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I think there is evidence that people's attitudes toward pain can affect both the amount of pain that they feel and how much they suffer from it, and more gener

by schoen 6y ago

I think there is evidence that people's attitudes toward pain can affect both the amount of pain that they feel and how much they suffer from it, and more generally that there are mental skills related to pain management and experience that are genuinely useful. (Also, there are cases where classic psychotherapy or psychoanalysis methods led to an alleviation or complete disappearance of somatic pain symptoms, even without focusing at all on the symptoms or pain themselves... although it doesn't seem ethically appropriate to somehow assume that that would be the best treatment for everyone.) I agree with the concern that this should not be seen as a substitute for helping reduce people's suffering with pain medication. But I think we also still have lots to learn about the mental component of pain and potentially identifying psychological interventions that make a difference in this area. I also agree that the "all the pain people experience is in their heads" angle isn't a constructive one, both because of its proximity to accusing people of lying or malingering, and because it doesn't seem like a helpful summary of any apparently-beneficial psychological techniques.

ska 6y ago
> "all the pain people experience is in their heads" The funny thing about this one is that it is literally true, and not easily actionable.
frereubu 6y ago
I remember reading during my neuroscience MSc that there are two distinct areas in the brain activated during pain, one which is to do with the feeling of pain, and the other which is to do with the mental anguish caused by that pain. It makes sense to me that there are non-medical ways of diminishing the anguish aspect of pain (although of course whether something "makes sense" doesn't automatically mean it's true). It also matches the different psychological responses to pain of soldiers in battle, where the pain is not as intrusive, vs a sportsperson who's injured during a game and who's in an otherwise safe space where they can ruminate about what the injury means for their career.
auganov 6y ago
The easiest "psychological technique" in this case is to simply understand the pain is likely not caused by any obvious identifiable physical cause. Just have people go through all the information. Pain usually signals something's wrong. Once you truly understand there's no basis for that pain, you will process it in a different way. Many reports of chronic pain completely going away just by reading. Psychotherapy sounds like a much less efficient way with potential to create new problems.
Someone 6y ago
There’s an enormous mental aspect to pain. As an extreme example, soldiers being shot may be happy getting a ticket home, even if their injury is severe. https://theconversation.com/emotions-affect-how-pain-feels-as-soldiers-know-only-too-well-25889 https://theconversation.com/emotions-affect-how-pain-feels-a...: “In 1943 and 1944, Beecher, who was described by friends as a street fighter in the field of medicine, travelled to the Venafro and Cassino fronts in Italy, where he questioned 215 seriously wounded men who were waiting on the beachfront to be evacuated by boat to hospital. He concluded that the anecdotal evidence was correct: there was no necessary correlation between the seriousness of any wound and men’s expressions of suffering. In fact, three-quarters of wounded soldiers claimed that they weren’t experiencing significant pain and didn’t ask for pain relief, even when offered it. […] In contrast, suffering a similar kind of injury in civilian contexts (a car crash, for example) was excruciatingly painful because it heralded “the beginning of disaster”. Beecher confirmed anecdotal evidence that being wounded was viewed as good luck: wounds enabled men to escape “this hell with nothing more perhaps than the loss of half a foot”, as one World War I soldier put it. Emotions and expectations affected physiological sensations.“ Also, I think we should educate people that, if an expert says “we can’t find anything physical, so I think it’s in your head” doesn’t mean you put it there, or that you should be able to take it out without any help and, hence you’re to be blamed for it. (I also think we should educate doctors to tell patients that “we can’t find” doesn’t mean “there isn’t”)
- bregma 6y ago
  You don't need to go to war and study soldiers to observe this very human phenomenon. You just have to be around young children for a short while. Kids will run and tumble and bonk their heads and get up laughing. Then they'll catch their finger and look at it: if it looks fine, they carry on but of they see a drop of blood, suddenly they're in mortal pain and the end times are nigh as they scream in agony. I don't think people grow out of that. The stakes just change as they get older.
  - Someone 6y ago
    Good example, but I think the military example better shows how enormous the mental aspect is. For kids, one could argue that they still have to learn what pain is, just as they have to learn what it is to be physically tired (go on a walk with them until they say they’re too tired to make another step. At that moment, point out there’s an ice cream vendor or a playground a kilometer away, and be amazed). Kids sometimes also (consciously or unconsciously) play the tired/injured card just to get attention (that probably applies to some grown ups, too)

by schoen 6y ago

ska 6y ago

> "all the pain people experience is in their heads" The funny thing about this one is that it is literally true, and not easily actionable.

frereubu 6y ago

I remember reading during my neuroscience MSc that there are two distinct areas in the brain activated during pain, one which is to do with the feeling of pain, and the other which is to do with the mental anguish caused by that pain. It makes sense to me that there are non-medical ways of diminishing the anguish aspect of pain (although of course whether something "makes sense" doesn't automatically mean it's true). It also matches the different psychological responses to pain of soldiers in battle, where the pain is not as intrusive, vs a sportsperson who's injured during a game and who's in an otherwise safe space where they can ruminate about what the injury means for their career.

auganov 6y ago

The easiest "psychological technique" in this case is to simply understand the pain is likely not caused by any obvious identifiable physical cause. Just have people go through all the information. Pain usually signals something's wrong. Once you truly understand there's no basis for that pain, you will process it in a different way. Many reports of chronic pain completely going away just by reading. Psychotherapy sounds like a much less efficient way with potential to create new problems.

Someone 6y ago

There’s an enormous mental aspect to pain. As an extreme example, soldiers being shot may be happy getting a ticket home, even if their injury is severe. https://theconversation.com/emotions-affect-how-pain-feels-as-soldiers-know-only-too-well-25889 https://theconversation.com/emotions-affect-how-pain-feels-a...: “In 1943 and 1944, Beecher, who was described by friends as a street fighter in the field of medicine, travelled to the Venafro and Cassino fronts in Italy, where he questioned 215 seriously wounded men who were waiting on the beachfront to be evacuated by boat to hospital. He concluded that the anecdotal evidence was correct: there was no necessary correlation between the seriousness of any wound and men’s expressions of suffering. In fact, three-quarters of wounded soldiers claimed that they weren’t experiencing significant pain and didn’t ask for pain relief, even when offered it. […] In contrast, suffering a similar kind of injury in civilian contexts (a car crash, for example) was excruciatingly painful because it heralded “the beginning of disaster”. Beecher confirmed anecdotal evidence that being wounded was viewed as good luck: wounds enabled men to escape “this hell with nothing more perhaps than the loss of half a foot”, as one World War I soldier put it. Emotions and expectations affected physiological sensations.“ Also, I think we should educate people that, if an expert says “we can’t find anything physical, so I think it’s in your head” doesn’t mean you put it there, or that you should be able to take it out without any help and, hence you’re to be blamed for it. (I also think we should educate doctors to tell patients that “we can’t find” doesn’t mean “there isn’t”)

bregma 6y ago
You don't need to go to war and study soldiers to observe this very human phenomenon. You just have to be around young children for a short while. Kids will run and tumble and bonk their heads and get up laughing. Then they'll catch their finger and look at it: if it looks fine, they carry on but of they see a drop of blood, suddenly they're in mortal pain and the end times are nigh as they scream in agony. I don't think people grow out of that. The stakes just change as they get older.
- Someone 6y ago
  Good example, but I think the military example better shows how enormous the mental aspect is. For kids, one could argue that they still have to learn what pain is, just as they have to learn what it is to be physically tired (go on a walk with them until they say they’re too tired to make another step. At that moment, point out there’s an ice cream vendor or a playground a kilometer away, and be amazed). Kids sometimes also (consciously or unconsciously) play the tired/injured card just to get attention (that probably applies to some grown ups, too)