Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain an RCT, 2021, Asher, Gordon et al

Trish said:
Thank you, it was all a very long time ago. I was glad that by the time my daughter started suffering severe period pains there were stronger pain killers available.
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That’s a relief to hear. I obviously don’t have any experience with period pains myself, but an ex had undiagnosed severe endometriosis and ended up with liver damage due to her very frequent use of paracetamol. That was my first bystander experience with the flaws of our healthcare system and especially women’s health.
 
dundrum said:
It's not about ignoring pain. It's more about removing the emotional attachment to pain, distraction, stress reduction, etc. It's not directly under your control, but factors such as stress and emotions can upregulate the pain, and other mental factors can downregulate the pain.
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So how does a 'person' reduce something that is not under 'their' control?
I use scare quotes because my understanding of brain dynamics is that psychologists are totally confused about what they mean by a 'person', or 'control'. Popper based his theory of what is science on the example of Freud as someone who did not practice science. I don't see psychology as having changed substantially from the Freudian approach - the use of uncontrolled observations to confirm what you already thin is the case.
 
A member suggested that people think the person in pain is performing or amplifying the discomfort by fixating on it

and conversely, if you can grit your teeth and hide the fact you're in pain, that obviously means the pain isn't that bad. There's no "correct" way to give an external idea of your internal state that will stop someone else dismissing it if that's what they want to do.
 
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Eleanor said:
and conversely, if you can grit your teeth and hide the fact you're in pain, that obviously means the pain isn't that bad. There's no "correct" way to give an external idea of your internal state that will stop someone else dismissing it if that's what they want to do.
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Exactly, well said! The only way out of it is to just not be sick any more.

Under those kind of dynamics, of course I’m going to be skeptical of someone claiming they’ve recovered after some cognitive reframing therapy. Even if they fully believe in their own recovery, those dynamics mean they’ve just undergone a multi-week coercion and compliance training in addition to whatever ‘stress management’ they’ve been learning.

self-report just doesn’t suffice in those cases. We’ve been saying it over and over.
 
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Jonathan Edwards said:
So how does a 'person' reduce something that is not under 'their' control?
I use scare quotes because my understanding of brain dynamics is that psychologists are totally confused about what they mean by a 'person', or 'control'. Popper based his theory of what is science on the example of Freud as someone who did not practice science. I don't see psychology as having changed substantially from the Freudian approach - the use of uncontrolled observations to confirm what you already thin is the case.
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The things I mentioned: stress, fear, emotional attachment, etc. Patients can't directly control the pain, but they do have some control over these things which can influence the pain. This study looks into the effectiveness of a technique to do just that.

Of course psychology has changed a lot since Freud. And we now have neuroscience which shows how pain is processed by the brain.
 
Jonathan Edwards said:
How does mapping out networks bear on any of this. It does not matter whether nerve pathways are on the right or left or above or below or join this or join that if we have no means of understanding what the result is in terms of thought. And we have absolutely no way of relating the two because we understand nothing about the way cells draw inferences from incoming data. This is the are of science I work in when not looking at ME/CFS. The neuroscience still tells us nothing whatever relevant to any hypotheses about causation in ME/CFS.
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We do now have methods such as fMRI. This review from 2016 explains it in detail, and I'm sure there are newer reviews as well:

https://www.tandfonline.com/doi/full/10.2147/JPR.S60433#d1e568

This study is not about ME/CFS, it's about back pain. However, there does seem to be a lot of overlap between chronic pain and ME/CFS, as well as with the interventions that help.
 
dundrum said:
Patients can't directly control the pain, but they do have some control over these things which can influence the pain.
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What is the evidence for that in any relevant situation?
What are the published papers?

dundrum said:
Of course psychology has changed a lot since Freud. And we now have neuroscience which shows how pain is processed by the brain.
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Has it, in its basic approach to evidence? Again, it would be useful to have some evidence from publications. I am talking about relevant clinical studies. And even in the more generic sort of psychology study wasn't there supposed to be a 'replication crisis' because nobody could replicate even the most accepted findings?

As I said, I don't see how having neuroscience changes anything much. I have spent a lot of time reading the people who studied mind in the seventeenth century - Descartes, Leibniz, Locke and so on. It is remarkable how much they understood about how the brain must work even though the concept of multicellular organism was only just beginning around 1650 with Hooke's drawings of cells and Leeuwenhoek's observations on protozoa. I studied basic neuroscience in Alan Hodgkin's department in the 1960s and work on fine detail of brain biophysics. I don't see that neuroscience has actually made much difference to the topic we are discussing. Descartes worked out that when the boy touches a fire messages were sent up to his brain via his nerve fibres involving subtle movements of tiny particles. We now know they are metal cations and neurotransmitters but what difference does that make to the overall analysis?

I am not hearing any arguments or seeing any evidence for psychology being able to tell us anything useful here.
 
dundrum said:
We do now have methods such as fMRI. This review from 2016 explains it in detail, and I'm sure there are newer reviews as well:
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You seem to be missing the point. If fMRI shows that pain is associated with metabolism over on the left hand side underneath - so what? Descartes knew it was somewhere up there. It tells us nothing useful.

dundrum said:
This study is not about ME/CFS, it's about back pain. However, there does seem to be a lot of overlap between chronic pain and ME/CFS, as well as with the interventions that help.
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Like there are no interventions that we have reliable evidence for efficacy for either?
Surgery is quite good for some back pain, not for ME/CFS.
CBT and exercise are likely useless for both. Ibuprofen may well help but I doubt anyone has done a trial.

I am intrigued to know where you think this evidence base is to be found? Whether you have an interest in psychology? Are you familiar with problems of methodology or are you talking as a lay person? Why, if there is any usable evidence around, has it not been flagged up here on S4ME. We get papers on CBT and exercise flagged up on an almost daily basis.
 
Jonathan Edwards said:
What is the evidence for that in any relevant situation?
What are the published papers?
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Well the study being discussed here is one example.

As I said, I don't see how having neuroscience changes anything much. I have spent a lot of time reading the people who studied mind in the seventeenth century - Descartes, Leibniz, Locke and so on. It is remarkable how much they understood about how the brain must work even though the concept of multicellular organism was only just beginning around 1650 with Hooke's drawings of cells and Leeuwenhoek's observations on protozoa. I studied basic neuroscience in Alan Hodgkin's department in the 1960s and work on fine detail of brain biophysics. I don't see that neuroscience has actually made much difference to the topic we are discussing. Descartes worked out that when the boy touches a fire messages were sent up to his brain via his nerve fibres involving subtle movements of tiny particles. We now know they are metal cations and neurotransmitters but what difference does that make to the overall analysis?

I am not hearing any arguments or seeing any evidence for psychology being able to tell us anything useful here.
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We know a lot more about how the brain works, in terms of which parts of it control emotions, planning, HPA axis, autonomic nervous system, etc. and we also have fMRI which can show how these brain networks function in humans. Animal studies can show in more detail how these networks operate. See the two neuroscience reviews I posted.
 
dundrum said:
Emotional circuits in the brain are fundamental to brain processing. See: https://pmc.ncbi.nlm.nih.gov/articles/PMC8675872/
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This review illustrates perfectly the points I have been making. It tells us nothing useful about managing either back pain or ME/CFS. It is full of masses of detail of anatomy and a lot of complicated buzz word language but it does not provide us with a basis for reliable predictions.
 
dundrum said:
We know a lot more about how the brain works, in terms of which parts of it control emotions, planning, HPA axis, autonomic nervous system, etc. and we also have fMRI which can show how these brain networks function in humans.
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Again, you seem to miss the point. We do not know enough more to make useful predictions because there are crucial steps in neural function for which we have no quantitative analysis that would allow us to explain the difference between normality and disease.

I have previously mentioned what I call the fallacy of explaining illness with normal function. One of the strange things about not only psychology but even things like immunology is that people think that we can explain disease using normal physiology. If stress caused ME/CFS then everyone stressed would have ME/CFS. They don't. What we need for an explanation of MECFS is why it does not follow what we know about pathways and responses. None of the stuff in the review you posted tells us why people have ME/CFS symptoms because it is all based on what we know about normal physiology. It gives no clue as to where the deviation is.
 
jnmaciuch said:
I think between friends, doctors, and random people without ME or a similar chronic illness, there’s just such a massive amount of projection. It’s so easy to frame someone’s behavior as being due to personal failings instead of realizing that their life has additional dimensions they’ve never even considered.
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People always judge others behavior in terms of how they think they would react in a certain situation. But I think that ignores what it would be like to experience the world as someone else, everyone has reasons for why they act like they do, even if in hindsight that person realizes they weren't good reasons.

For the person who hears and sees helicopters that only exist in their perception, it is so easy to write them off as crazy from our collective perspective. But if you were actually convinced that you were being hunted because you could see and hear things coming would it would be rational to run and hide in that moment? Is there any action anyone could take that is irrational from their own perspective?
 
Trish said:
@dundrum, I don’t understand what you mean by 'emotional attachment to pain'. Can you explain what you mean?
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dundrum said:
Check out the review I posted in another comment.
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I'm sorry I don't have the capacity to search through all your comments to find an unnamed review and search it to find evidence that pwME have an 'emotional attachment to pain'. Can you help? Since you used the term you clearly have an idea of what you mean by it and its relevance to ME/CFS and/or chronic back pain.
 
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