The Canadian Chronic Pain Task force report

[Milo]

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:


Feedback on accompanying notes:

Thank you for doing this @rvallee i agree with everything you said. I am planning to write something too and would like to show them how a bio-psycho-social approach slows down biomedical research and is problematic on so many levels including perpetuating the stigma of chronic pain. I would also like to say that our disease has gone there and we do have experience of applying the bps model and it doesn’t end well.

 

[Barry]

@Milo as a fellow sufferer of non- ME related pain, the revelation that chronic pain causes significant distress, depression etc, just makes me want to punch someone. As we know, we get depressed/desperate/upset etc, and that is not the cause of the pain, but a reaction to living with it.

Having lived with daily disabling chronic pain for years, I have found a lot of empathy and support from a uk pain forum. It is interesting to me that in the 4 years I have been on there, although there are often calls for pain patients to fill in pain surveys to help researchers, every survey is heavily weighted towards the psychological attitude of the patient. Ditto Pain Management, whose philosophy seems to be that you make it clear to the patient that they will never recover, then discourage them from taking adequate medication, and tell you to 'Keep Calm and Carry On.'

When are these geniuses going to focus on the physical mechanism that leads to chronic pain, and how to mend it???

I am not throwing shade on the benefits of counselling/therapy and meditation- all of which I have found useful tools, but the most useful thing of all would be discovering how to make the pain stop!

I hope you are having one of the good days.
Helly

Long before I was remotely aware of any of the things I know now, I had the sense that doctors, clinicians, simply cannot cope with conditions the have no easy answer for, and rather than admit that they revert to something that makes them sound like they know what they are talking about. I realise now I was nearer the mark than I thought.

 

[Squeezy]

"Females

Chronic pain is more common among females compared to males across all ages, with women aged 65 years and older consistently reporting the highest prevalence of chronic pain (Schopflocher et al., 2011; Reitsma et al., 2011; King et al., 2011). Fibromyalgia, irritable bowel syndrome, rheumatoid arthritis, chronic pelvic pain, and migraine headache are disproportionately reported by women (International Association for Study of Pain [IASP], 2018b; Bartley & Fillingim, 2013). Prevalence among women may also be influenced by sexual orientation; for example lesbians and bisexual women are at higher risk for a number of chronic illnesses including arthritis compared to heterosexual women (Fredrikson-Goldsen et al., 2012)."

SERIOUSLY!!!

Is there any allowance made for the fact of hormonal differences between women and men possibly accounting for the greater prevalence of pain? Or other factors relating to gender?

Some types of Migraines, included here in their BPS bullshit, have been shown to be related to the ovulatory cycle. Cyclical Migraines, so of course they're more prevalent in women, morons. They tend to disappear after menopause.

Given the overall tone of what has been posted here, the inference is that woman are more prone to somatisation.

Sexual orientation influencing chronic pain? Oh dear lord. I just can't even... One alternative interpretation - living with a man, they REALLY don't want to hear it, (noted lovely exceptions on this forum), and wives and girl friends of men probably under-report and are under-counted.

Possibly if you are partnered with a woman you receive more support, empathy and kindness and fear less they'll leave... A huge percentage of men leave chronically ill women, compared to vice versa.

Maybe what they have here is reporting bias, rather than a genuine phenomenon

 

[Snow Leopard]

@Trish, oh yes, "resilience" is definitely one of the most overused buzz words, in my opinion. I loathe it. Especially when I hear it in the context of "building resilience" in children.

Oh, me too!

The sad part is, resilience in our society is not really determined by innate traits, but rather social support.

 

[adambeyoncelowe]

"Females

Chronic pain is more common among females compared to males across all ages, with women aged 65 years and older consistently reporting the highest prevalence of chronic pain (Schopflocher et al., 2011; Reitsma et al., 2011; King et al., 2011). Fibromyalgia, irritable bowel syndrome, rheumatoid arthritis, chronic pelvic pain, and migraine headache are disproportionately reported by women (International Association for Study of Pain [IASP], 2018b; Bartley & Fillingim, 2013). Prevalence among women may also be influenced by sexual orientation; for example lesbians and bisexual women are at higher risk for a number of chronic illnesses including arthritis compared to heterosexual women (Fredrikson-Goldsen et al., 2012)."

SERIOUSLY!!!

Is there any allowance made for the fact of hormonal differences between women and men possibly accounting for the greater prevalence of pain? Or other factors relating to gender?

Some types of Migraines, included here in their BPS bullshit, have been shown to be related to the ovulatory cycle. Cyclical Migraines, so of course they're more prevalent in women, morons. They tend to disappear after menopause.

Given the overall tone of what has been posted here, the inference is that woman are more prone to somatisation.

Sexual orientation influencing chronic pain? Oh dear lord. I just can't even... One alternative interpretation - living with a man, they REALLY don't want to hear it, (noted lovely exceptions on this forum), and wives and girl friends of men probably under-report and are under-counted.

Possibly if you are partnered with a woman you receive more support, empathy and kindness and fear less they'll leave... A huge percentage of men leave chronically ill women, compared to vice versa.

Maybe what they have here is reporting bias, rather than a genuine phenomenon

It might also be a social thing. If you've had to come out once, coming out with chronic pain might be (a bit) less scary. Equally presumptuous, of course, but the point is that we can't guess about associations such as these. Most likely, it's some kind of reporting bias because nothing else makes sense.

 

[rvallee]

It might also be a social thing. If you've had to come out once, coming out with chronic pain might be (a bit) less scary. Equally presumptuous, of course, but the point is that we can't guess about associations such as these. Most likely, it's some kind of reporting bias because nothing else makes sense.

It's also seen by many as a sign of "strength" to hide their pain, whatever that means. Lots of weird notions about what "real men" do, just plowing through their problems until they drop dead. Very cartoonish. I think it's very likely the rates are similar and men simply don't report it as much because they have internalized that it's a sign of weakness. The reporting bias is undeniable, just a question of how much % it explains.

It also doesn't help that pain management is generally a disaster. Most of the time it's not even worth mentioning so why bother? Often it can lead to suspicion by physicians, who could then miss out on important details because they are too focused on the possibility of a pill-seeker. Especially now with the tapering off painkillers, it's almost riskier to find yourself finding some relief only to have it yanked away arbitrarily.

 

[Squeezy]

This whole chronic pain thing is so bizarre when one suffers from chronic pain that is "allowed" by the medical establishment because it can be proven to their satisfaction via x rays, scans or blood tests, and thus "validated" by them, as well as chronic pain which is "only" self-reported.

I've been out today so the fallen metatarsals in my feet are howling even more loudly than when I'm just in bed. Oh, I'm allowed THAT pain! Proven by x ray! Empathy ahoy! But my knees, elbows and ankles? Very similar pain, but nothing shows up, so that MUST be in my head... "Chronic Fatigue" wink wink.

Bursitis in my shoulder - well, it won't heal, so perhaps it's now psychosomatic as it's refractory, despite showing on the scan! No, it won't heal because it gets sore being in bed for days on end with my blasted migraines. Ah, now those...

We did say your migraines are a physical problem, and you were very relieved it was respected when your ME wasn't, but as it's "Self Reported Pain" we've now decided you're somatising... Without interviewing you as an individual. It's a blanket statement. For all of you dreadful whiny "headache" complainers malingering with your heads hidden under your blankets.

 

[rvallee]

This whole chronic pain thing is so bizarre when one suffers from chronic pain that is "allowed" by the medical establishment because it can be proven to their satisfaction via x rays, scans or blood tests, and thus "validated" by them, as well as chronic pain which is "only" self-reported.

I've been out today so the fallen metatarsals in my feet are howling even more loudly than when I'm just in bed. Oh, I'm allowed THAT pain! Proven by x ray! Empathy ahoy! But my knees, elbows and ankles? Very similar pain, but nothing shows up, so that MUST be in my head... "Chronic Fatigue" wink wink.

Bursitis in my shoulder - well, it won't heal, so perhaps it's now psychosomatic as it's refractory, despite showing on the scan! No, it won't heal because it gets sore being in bed for days on end with my blasted migraines. Ah, now those...

We did say your migraines are a physical problem, and you were very relieved it was respected when your ME wasn't, but as it's "Self Reported Pain" we've now decided you're somatising... Without interviewing you as an individual. It's a blanket statement. For all of you dreadful whiny "headache" complainers malingering with your heads hidden under your blankets.

The day someone figures out how to actually measure pain will be a serious eye-opener to many, very sobering.

Or alternatively if someone can figure out a painkiller that has zero side-effects. Right now the dogma seems to be everyone is faking to be in pain to have opioids, as if they were all fun and games.

Though you have to marvel at the doublethink of "all pain is subjective" going along with "yes, you report you are in pain but I just don't believe you so go away". It's right up there with "these people are lazy" being mixed in "these people are type A personality overachievers with unrealistically high aspirations but also a catastrophizing personality filled with gloom". It would be hilarious if the consequences weren't so disastrous.

It's really not surprising that people turn to alternative medicine when standard medicine is filled with woo. If there's woo on both sides, might as well go to someone who won't insult you to your face. Choosing neither is preferable but then people blame you for not trying moonlight kale-celery enemas, or whatever.