that medicine after that.
    - tome 8y ago
      > I was lucky: Once it got a little ahead of itself and my body started acting funny before I'd even taken the medication. This is really interesting! I have a funny reaction to spicy foods: my scalp starts itching. I've notice that the itching can start even before eating when I merely have the spicy food in front of me and I'm anticipating eating it.
      - hnick 8y ago
        I've read anecdotally this applies to drug tolerance too. If an addict uses a drug in an unfamiliar setting their body won't have steeled itself to expect it, and they can overdose more easily. It was definitely a weird idea when I first heard it.
SeanDav 8y ago
If anyone doubts the power of the mind-body effect, look up Nocebo effects (opposite of placebo) where the mind manufactures "real" symptoms as side effects to medication. I can't find the source(s) right now - but I have previously read about cases as extreme as blindness and paralysis with purely mind-induced and non-physical causes.
wavepruner 8y ago
My personal experience with RSI is that it crippled me. My forearm muscles, for example, became rock hard. Not sure how that could be just my mind. Fortunately, I found the underlying physical cause and am responding quickly to treatment. Glad to hear Sarno helped you though :)
mrfredward 8y ago
I tend to think that any disease that is diagnosed without a well understood mechanism and a physical marker is very commonly misdiagnosed. We may find out depression and CFS/ME are two flavors of the same thing, or we may one day prove they are distinct and that many diagnosed with depression have CFS/ME. I think this applies to all the diseases that are diagnosed as a bucket of symptoms. For example headaches...someday when we understand the mechanisms behind migraines, cluster headaches, tension headaches, etc... we'll probably find that we drew the buckets in the wrong spot.
SCdF 8y ago
Just so there is a dissenting reply about Sarno's book, I have chronic RSI and his book did not help me at all. I wish it did, I'm pretty over RSI in general, but after going through a variety of different ideas and experiments pretty much "don't use your hands" is all I've got :-(
- kmundnic 8y ago
  Sarno’s book concludes with the idea that negative emotions cannot be changed, and I disagree. I _think_ this is due to the psychoanalysis framework he employs for his analysis. For me, it didn’t help either, but guided me to search how I could change my emotions. A mix of yoga and meditation plus techniques from “Code to Joy” by George Pratt helped me chronic headaches. Yoga helps you become more aware of your mind-body. Meditations practiced in Kundalini yoga can help you become more deeply aware of your mind, or trigger certain helpful ideas (they usually have a very specific intention). What was left for me was to change negative beliefs that were created throughout my life, and that I accomplished with Code to Joy (and some of their previous work, which is more focused in emotions rather than beliefs).
  - kr4 8y ago
    It's difficult to put forward the science behind Kundalini Yoga / meditation to audience stuck in modern scientific mindset. There's a huge literature in India for holistic living that encompasses from Ayurveda, yoga to tantra written over thousands of years based on direct experience and experiments. If you’re curious to know more you can start with The Wellness Sense https://www.amazon.com/Wellness-Sense-practical-emotional-Ayurvedic-ebook/dp/B00QKQYFE0 https://www.amazon.com/Wellness-Sense-practical-emotional-Ay...
- dkersten 8y ago
  Give this a look: https://www.mijncarpaletunnel.nl/en/home https://www.mijncarpaletunnel.nl/en/home I can't guarantee that it will work for you, but it helped me.
dkersten 8y ago
> I struggled with RSI for a couple of years until I read John Sarno's "The Mind-Body Connection" on the recommendation of someone from HN. Sarno's thesis is that many chronic pain conditions (those without a clear physical mechanism, such as RSI or chronic back pain) are psychosomatic. I've had two RSI episodes in my life. The first one was similar to what you described and went away without any physical intervention, after I read something similar. The second (specifically, I had carpel tunnel syndrome symptoms) was more recently and didn't go away until I tried these: https://www.mijncarpaletunnel.nl/en/home https://www.mijncarpaletunnel.nl/en/home They say to use them for 6 weeks. For about 4 weeks I didn't notice any change, but by the end of week 5 I was pain-free. They claim that you should remain pain-free for a couple of years after, which wasn't the case for me, I get some symptoms every so often (rarely pain, usually tingling fingers), but between using a Kinesis Advantage2 keyboard with foot pedals and taking regular breaks, its been manageable so far and hasn't caused any problems.
- ip26 8y ago
  1) Is it worse in your mouse hand? Don't overlook the mouse. 2) Is the KA2 wide enough for your shoulders? A split keyboard was the ticket for me, due to the set of my shoulders.
  - sewercake 8y ago
    what split keyboard are you using? Do you recommend it? Currently in the market for one.
    - redwards510 8y ago
      Not him, but... Microsoft nailed it with the Sculpt ergonomic keyboard imho. Detached numpad so you can put the mouse closer to the keyboard, gentle sloping, nice key travel. It's a good split starter keyboard. This one is cheaper than the combo version because it doesn't include the mouse. Don't get the grey bluetooth one. It has a numpad and weird feel along with bt issues. https://www.amazon.com/Microsoft-Ergonomic-Keyboard-Business-5KV-00001/dp/B00CYX26BC/ https://www.amazon.com/Microsoft-Ergonomic-Keyboard-Business...
internet_user 8y ago
Expect that as we speak, the actual biological cause are being discovered. Just like it turns out 50%+ of fibromyalgia patients have actual neuropathies, that can unfortunately diagnosed by biopsy only, which is expensive - and it's oh so much cheaper and efficient to write off as a psychosomatic disease instead.
vgoh1 8y ago
When I was a child, I would suffer from terrible muscle contractions in my calves. I would get a charlie horse in the middle of the night, and it would not go away completely for over a day. I couldn't put my foot flat to walk properly, and it was very painful. After about a dozen of these attacks, I noticed a pattern - they would occur on the night before something that I was dreading - a test I wasn't prepared for, a school dance, etc. Once I realized this, it never came back again. On the outside, it appeared that I was faking the muscle issues, but actually, my mind was causing charlie horses deliberately. It was very odd, but will always stick with me that the connections between body and mind are not well understood.
- freeflight 8y ago
  Wow, that's like the exact opposite to my nighty calf cramps. I tend to get them when I'm way too relaxed as that makes me "stretch out" during sleep, which I kinda notice in half-sleep as feeling great, until I seemingly "overstretch" and get fully woken up to a painful calf cramp. Tho that whole problem kinda fixed itself once I started taking Magnesium supplements before going to bed, to help with teeth gnashing/neck pains.
  - tomlock 8y ago
    Anecdata +1 but taking magnesium every now and then has done wonders for my leg cramp issues.
    - jeffwass 8y ago
      Did you take the magnesium also just before bed or morning?
      - tomlock 8y ago
        I don't take it on a schedule. I only take it when I feel a twinge in my calf. I figure I'm probably deficient in magnesium or something. Even if it is a placebo, it seems to work.
      - 8y ago
11thEarlOfMar 8y ago
Your comment reminds me of the sensation I get in my legs when I watch someone jump from a significant height and land on their feet. It's the same feeling I felt when I jumped from more than 4 feet or so and landed on my legs as a child on the playground. Not really a pain, but a sharp jolting sensation that ran from my feet up my legs. Decades later, it still happens when I am sitting still in a theater and I watch a character jump and land on their feet in a similar manner. It's a real sensation. There is a mind-body connection and the mind can induce nervous system sensation when no physical cause is present.
yznovyak 8y ago
Where I'm from (Ukraine) RSI is pretty much unheard of, and I only learned about it when I moved to the US (when I was 21). Interestingly not long after learning about it I've started experiencing pain in my wrists and started to get really worried about getting an RSI. One of my coworkers recommended Kinesis Advantage keyboard, so I bought it off ebay and started using it and the pain disappeared. Interestingly I've seen this keyboard quite a lot, off top of my head I think something like 5% of engineers were using it. I'm not saying that RSI doesn't exist, but I'm now positive that in my case all those RSI-like symptoms were all in my head -- some kind of a nocebo (an anti-placebo) effect. When I was 27 I had to do an MRI of my hand for an unrelated reason (boxing injury), so naturally I asked them to do an MRI of my wrist since they'll be immobilizing my hand anyway [1]. So either my wrist was healed in those 6 years, or it was fine all along -- can't tell because I didn't have a "before" picture. Just in case, I explicitly double checked with another doctor if he was sure about my wrist and he said that my MRI could be used as a textbook example of a healthy wrist joint. I am now wondering if all those "mental-health awareness" things could have an adverse effect. I wonder how many hypochondriacs self-suggested themselves an OCD or an ADHD, and while marinating in those thoughts they somehow turned those thoughts into an actual condition (self-fulfilling prophecy?). Like ... you guys already have tidy people joking about having an OCD, and people who like to wash hands are joking about being a germaphobs. edit: I think I've seen an article "willpower is limited only if you believe so" posted somewhere here on HN, but I can't find it now. Anyway here's another link: [3], and here's the Stanford study they cite [4]. This can be another example of people self-suggesting themselves a handicap. [1] There are a lot of posts on HN talking about healthcare costs in the US, so I'll share my anecdote too. I did an MRI in Ukraine and the whole thing was like $80: $50 for the hand and extra $30 for the wrist. The machine was 1.5 Tesla one, but there are other clinics that have 3 Tesla machines too (a little bit more expensive). Scheduling an appointment was done by a phone a couple of days in advance and didn't require any doctor referral. There are many small private clinics offering imaging services (MRI/CT/Ultrasound/...), and all of them are very easy to Google and all of the prices are available online, for example: [2]. After the procedure they give you a CD with the info, a print-out on some largish transparent plastic, and their staff doctor's conclusion. You usually take those results to your specialist doctor of choice. [2] For example: https://translate.google.com/translate?sl=auto&tl=en&u=https%3A%2F%2Fmrt-m24.com%2Fua%2Fcini%2F https://translate.google.com/translate?sl=auto&tl=en&u=https... all prices in UAH, to get rough USD estimate divide those numbers by 25 (or 26.75 to get exact number as of 2019-03-13 if you're OCD). [3] https://lifehacker.com/your-willpower-is-only-a-finite-resource-if-you-believe-5967249 https://lifehacker.com/your-willpower-is-only-a-finite-resou... [4] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0038680 https://journals.plos.org/plosone/article?id=10.1371/journal...
bjourne 8y ago
It is not crazy at all. But realize that patients that suffer from these disorders have likely been hounded for decades by doctors, employers and various government workers. I think they have heard all the variants of "I think you are faking it" that you can ever think of. That doesn't excuse the patients death threats, but one should thread carefully. There are also a lot of diseases that were thought of to be psychosomatic that turned out to not be such as peptic ulcer disease. There is also gender bias in play. Pain or illness affecting males are more likely to be classified as physiological while the same thing affecting females is more likely to be classified as psychological.
KorematsuFred 8y ago
The harassment in general might be good and scientists would be compelled to think "how will general audience read and understand my research" question before writing "academia speak". People are not in general evil, academia on other hand is a bit arrogant and engages in needless jargons and complications leading.
m463 8y ago
I think a lot of RSI is related to holding tension in your body. The more direct physical way to "fix" it is to adopt a neutral stance with your body. Let your arms hang down neutrally at your sides without using your shoulders to hold them up. Let your wrists be supported in a good position so the strings and pulleys from your forearms to your fingers function well. Support them off the sharp and low edges of the desk at a good temperature. Let your head be balanced over your neck and shoulders instead of holding it in position with your back and head muscles. The way to exacerbate the problem is the power through it like a new runner with shitty shoes. Ignore all of it, hold tension in your neck and back and ignore the signals your body is sending. Keep your monitor off-axis. Use a shitty mouse and keyboard. Sit at a laptop for hours and get-er-done in spite of terrible ergonomics. (Do you know there are no OSHA approved laptops?) The exacerbate case ignores your mind-body connection. Now, it's not "all in your head" but your head is part of the problem.

mcv 8y ago

> those without a clear physical mechanism, such as RSI or chronic back pain But RSI has a clear physical mechanism. I don't know as much about chronic back pain, but considering how much physical stuff there is in our back, I'd assume it's similar. Or does "physical mechanism" mean something other than it seems to mean?

dwighttk 8y ago
to be clear... RSI is repetitive stress injury, correct? Or strain?
- __blockcipher__ 8y ago
  strain.
hirundo 8y ago
John Sarno's theory is that such pain is indeed caused by physical mechanisms ... which are triggered by psychological mechanisms. Such things are common, like a blush to the cheeks, hair on your arm raised by fright, erections and other sexual responses, etc. He was also clear that this is not always the case, and that direct physical causes should be looked for by a specialist before pursuing psychological remedies.
- mcv 8y ago
  You mean that stress can play a factor in RSI? I don't think that's in any way controversial, but that doesn't make it in any way less real, or less physical. Although in the case of RSI, there are a lot more factors than that: bad posture, lack of exercise, and most importantly of course repetitive motions that very slowly build up strain on surrounding tissue, wrists, shoulders, back, etc.
  - Pimpus 8y ago
    It's not stress and it's not playing a factor. Unconscious, repressed emotions are the direct cause of RSI and many other ailments, including Chronic Fatigue Syndrome. I highly recommend reading the book.
  - SubiculumCode 8y ago
    Psychological IS physical. Full stop.
  - hisnameisjimmy 8y ago
    The implication by Sarno is that stress, or other psychological factors, is the whole reason for the physical pain. Not always, but in many (if not a majority) of cases. The idea is the pain is very, very real, and very, very painful. But that the cause is psychological. The reason why RSI and back pain type issues persist is because psychologically they are very easy to justify. Of course we put load on our backs! Of course we do repetitive things! So it's easy to draw the conclusion that this is the cause, especially for your brain. This prevents people from exploring a root cause. It's interesting material, but I think you have to be pretty open minded to consider it.
pjc50 8y ago
In practical terms, "physical mechanism" means something a GP can see or test for, rather than relying on asking the patient whether it hurts.
- mcv 8y ago
  GPs aren't always sufficiently specialised to do a detailed diagnosis, but in my experience, a good physical therapist should be able to find the problem. (They have in my case, whereas the GP just asked some vague questions and decided it's probably some form of RSI.)
- ryukafalz 8y ago
  That’s an ever-changing category, though, as medical technology improves. Bone fractures would have been more difficult to observe directly before the invention of x-ray machines, but that doesn’t change the underlying physical condition.
bunderbunder 8y ago
What is a person, if not a whole bunch of physical mechanisms under the control of a central nervous system that is itself another physical mechanism?
jacobolus 8y ago
Yes, there’s some physical mechanism, but triggered by emotional responses. Speaking for myself, I don’t have serious back pain, but when I occasionally experience momentary strong anxiety my back muscles get noticeably tight/strained, especially while sleep deprived. Drinking 1 beer typically alleviates that, or I’m sure some other anxiolytic medicine could. I would not be surprised at all if chronic severe anxiety (e.g. taking care of a chronically ill child, working a high-stakes short-deadlines job, living with an emotionally abusive person, experiencing trauma and then suffering PTSD, ...) might cause me to develop a real back pain problem.
flatline 8y ago
For example, everyone’s disks degenerate with old age. They squash, bulge, even herniate. But only some people experience notable pain from this. And back pain has been a growing epidemic for decades! Are there physiological differences between people that explain this? Probably. But I suspect in many cases Sarno is right, it’s not purely physical. Look into neuromatrix theory and non-proprioceptive pain for a somewhat more scientific attempt at an explanation.
wpietri 8y ago
Yeah, "clear physical mechanism" is a hole I could drive a truck through. Clear to whom? And what does "clear" have to do with "verified through rigorous scientific exploration of this and competing hypotheses"? As Mencken said, "Explanations exist; they have existed for all time; there is always a well-known solution to every human problem — neat, plausible, and wrong." My experience with most serious medical things is that doctors have a clear general-audience explanation, because part of their job is making patients feel like they understand what's going on. But if you get into the details, the good doctors will say, "Well, actually, the picture is much murkier, but here's what we know based on studies X, Y, and Z, but there's a lot yet to learn." Back pain in particular is an area of open dispute. Many people have many theories, all of them very hard to test. When I was dealing with back pain, a spine-center doctor recommended a book called "Treat Your Own Back" [1]. It was hugely helpful to me. And in it, the doctor explains that he hit upon his method because a patient came in, used a piece of equipment that was set up totally the wrong way, and said, "Gosh, doc, that was great!" It led him to reexamine what he had been taught about backs, coming up with a different "clear physical mechanism" to explain a common class of pain. That we are still figuring something out does not mean it's psychosomatic. It doesn't mean it's not, but a doctor suggesting otherwise is doing the medical equivalent of "god of the gaps" theology, where anything mysterious is attributed to your preferred cause. [1] https://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/0959774661 https://www.amazon.com/Treat-Your-Back-Robin-McKenzie/dp/095...

jimmy1 8y ago

> the pain is real, it's just caused by processes in your brain, I don't find this particular statement very revolutionary. We have known for a long time that physical pain is manufactured by the brain as an evolutionary tactic to help us prevent further harm to ourselves. If we didn't "feel pain" when we were on fire, we would burn to death.

nateberkopec 8y ago
I completely agree with you, but our society has such a stigma around mental illness that if you tell someone their back pain is caused by repressed emotions, you get what happens in the article.
- mikojan 8y ago
  Maybe it's because you're not a doctor
  - ergothus 8y ago
    I felt plenty of resentment and disbelief when a doctor said it. (Not about RSI in my case, but the point that "it's in your head" does not come off well.)
    - kmundnic 8y ago
      I used to feel the same way, until I read Sarno’s book. The way he explained what psychosomatic means completely changed my perspective over it. I think the main problem with many doctors is the fact that the patient tends to feel blamed when told that their minds are causing the problem. This is not Sarno’s approach at all, since he states that chronic pain can be seen as a defense mechanism against deep negative emotions.
- theli0nheart 8y ago
  > if you tell someone their back pain is caused by repressed emotions, you get what happens in the article. But...you would (or could?, or should?) never tell someone that, because how would you know? Maybe there is some link but to conclude that it could be the case is pretty silly. So it's not like that's a stigma, it's just a statement not based in fact that evokes a strong reaction because you're telling someone why they're feeling a certain way when in reality you have no idea at all.

gerbilly 8y ago

> that the pain is real, it's just caused by processes in your brain, not the rest of your body. I was also helped by Dr Sarno's book, and for me the news that it was "all in my head" was encouraging. I can control my mind[1], and if my mind is the source of the problem, it's a lot easier for me to fix it that if I required surgery or medicine. [1] At least partially, the mind is a slippery thing too.

Delmania 8y ago
The more I learned the more terrifying that statement has become. The mind exerts incredible power of the body (and vice versa) and it's much harder to get rid of pain caused by a something in your brain than a cut or a broken leg.
- reitanqild 8y ago
  Agree. This is kind of embarrasing as a grown up, an engineer and a soldier, but the brain can really prank some of us. (Edit: I guess it might be even worse as a doctor or nurse. My point is only that I consider myself a reasonable adult, not too easily scared.) My brain used to have my body act up when I took a certain medication. I was lucky: Once it got a little ahead of itself and my body started acting funny before I'd even taken the medication. At that point I knew it was all in my head and never had any more problems with that medicine after that.
  - tome 8y ago
    > I was lucky: Once it got a little ahead of itself and my body started acting funny before I'd even taken the medication. This is really interesting! I have a funny reaction to spicy foods: my scalp starts itching. I've notice that the itching can start even before eating when I merely have the spicy food in front of me and I'm anticipating eating it.
    - hnick 8y ago
      I've read anecdotally this applies to drug tolerance too. If an addict uses a drug in an unfamiliar setting their body won't have steeled itself to expect it, and they can overdose more easily. It was definitely a weird idea when I first heard it.

SeanDav 8y ago

If anyone doubts the power of the mind-body effect, look up Nocebo effects (opposite of placebo) where the mind manufactures "real" symptoms as side effects to medication. I can't find the source(s) right now - but I have previously read about cases as extreme as blindness and paralysis with purely mind-induced and non-physical causes.

wavepruner 8y ago

My personal experience with RSI is that it crippled me. My forearm muscles, for example, became rock hard. Not sure how that could be just my mind. Fortunately, I found the underlying physical cause and am responding quickly to treatment. Glad to hear Sarno helped you though :)

mrfredward 8y ago

I tend to think that any disease that is diagnosed without a well understood mechanism and a physical marker is very commonly misdiagnosed. We may find out depression and CFS/ME are two flavors of the same thing, or we may one day prove they are distinct and that many diagnosed with depression have CFS/ME. I think this applies to all the diseases that are diagnosed as a bucket of symptoms. For example headaches...someday when we understand the mechanisms behind migraines, cluster headaches, tension headaches, etc... we'll probably find that we drew the buckets in the wrong spot.

SCdF 8y ago

Just so there is a dissenting reply about Sarno's book, I have chronic RSI and his book did not help me at all. I wish it did, I'm pretty over RSI in general, but after going through a variety of different ideas and experiments pretty much "don't use your hands" is all I've got :-(

kmundnic 8y ago
Sarno’s book concludes with the idea that negative emotions cannot be changed, and I disagree. I _think_ this is due to the psychoanalysis framework he employs for his analysis. For me, it didn’t help either, but guided me to search how I could change my emotions. A mix of yoga and meditation plus techniques from “Code to Joy” by George Pratt helped me chronic headaches. Yoga helps you become more aware of your mind-body. Meditations practiced in Kundalini yoga can help you become more deeply aware of your mind, or trigger certain helpful ideas (they usually have a very specific intention). What was left for me was to change negative beliefs that were created throughout my life, and that I accomplished with Code to Joy (and some of their previous work, which is more focused in emotions rather than beliefs).
- kr4 8y ago
  It's difficult to put forward the science behind Kundalini Yoga / meditation to audience stuck in modern scientific mindset. There's a huge literature in India for holistic living that encompasses from Ayurveda, yoga to tantra written over thousands of years based on direct experience and experiments. If you’re curious to know more you can start with The Wellness Sense https://www.amazon.com/Wellness-Sense-practical-emotional-Ayurvedic-ebook/dp/B00QKQYFE0 https://www.amazon.com/Wellness-Sense-practical-emotional-Ay...
dkersten 8y ago
Give this a look: https://www.mijncarpaletunnel.nl/en/home https://www.mijncarpaletunnel.nl/en/home I can't guarantee that it will work for you, but it helped me.

dkersten 8y ago

> I struggled with RSI for a couple of years until I read John Sarno's "The Mind-Body Connection" on the recommendation of someone from HN. Sarno's thesis is that many chronic pain conditions (those without a clear physical mechanism, such as RSI or chronic back pain) are psychosomatic. I've had two RSI episodes in my life. The first one was similar to what you described and went away without any physical intervention, after I read something similar. The second (specifically, I had carpel tunnel syndrome symptoms) was more recently and didn't go away until I tried these: https://www.mijncarpaletunnel.nl/en/home https://www.mijncarpaletunnel.nl/en/home They say to use them for 6 weeks. For about 4 weeks I didn't notice any change, but by the end of week 5 I was pain-free. They claim that you should remain pain-free for a couple of years after, which wasn't the case for me, I get some symptoms every so often (rarely pain, usually tingling fingers), but between using a Kinesis Advantage2 keyboard with foot pedals and taking regular breaks, its been manageable so far and hasn't caused any problems.

ip26 8y ago
1) Is it worse in your mouse hand? Don't overlook the mouse. 2) Is the KA2 wide enough for your shoulders? A split keyboard was the ticket for me, due to the set of my shoulders.
- sewercake 8y ago
  what split keyboard are you using? Do you recommend it? Currently in the market for one.
  - redwards510 8y ago
    Not him, but... Microsoft nailed it with the Sculpt ergonomic keyboard imho. Detached numpad so you can put the mouse closer to the keyboard, gentle sloping, nice key travel. It's a good split starter keyboard. This one is cheaper than the combo version because it doesn't include the mouse. Don't get the grey bluetooth one. It has a numpad and weird feel along with bt issues. https://www.amazon.com/Microsoft-Ergonomic-Keyboard-Business-5KV-00001/dp/B00CYX26BC/ https://www.amazon.com/Microsoft-Ergonomic-Keyboard-Business...

internet_user 8y ago

Expect that as we speak, the actual biological cause are being discovered. Just like it turns out 50%+ of fibromyalgia patients have actual neuropathies, that can unfortunately diagnosed by biopsy only, which is expensive - and it's oh so much cheaper and efficient to write off as a psychosomatic disease instead.

vgoh1 8y ago

When I was a child, I would suffer from terrible muscle contractions in my calves. I would get a charlie horse in the middle of the night, and it would not go away completely for over a day. I couldn't put my foot flat to walk properly, and it was very painful. After about a dozen of these attacks, I noticed a pattern - they would occur on the night before something that I was dreading - a test I wasn't prepared for, a school dance, etc. Once I realized this, it never came back again. On the outside, it appeared that I was faking the muscle issues, but actually, my mind was causing charlie horses deliberately. It was very odd, but will always stick with me that the connections between body and mind are not well understood.

freeflight 8y ago
Wow, that's like the exact opposite to my nighty calf cramps. I tend to get them when I'm way too relaxed as that makes me "stretch out" during sleep, which I kinda notice in half-sleep as feeling great, until I seemingly "overstretch" and get fully woken up to a painful calf cramp. Tho that whole problem kinda fixed itself once I started taking Magnesium supplements before going to bed, to help with teeth gnashing/neck pains.
- tomlock 8y ago
  Anecdata +1 but taking magnesium every now and then has done wonders for my leg cramp issues.
  - jeffwass 8y ago
    Did you take the magnesium also just before bed or morning?
    - tomlock 8y ago
      I don't take it on a schedule. I only take it when I feel a twinge in my calf. I figure I'm probably deficient in magnesium or something. Even if it is a placebo, it seems to work.
    - 8y ago

11thEarlOfMar 8y ago

Your comment reminds me of the sensation I get in my legs when I watch someone jump from a significant height and land on their feet. It's the same feeling I felt when I jumped from more than 4 feet or so and landed on my legs as a child on the playground. Not really a pain, but a sharp jolting sensation that ran from my feet up my legs. Decades later, it still happens when I am sitting still in a theater and I watch a character jump and land on their feet in a similar manner. It's a real sensation. There is a mind-body connection and the mind can induce nervous system sensation when no physical cause is present.

yznovyak 8y ago

Where I'm from (Ukraine) RSI is pretty much unheard of, and I only learned about it when I moved to the US (when I was 21). Interestingly not long after learning about it I've started experiencing pain in my wrists and started to get really worried about getting an RSI. One of my coworkers recommended Kinesis Advantage keyboard, so I bought it off ebay and started using it and the pain disappeared. Interestingly I've seen this keyboard quite a lot, off top of my head I think something like 5% of engineers were using it. I'm not saying that RSI doesn't exist, but I'm now positive that in my case all those RSI-like symptoms were all in my head -- some kind of a nocebo (an anti-placebo) effect. When I was 27 I had to do an MRI of my hand for an unrelated reason (boxing injury), so naturally I asked them to do an MRI of my wrist since they'll be immobilizing my hand anyway [1]. So either my wrist was healed in those 6 years, or it was fine all along -- can't tell because I didn't have a "before" picture. Just in case, I explicitly double checked with another doctor if he was sure about my wrist and he said that my MRI could be used as a textbook example of a healthy wrist joint. I am now wondering if all those "mental-health awareness" things could have an adverse effect. I wonder how many hypochondriacs self-suggested themselves an OCD or an ADHD, and while marinating in those thoughts they somehow turned those thoughts into an actual condition (self-fulfilling prophecy?). Like ... you guys already have tidy people joking about having an OCD, and people who like to wash hands are joking about being a germaphobs. edit: I think I've seen an article "willpower is limited only if you believe so" posted somewhere here on HN, but I can't find it now. Anyway here's another link: [3], and here's the Stanford study they cite [4]. This can be another example of people self-suggesting themselves a handicap. [1] There are a lot of posts on HN talking about healthcare costs in the US, so I'll share my anecdote too. I did an MRI in Ukraine and the whole thing was like $80: $50 for the hand and extra $30 for the wrist. The machine was 1.5 Tesla one, but there are other clinics that have 3 Tesla machines too (a little bit more expensive). Scheduling an appointment was done by a phone a couple of days in advance and didn't require any doctor referral. There are many small private clinics offering imaging services (MRI/CT/Ultrasound/...), and all of them are very easy to Google and all of the prices are available online, for example: [2]. After the procedure they give you a CD with the info, a print-out on some largish transparent plastic, and their staff doctor's conclusion. You usually take those results to your specialist doctor of choice. [2] For example: https://translate.google.com/translate?sl=auto&tl=en&u=https%3A%2F%2Fmrt-m24.com%2Fua%2Fcini%2F https://translate.google.com/translate?sl=auto&tl=en&u=https... all prices in UAH, to get rough USD estimate divide those numbers by 25 (or 26.75 to get exact number as of 2019-03-13 if you're OCD). [3] https://lifehacker.com/your-willpower-is-only-a-finite-resource-if-you-believe-5967249 https://lifehacker.com/your-willpower-is-only-a-finite-resou... [4] https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0038680 https://journals.plos.org/plosone/article?id=10.1371/journal...

bjourne 8y ago

It is not crazy at all. But realize that patients that suffer from these disorders have likely been hounded for decades by doctors, employers and various government workers. I think they have heard all the variants of "I think you are faking it" that you can ever think of. That doesn't excuse the patients death threats, but one should thread carefully. There are also a lot of diseases that were thought of to be psychosomatic that turned out to not be such as peptic ulcer disease. There is also gender bias in play. Pain or illness affecting males are more likely to be classified as physiological while the same thing affecting females is more likely to be classified as psychological.

KorematsuFred 8y ago

The harassment in general might be good and scientists would be compelled to think "how will general audience read and understand my research" question before writing "academia speak". People are not in general evil, academia on other hand is a bit arrogant and engages in needless jargons and complications leading.

m463 8y ago

I think a lot of RSI is related to holding tension in your body. The more direct physical way to "fix" it is to adopt a neutral stance with your body. Let your arms hang down neutrally at your sides without using your shoulders to hold them up. Let your wrists be supported in a good position so the strings and pulleys from your forearms to your fingers function well. Support them off the sharp and low edges of the desk at a good temperature. Let your head be balanced over your neck and shoulders instead of holding it in position with your back and head muscles. The way to exacerbate the problem is the power through it like a new runner with shitty shoes. Ignore all of it, hold tension in your neck and back and ignore the signals your body is sending. Keep your monitor off-axis. Use a shitty mouse and keyboard. Sit at a laptop for hours and get-er-done in spite of terrible ergonomics. (Do you know there are no OSHA approved laptops?) The exacerbate case ignores your mind-body connection. Now, it's not "all in your head" but your head is part of the problem.