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.

 

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.)

 

@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.

 

There will be a tweetchat tomorrow on international definition of pain for Canadians for those interested:

https://twitter.com/user/status/1160656331835084802


Take a look at the proposed definition. They are on BPS mode, minus the B

 

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.

 

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.

 

My tweet:

 

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.

 

From Harvard health
https://www.health.harvard.edu/blog...-2874-4f03-aa78-bcc45594ca41&dlv-mlid=1500931

 

Looks like Harvard Health continues its descent into being a goop.com subsidiary.

This article is seriously vomit-inducing and clearly written by someone who never experienced pain for more then 5 seconds.

 

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.

 

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.

 

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?

 

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.

https://twitter.com/user/status/1159202585141817344

 

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: