The Canadian Chronic Pain Task force report

The overly broad generalizations about psych therapies being so direly useful--is just baked rehash-trash.

Sure, some people, when just diagnosed, need to try to relax a little when they have chronic pain.

But perhaps sessions with an occupational therapist would be more useful. Of course, they would be more expensive, by far. We can't have that!

Learning to adapt one's life to the effects of pain, is useful. Relaxation and mindfulness? Not much.

Drug therapy should be emphasized over psych therapy, that's for sure. Trials of various drugs should be encouraged. Methadone is a useful opioid that doesn't incur an escalation of dose to achieve the same effect.


Why not ask patients what they would have found helpful at onset of chronic pain. And after years of it.

Yup, up against the hard science, psychs, up against it. Need to attract the best scientists to work on basic science of pain. At the peripheral, spinal, and cortical levels.

Emphasis on psych. Why? Because it can be packaged and delivered cheaply in large classes or online. Apparently pain patients don't deserve more. Because we're a pain somewhere.
 
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Milo said:
I wonder how others feel about this report.
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I haven't read the full report, but I share your concern.

Some months back I started looking into different approaches to chronic pain management around the globe, particularly those promoted by pain charities/organisations, and discovered that they're not different, they all seem to be focused on the BPS model, with central sensitization, childhood trauma etc, as explanations for almost everything.

And the "treatment" seems to be primarily psychological, CBT, Acceptance and Commitment Therapy etc.

(I was planning to start a thread on it, as I think we need to pay attention to what the chronic pain organizations are up to. Will try to get back to that plan soon.)
 
It reminds me of the current fashion for businesses to employ therapists/trainers to give their staff training in 'resilience'. It's a cop out from dealing with the real problems of bullied and overworked staff. Blame the victim and help them to be more 'resilient' when bullied and overstretched, rather than disciplining and getting rid of the bullies and sorting out workloads.

As with pain, the blame if you can't cope is laid on the sufferer/victim, not on those who should be providing real help.
 
One thing that terrifies me is what happens when someone has chronic pain which is considered by doctors to be emotional and "all in the head", and then that pain gets much worse because the sufferer has developed cancer or some other life-threatening problem. It will mean that people will die in agony, effectively untreated. But look on the bright side [ *sarcasm* ] - it will save money on actual, real health treatment and pensions.
 
Arnie Pye said:
One thing that terrifies me is what happens when someone has chronic pain which is considered by doctors to be emotional and "all in the head", and then that pain gets much worse because the sufferer has developed cancer or some other life-threatening problem
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Cancer and life-threatening problem usually gives you a pass. And should the ‘unexplained’ or invisible pain develops into something explainable or understood, suddenly you get empathy.

It remains to be seen whether the patient with chronic pain who gets a totally unrelated cancer gets sympathy for their pain. And one needs to understand that not all cancers cause pain and that pain within the cancer patient population varies from neuropathic to post op, to tissue compression (bulky tumors) to neurone invasion (skin). Then there is pain from chemo and radiation. But one thing is clear, pain from cancer definitely gets more empathy than the rest of the pain patients.
 
Milo said:
Cancer and life-threatening problem usually gives you a pass. And should the ‘unexplained’ or invisible pain develops into something explainable or understood, suddenly you get empathy.

It remains to be seen whether the patient with chronic pain who gets a totally unrelated cancer gets sympathy for their pain. And one needs to understand that not all cancers cause pain and that pain within the cancer patient population varies from neuropathic to post op, to tissue compression (bulky tumors) to neurone invasion (skin). Then there is pain from chemo and radiation. But one thing is clear, pain from cancer definitely gets more empathy than the rest of the pain patients.
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I think you've missed my point. If someone is assumed to be lying or exaggerating or mentally ill or a hypochondriac or an attention-seeker or suffering from psychogenic pain, then if or when it gets worse they won't be believed then either and their pain won't be investigated, or the patient will be put on a long waiting list for treatment while their problem gets worse and worse because they are assumed to be somatising or attention-seeking and so they come at the bottom of the pile when it comes to waiting lists. I think there are going to be loads of people who are going to have cancer or other life-threatening problems that won't even be discovered because the patient who complains that their pain has got much worse will just be dismissed or ignored. So mortality rates among people with chronic pain are going to sky-rocket because their problem was never taken seriously, never investigated, and never treated.
 
Marathon runners and other athletes get muscle pain when they push themselves -- Is that tissue damage? Because if not then I don't see why other people cannot experience real pain of the same kind just driven by some malfunctioning part of the system.
 
appears to make it seem that things that exist do not exist.

approximately like this:

1] not stated [but true]: x exists.

2] not stated [but true]: x that includes a specific characteristic c exists.

3] not stated [but true]: x with specific characteristic c is a problem supposed to be addressed.

4] stated [and sophistry]: x' [label] is x [thing that exists] that includes [arbitrary modification of c and additional characteristics such that x' cannot in practice be a meaningful label for x with or without c].

4] stated [and sophistry]: x' annexes entities x1 x2 x3 [labels some of which have been used to label x or x with c.]

5] not stated [but true]: the annexation invalidly implies that the arbitrary and additional characteristics stated in x' apply to the things labeled by entities x1 x2 x3.

6] second quote: [unevidenced, insufficiently evidenced, and misleading claims, possibly combined with prevarication between label and thing]

7] not stated [but possibly true]: intent to create policy that denies right to health.[1]

8] not stated [but possibly true]: x' gets used to gather various problems that exist that are inconvenient. flouting of responsibility to protect.[1]


need a philosopher. never thought i would ever say that.

possibly needed to testify.

@Diane O'Leary.


better painkillers are needed. sophistry as policy is wrong.


to me this constitutes part of a systematic and widespread attack on a civilian population that inflicts great suffering and serious injury.


[1] human rights concepts. right to health does not mean the right to be healthy. responsibility to protect includes responsibility to prevent incitement.
 
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Sorry, Amw66, but I simply can't make myself like your link, even as an acknowledgement that I've read it (which I have done). As someone whose pain was laughed at aged 13, and ignored thereafter for decades I will never agree that I am to blame for my own chronic pain.
 
Snowdrop said:
Sorry, running out of steam so will just post a link to new pain definition as devised by this group: https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=9218&navItemNumber=643

Two Canadians involved and they are inviting comments.
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It seems to be reserved for medical professionals. There are questions relating to employment in the medical profession and specialty.

I was going to add a comment to tone it down with the emotional baggage stuff, not everyone experiencing pain has issues with that and relying so much on something that is optional distorts perception when it is inexplicably believed to be universal, but it looks like those comments are not welcome.

It's not as if people experiencing pain had a stake in this anyway...
 
Ah, I see @rvallee Thanks for the attempt. And you're right of course and I believe the point was even made at the big big reveal speech yesterday patient input should be valued as well informed on some of the issues around any illness.

Are there any Canadian MD's among us?
 
rvallee said:
It seems to be reserved for medical professionals. There are questions relating to employment in the medical profession and specialty.

I was going to add a comment to tone it down with the emotional baggage stuff, not everyone experiencing pain has issues with that and relying so much on something that is optional distorts perception when it is inexplicably believed to be universal, but it looks like those comments are not welcome.

It's not as if people experiencing pain had a stake in this anyway...
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Actually someone from twitter said they were welcoming comments from anyone. Your comment is important @rvallee and i very much agree with what you said.

 
OK well I added mine as a member of the public. Will probably be ignored as it is definitely not what they want to hear but whatever.

I selected dissatisfied, as my worries are not strictly with the definitions themselves but rather in combination with the oversight and protection lapses for patients and the growing creep of woo within medicine.

Feedback on general definition:
I am worried about the growing emphasis about emotional components to pain. I understand it's trendy these days but although emotional state can contribute to pain, both ways, it is also entirely superfluous in the vast majority of cases, impacting the experience of pain exactly as much as current wind conditions on Titan.
What worries me most is that an optional component, one that may or may not influence (and truly we have no way of measuring so at best it's all conjecture), is being treated as somehow central, almost necessary and omnipresent. The "and" preceding the emotional experience makes it a necessary experience, which is unknowable at best and mostly false, all other things being equal.
I am also puzzled by the bizarre myths being increasingly promoted within the medical profession about how chronic pain is different from acute pain. It seems that emotional state is the bridge that tries to reconcile this arbitrary differentiation, despite a complete lack of reliable objective evidence. As a chronic pain patient, to me this seems too much like hacking away random square pegs to fit into arbitrary round holes. It's OK to say we don't know, in fact it's preferable.
There are plenty of people experiencing chronic pain who have never experienced any significant trauma, in fact have an otherwise happy and balanced life. In practice, those ideas are not used as questions to be validated but rather made as irrefutable assertions, a dangerous ethical blind spot. The unaccountable power asymmetry in the patient-clinician relationship, which lacks any process of review or appeal, is simply not a proper place for such wild-ass-guessing.
Unfortunately as it is still impossible to test for pain, a lot of pseudoscientific magical thinking has been creeping in and this is frankly worrying for the reliability of the whole of medicine. Once pseudoscience finds a home, it tends to spread out and this is exactly what seems to be happening with the vague, hand-wavy belief systems supporting the pop psychology of hysteria/conversion disorder/functional disorders/medically unexplained symptoms. In truth, they have the same foundations (and not coincidentally the exact same rhetoric) as prior discredited belief systems, such as psychosomatic models of peptic ulcers.
Stick to science, please. Trust the scientific method, it works. It's slow and expensive but it is truly the crowning achievement of human civilization. And despite being a popular belief, there is simply no quantifiable objective evidence for this bizarre regression into Freudian theories about mind-over-body. I honestly find that large segments of the medical profession have lost the plot lately, veering into wild ideologies with exactly the same misplaced confidence as the god of the gaps of old.
It's painfully obvious that very few people involved in pain medicine have themselves experienced it. This is a critical lapse that cannot be compensated without taking into account the lived experience of those who do. More often than not, patient testimony takes the form of a monologue from the clinician, rather than a dialogue, immutable to facts or even the true psychological state of the patient (which is always filtered by the clinician's own beliefs, biases and prejudices).
Too much of the published literature on pain is quite frankly as bizarre and fictitious as would a manual on female sexual satisfaction by a group of very geriatric Catholic priests. Medical professionals typically do not have the necessary perspective and I will honestly say that the outcome is generally embarrassingly bad when it concerns almost all unquantifiable/subjective symptoms.
So I can't really say that the current proposed changes are a step in any particular direction and will likely not produce good outcomes given the current fad of giving magical powers to the brain that is overtaking much of medicine.
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Feedback on accompanying notes:
On "A person’s report of an experience as pain should be accepted as such and respected", unfortunately this is absolutely not true in practice. It is dangerous to rely on assumptions that are so evidently false. It certainly should be, in practice it is not. Without proper protections for patients (which I must sadly report are currently inappropriate), this already often leads to disastrous consequences.
On "Pain and nociception are different phenomena: the experience of pain cannot be reduced to activity in sensory pathways", there is no evidence of this as we have no capacity to witness in vivo the experience of pain. In truth we simply do not know whether this is true and should absolutely not be written as a statement of fact.
"Through their life experiences, individuals learn the concept of pain and its applications", this is frankly bizarre woo. Substitute with Thetans or karma and see how it sounds. Pseudoscience based on magical psychology is no better than with magical spirituality, in fact it is very much the same. There is in truth very little thought about pain beyond "it hurts" and "I would really like it not to hurt", you are simply trying to read too much into it.
On "Pain is always a subjective experience that is influenced to varying degrees by biological, psychological, and social factors", the psychological and social factors of pain are currently unknown and untestable. The BPS model is frankly mostly woo as well, so long as we cannot reliably and objectively test its hypotheses anyway. Interesting research path, not remotely close to being mature enough for clinical practice (which I am painfully aware has been a thing for years, it is still very much just a set of bizarre untested assumptions that simply add nothing to our comprehension of physiology and has achieved no benefits to patients).
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