The Effect of Literacy-Adapted Psychosocial Treatments on Biomedical and Biopsychosocial Pain Conceptualization, 2021, Morais et al

[Andy]

Highlights

• Literacy-adapted psychosocial pain treatments produce changes in pain beliefs.
• Individuals of low-socioeconomic status show improvements in pain beliefs.
• Teaching patients about the biopsychosocial nature of pain is promising.

Abstract
This is a secondary data analysis of a subgroup of participants who received the Learning About My Pain (LAMP) interventions (clinicaltrials.gov identifier NCT01967342). We examined the effects of LAMP on pre-to-post changes in biomedical and biopsychosocial pain conceptualization and whether those changes in pain conceptualization were associated with physical and psychological functioning. Participants were randomized into three conditions: Cognitive Behavioral Therapy (CBT), Pain Psychoeducation (EDU), or Usual Medical Care (UC). Results based on 225 participants who completed the Pain Concepts Questionnaire (PCQ) showed a pre-to-post reduction in biomedical pain conceptualization (BM), an increase in biopsychosocial pain conceptualization (BPS), and an increase in BPS/BM ratio for CBT and EDU but not UC. There were no differences between CBT and EDU in post-treatment PCQ scores. Compared to those with lower BM pain beliefs scores at post-treatment, participants endorsing higher BM pain beliefs scores reported greater pain intensity and greater pain interference. Furthermore, higher BM pain beliefs scores at post-treatment and lower BPS/BM ratio were associated with higher levels of pain catastrophizing. Overall, results of this study suggest the need for targeting specific pain beliefs that influence pain-related outcomes.

Perspective: This article presents the potential benefits of providing literacy-adapted psychosocial treatments to expand pain conceptualization beyond a biomedical-only understanding and toward a biopsychosocial conceptualization of the experience of pain. Furthermore, the association of changing pain conceptualization and pain-related functioning argues for its potential clinical relevance.

Paywall, https://www.jpain.org/article/S1526-5900(21)00213-3/fulltext

 

[Arnie Pye]

This article presents the potential benefits of providing literacy-adapted psychosocial treatments to expand pain conceptualization beyond a biomedical-only understanding and toward a biopsychosocial conceptualization of the experience of pain. Furthermore, the association of changing pain conceptualization and pain-related functioning argues for its potential clinical relevance.

So, people are going to be assumed to be thick? But that is absolutely normal! Doctors think almost all patients are thick!

 

[rvallee]

Completely beyond parody and shows the intellectual bankruptcy behind creating arbitrary targets that are then the focus of everything.

And of course identical experiments have been done many times before, yet every time these are presented as new, even though past experiments are used to justify its use in practice. It's always both new and evidence-based, mutually exclusive concepts but nobody seems to care.

Basically no difference with making angels dancing on hairpins a relevant target for pain management and showing how you can influence beliefs about angels dancing on hairpins. Or reducing Thetan levels. Same difference.

It's a serious underestimate to say that half of all medical research is useless, it's definitely above 80% and probably 90%. But in large part that's because most of it is just doing the same things over and over again with a "NEW!" sticker.

But it's really the complete detachment from reality that does it. There is no relationship at all between this and reality, objective or subjective. Medicine has gone circular, putting its wants above patients' needs. It exists above all to continue existing, has lost sight of its purpose.

 

[Invisible Woman]

This is a secondary data analysis of a subgroup of participants who received the Learning About My Pain (LAMP) interventions (clinicaltrials.gov identifier NCT01967342). We examined the effects of LAMP

Where ai come from to "lamp" someone pretty much means to punch their lights out. So

Completely beyond parody and shows the intellectual bankruptcy behind creating arbitrary targets that are then the focus of everything.

Yes, I would say way beyond parody, and a long way beyond the far side of mockery.

This seems like clear discrimination against those whose pay packets are very slim. Just because people don't earn much it doesn't mean they're stupid or lazy.

Far from needing some patronising s*d re-educating them on attitudes to pain, many of those who earn least continue to work in jobs that aggravate painful conditions because they simply cannot afford not to work anymore.

If anyone's attitude and beliefs need adjustment I really doubt it's those targeted by this kind of cr@p.

 

[Hutan]

I can't access the paper. But I note that the abstract doesn't say anything directly about the treatments lowering reported pain, much less give us any statistics to indicate the strength of the effect. (Not that that would prove anything more than the treatments are effective in changing how people report their pain.)

Results based on 225 participants who completed the Pain Concepts Questionnaire (PCQ) showed a pre-to-post reduction in biomedical pain conceptualization (BM), an increase in biopsychosocial pain conceptualization (BPS), and an increase in BPS/BM ratio for CBT and EDU but not UC.

So the study found that it was possible to increase the numbers of people reporting that their pain isn't just caused by a medical problem.

There were no differences between CBT and EDU in post-treatment PCQ scores.

CBT and some other sort of brainwashing both worked equally as well at getting people to report that their pain isn't just caused by a medical problem.

Compared to those with lower BM pain beliefs scores at post-treatment, participants endorsing higher BM pain beliefs scores reported greater pain intensity and greater pain interference.

After treatment (so, presumably for all of the treatments), those who believed that their pain was mostly caused by medical problem reported that they had a higher level of pain, and that it affected their life more. This does not seem very surprising. It's harder to wave away really bad pain. The abstract does not say that CBT or EDU reduced reported pain intensity or pain interference. The abstract does not say that CBT or EDU made any material difference in people's lives.

Furthermore, higher BM pain beliefs scores at post-treatment and lower BPS/BM ratio were associated with higher levels of pain catastrophizing.

If 'pain catastrophising' means 'complaining about pain when we really think they shouldn't', then, given people who thought there was a medical cause for their pain had the highest levels of pain, it's hardly surprising that these people would also score highly on a so-called 'pain-catastrophising' scale.

Overall, results of this study suggest the need for targeting specific pain beliefs that influence pain-related outcomes.

No, it really doesn't. There's no evidence here that 'targeting specific pain beliefs' with CBT or psychoeducation has any impact on 'pain-related outcomes' that matter to patients e.g. reducing pain or increasing function.

All it shows is that, if you try to convince people that their pain is caused by things other than a medical problem, you will get some of them to report that they are convinced, although mostly those with a low level of pain. This may perhaps be useful in getting such people to stop bothering doctors about their pain. (Instead, these people with pain may spend their own money and time trying to correct what they have come to believe is their personality problem, or may blame their parents or spouse for causing them trauma. And the people they have in their life to support them may withdraw their support, concerned that they are facilitating false illness beliefs.)

But, in terms of how to reduce suffering due to pain, this paper tells us nothing at all.

(sorry for late edits, my computer ran out of power.)

 

[alktipping]

wouldn't it be nice to change the maladaptive beliefs of those who fund this tripe .also it would be really beneficial to society as a whole to sack them .

 

[Trish]

Does this paper amount to:

If we explain slowly in simplified language, more patients learn to fill in the questionnaires how we tell them to.

 

[rvallee]

CBT and some other sort of brainwashing both worked equally as well at getting people to report that their pain isn't just caused by a medical problem.

After being told that very insistently, assured that it's real important science that works. This is not discussed enough, that those interventions explicitly encourage people to rate themselves differently then ask them to rate themselves. It's all so damn insane that no one objects to this being blatant manipulation but it's considered normal because otherwise how would psychology ever show anything useful?

Milgram's experiment has been recognized to have been pretty flawed, biased. And the response of the field has been essentially to explore all the possible ways to make cheap meaningless research say something unrelated to reality by amplifying the lab coat effect and having people essentially repeat stuff they were told would make a difference if only they repeated them enough to keep repeating them on an arbitrary questionnaire that asks them specifically about the thing they were told to repeat.

There's seriously no significant opposition to this, the whole field of psychology has completely lost the plot.

 

[Sean]

1. Tell patients not to report their symptoms.

2. Patients don't report their symptoms.

3. Declare success.

 

[Mithriel]

1. Tell patients not to report their symptoms.

2. Patients don't report their symptoms.

3. Declare success.

And if they say they are in bad pain decide it is because they think it is physical so the answer is to find ways to make them believe it is not physical because we firmly believe that will make the pain magically go away.

If the pain does not go away that will be proof we are right because they are not believing hard enough.