Chronic pain is not a disease (Psychology Today, 27 May 2018)

While I may agree that unproven symptoms count as syndromes or illnesses, rather than specific diseases, the number of assumptions and false ideas in this article is appalling:

Link: https://www.psychologytoday.com/gb/blog/patient-zero/201805/chronic-pain-is-not-disease

Firstly, brain changes in chronic pain, and in other disorders mentioned (I'm mainly thinking of ME here), show different changes in brain function and structure than depression. As I understand it, astrocytes and microglia appear to be involved in chronic pain. In ME, there appear to be distinct areas of hypoperfusion and structural changes that can be differentiated from depression.

Secondly, he makes lots of leaps without recognising the flaws of such assumptions. Rather than accept that correlation =/= causation, he goes on to suggest psychological problems are causative in unexplained syndromes, rather than being a consequence of them. It's a flaw that's even more egregious when you realise that not every patient with these symptoms has MH problems.

Thirdly, he goes on to promote the BPS model as both 'the only way' and 'a neglected' area of medicine (I'm paraphrasing), despite the increasing take-up of BPS models by the DWP, many pain (and other) clinics and other parts of the NHS. It's yet another desperate call for even more of the shockingly poor BPS models we've been subjected to for the last 30 years.

/rantover

 

I'd like to cite @Jonathan Edwards here:
https://www.s4me.info/threads/chron...apy-can-reduce-the-suffering.4176/#post-72812

I know "Ye shall not"...but I really wish people who dismiss pain as "psychogenic" would have it. And I'll want them to know it won't stop until they die. I bet lots of them would get depressed, too. And then I'll want others to tell them "You were depressed in the first place" (or "you had a mental health issue") "that led to changes in the brain, and these caused your pain; now we can redeem you! We can change those brain changes back - you only have to want, that's all."

It's so absolutely unbelievably dumb...Instead of thinking the obvious, "hey, those people have severe symptoms that affect their lives - sure you'll be sad, frustrated, maybe even desperate" they reverse it by saying severe symptoms show an underlying mental illness. (I mean, principally this could be an explanation, but it would have to be proven...but we know the rest.)

They really do live in their own reality, and they are fixed on that reality. They are unable to see alternatives. Actually, if they were consequent, they had to diagnose themselves with a "personality/mental disorder".

 

House of cards

 

If an effective and profitable treatment were found tomorrow, chronic pain would be reclassified as a disease on the same day.

 

I haven't seen this 'disease'/'illness' distinction before. Another one for the repository.

A seminal insight, to be sure.

Yes, well, that is the stratégie politique du jour. Claim your side is under siege and losing. It feels good to play victim.

___
This whole thing with psychogenic pain baffles me. Of all the symptoms I have ever experienced as a result of anxiety or sadness or whatever - nausea, wooziness, headache, palpitations, shortness of breath, diarrhea, weakness, indigestion, tiredness, etc. - none remotely resembled 'pain' in the way we usually mean it, and none were not obviously linked with the 'psychosocial' 'distress' I was going through at the time.

I think this category is empty.

 

And so absolutely unbelievably cruel.

 

Confounding and the Biopsychosocial Model
by Chris Centeno, MD / June 11, 2017
Interesting article.

full article here
https://regenexx.com/blog/confounding-biopsychsocial-model/

(warning; there are ads on this site.)

 

Huh, I wonder why 94% of people with chronic severe pain would have depression...

 

It is an interesting article, but it goes into a pretty weird flex here. If the BPS hegemony was caused by the US having better, more comprehensive, more modern healthcare than the UK and Canada, then surely no patients in the US would ever be told that their chronic pain only exists in their heads? But we know that they do.

 

Right target but for the wrong reasons. For all its faults, and it has many, the one redeeming quality of the US health care is tort. Most universal health care systems are "no fault", mistakes are to be buried and silenced, no one is ever to be blamed (except the patient, of course, always blame the patient). In the US system, misdiagnosis can carry actual consequences and it makes bold assertions without evidence, such as "there is no disease and you can aim for full recovery" liable malpractice (hello, Mayo clinic and other lying liars, see you in court in a few years).

This is the only advantage the US health care system has: you can't bullshit your way officially and lack of due diligence has consequences. It makes "I don't know" the right answer to complex problems, whereas some systems like the NHS will actively encourage their practitioners to promote completely made-up pseudoscience like the psychosocial model, telling them they will be shielded from all liability if ever it comes to that.

That's likely the main reason the US has been reluctantly leading the way out of making bold assertions about the psychosomatic nature of ME. Since they are simply not backed by evidence practitioners understand they may face consequences for straight-up lying to their patients, they do not have the protection the NHS gives its GPs, instead actually encouraging them to straight-up to go all in and gaslight their patients because they think it's cheaper.