Thoughts on this article?

[Timeoutofmind]

It’s hard for me to reconcile to my real world experiences…

I referred hundreds of patients to pain psychology my first few years out.

I never had anyone tell me it helped significantly….even those who stuck with it…

Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain

This randomized clinical trial tests whether pain reprocessing therapy can provide durable and substantial relief from chronic back pain and investigates treatment mechanisms.

jamanetwork.com

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[hyperalgesia]

It’s hard for me to reconcile to my real world experiences…

I referred hundreds of patients to pain psychology my first few years out.

I never had anyone tell me it helped significantly….even those who stuck with it…

Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain

This randomized clinical trial tests whether pain reprocessing therapy can provide durable and substantial relief from chronic back pain and investigates treatment mechanisms.

jamanetwork.com

I think this will be wildly dependent on the service providers and their program. I don't think you can generalize about the modality.

 

[Ducttape]

also, as an interventional spine physician, the way you present pain psychology may influence the likelihood of benefit.

I don't have an N, but I have multiple positive reports of pain psychology helping (not curing) chronic pain.

 

[drusso]

It’s hard for me to reconcile to my real world experiences…

I referred hundreds of patients to pain psychology my first few years out.

I never had anyone tell me it helped significantly….even those who stuck with it…

Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain

This randomized clinical trial tests whether pain reprocessing therapy can provide durable and substantial relief from chronic back pain and investigates treatment mechanisms.

jamanetwork.com

I have "lived experience" implementing these interventions--ie I've opened up my wallet & paid to bring this kind of program in-house: Pain Education, Acceptance and Commitment Therapy, CBT, Shame-Resiliency Therapy, and Drug & Alcohol Counseling.

Here's the truth: None of these treatments can heal an HIZ or annular tear, improve Modic Changes (of which we're experiencing an epidemic), improve epidural fibrosis, reduce facet arthropathy, heal tendinosis, or fix causalgia. None of them.

Probably Shame Resiliency helps the best at making people "feel good" about their lot in life. Giving people practical skills to help with behavior modification is also useful. You can't "talk people of out their pain." If you told me that my claudication was all in my head, I'd be pissed.

Sometimes you can Jedi-Mind trick patients into understanding that "other people have it worse than you." But, that's about it. De-medicalizing pain generators by psychologizing them is useless, resource-intensive, and doesn't scale.

 

[hyperalgesia]

I have "lived experience" implementing these interventions--ie I've opened up my wallet & paid to bring this kind of program in-house: Pain Education, Acceptance and Commitment Therapy, CBT, Shame-Resiliency Therapy, and Drug & Alcohol Counseling.

Here's the truth: None of these treatments can heal an HIZ or annular tear, improve Modic Changes (of which we're experiencing an epidemic), improve epidural fibrosis, reduce facet arthropathy, heal tendinosis, or fix causalgia. None of them.

Probably Shame Resiliency helps the best at making people "feel good" about their lot in life. Giving people practical skills to help with behavior modification is also useful. You can't "talk people of out their pain." If you told me that my claudication was all in my head, I'd be pissed.

Sometimes you can Jedi-Mind trick patients into understanding that "other people have it worse than you." But, that's about it. De-medicalizing pain generators by psychologizing them is useless, resource-intensive, and doesn't scale.

You are starting with the premise that normal, age-related changes are "medical". Another perspective is that these anatomic findings are non-pathological, with a normal and temporary pain response that will, in a psychologically healthy individual, often (not always) resolve over time.

With this perspective, psychological intervention is a natural opportunity.

 

[SSdoc33]

this entire thread is why i cant stand the entire fields of psychology, psychotherapy, etc.

you sort of have to be a believer or you are not a believer. i really dont want to hear about mindfulness or shame resiliency, or threat values.

it may help for some people. i guess.

 

[Ducttape]

do any of your injections heal an HIZ or annular tear, or improve Modic changes, improve epidurl fibrosis, reduce facet arthropathy, heal tendinosis, or fix causalgia?

do you actually tell patients you will cure them of their chronic back pain?

 

[drusso]

this entire thread is why i cant stand the entire fields of psychology, psychotherapy, etc.

you sort of have to be a believer or you are not a believer. i really dont want to hear about mindfulness or shame resiliency, or threat values.

it may help for some people. i guess.

That's ironic. You seem like you'd benefit from therapy.

 

[drusso]

You are starting with the premise that normal, age-related changes are "medical". Another perspective is that these anatomic findings are non-pathological, with a normal and temporary pain response that will, in a psychologically healthy individual, often (not always) resolve over time.

With this perspective, psychological intervention is a natural opportunity.

Normal age-related changes? Knock that crap off. That's population health happy talk. You're a doctor. You treat patients with a soul. Not populations with a mean and standard deviation. What "population-based" intervention are you proposing to reduce the rates of spondylosis in our society? Fluoride in the drinking water?

Are atherosclerosis, osteoporotic compression fractures, dental caries, peripheral vascular disease, and painful polyneuropathy "age-related changes?" If you told me that my ligamentum flavum hypertrophy, Modic-end plate changes, and my dynamic anterollisthesis on flex/ext films were imaginary I'd be pissed.

 

[kstarm]

Normal age-related changes? Knock that crap off. That's population health happy talk. You're a doctor. You treat patients with a soul. Not populations with a mean and standard deviation. What "population-based" intervention are you proposing to reduce the rates of spondylosis in our society? Fluoride in the drinking water?

Are atherosclerosis, osteoporotic compression fractures, dental caries, peripheral vascular disease, and painful polyneuropathy "age-related changes?" If you told me that my ligamentum flavum hypertrophy, Modic-end plate changes, and my dynamic anterollisthesis on flex/ext films were imaginary I'd be pissed.

Are you telling your patients with non-pathologic findings, or pain out of proportion to their work-up that their pain is imaginary?

 

[Ducttape]

Normal age-related changes? Knock that crap off. That's population health happy talk. You're a doctor. You treat patients with a soul. Not populations with a mean and standard deviation. What "population-based" intervention are you proposing to reduce the rates of spondylosis in our society? Fluoride in the drinking water?

Are atherosclerosis, osteoporotic compression fractures, dental caries, peripheral vascular disease, and painful polyneuropathy "age-related changes?" If you told me that my ligamentum flavum hypertrophy, Modic-end plate changes, and my dynamic anterollisthesis on flex/ext films were imaginary I'd be pissed.

yet you treat the pathology and not the soul.... psychological based treatments are for the soul.

 

[hyperalgesia]

Normal age-related changes? Knock that crap off. That's population health happy talk. You're a doctor. You treat patients with a soul. Not populations with a mean and standard deviation. What "population-based" intervention are you proposing to reduce the rates of spondylosis in our society? Fluoride in the drinking water?

Are atherosclerosis, osteoporotic compression fractures, dental caries, peripheral vascular disease, and painful polyneuropathy "age-related changes?" If you told me that my ligamentum flavum hypertrophy, Modic-end plate changes, and my dynamic anterollisthesis on flex/ext films were imaginary I'd be pissed.

You seem to be going off the rails. To calm you down, I give you this picture...

 

[lobelsteve]

You seem to be going off the rails. To calm you down, I give you this picture...

View attachment 343991

I will one up you.

 

[drusso]

I will one up you.

My idol and twin flame. He's into red heads. He's just up the road from me.