PainScience

So you go for a session of Deep Unwinding Meridian Balancing and it seems to help and you spend the rest of your life telling people that DUMB works for you. What ACTUALLY happened? Because it probably wasn’t the unwinding and balancing of the meridians. Neurology, baby. Counterstimulation especially.... New post! This one is a short (2-minute) excerpt from a new article about counterstimulation that I forgot to announce after publishing it last summer. ~ Paul Ingraham, PainScience.com publisher https://www.painscience.com//counterstimulation-as-an-obsc

Researchers tested #CBD (not THC) in the same situation where doctors might normally prescribe powerful anti-inflammatories or opioids: in people who have gone to the emergency room with severe #backpain. This was quite a fair testand CBD failed it. https://www.painscience.com//noteworthy-new-trial-of-cbd-f

TRIGGER POINTS! Sore spots associated with aching and stiffness. They are the gods of major gaps in medicine. It seems like they could be the solution to many a painful puzzle. But the science? Still half baked after decades in the oven. I think this is some of the best and most important science writing I’ve ever done. And you can read the whole thing free for about oh another 3-4 hours. After that, a big chunk of it some of the best details will be for members only.... If you’ve always meant to read it, do it now. If you read it 3 years ago and thought it was great, great but read it again. It has been updated a lot. Or read it tomorrow after buying a membership. This will be the 12th and final BIG members-only section I create for my new membership program. An even dozen feels about right. Roughly 40,000 words of content for patrons/members out of about a million words of content that remains free. ~ Paul Ingraham, PainScience.com publisher https://www.painscience.com/articl/trigger-point-doubts.php

Phil Greenfield with a nice list of 18 ways to use physiology not psychology to tame anxiety: If only ‘anxiety’ was more widely viewed as a physiological disturbance with associated psychological effects, rather than the other way around. Anything you can do to reduce the dominance of sympathetic arousal, and encourage activation of the parasympathetic system, might well be of use in reducing symptoms of anxiety. That's the gist of my writing on this topic!... +1 for the whimsy of nailing the toe-painting https://www.facebook.com/phil.greenfield.3/posts/10159415147974519 P.S. Coming soon: more about the neurophysiology of deep breathing and whether or not a rhythm with longer exhalations is helpful.

An important analysis of The Lancet report on the opioids crisis. Alex Gaertner, PhD: I have many concerns related to omitted information, claims without evidence, and stigmatizing statements. I’ll detail some of these concerns here. https://twitter.com/gertner_alex/status/1490778542807736324... And hoo boy does he ever. This is an enormous thread by Twitter standards. Easier to read here: https://threadreaderapp.com/thread/1490778542807736324.html

I finally did it: an interview dedicated to trigger points. Trigger points are the label for the sore spots that almost everyone gets. They are super common, seem to be associated with aching pain and stiffness, sometimes quite fierce. They seem like an important piece of the big chronic pain puzzle. But we don’t know what causes them, the science is half-baked, and treatment is often highly overconfident and misguided. And so they have become extremely controversial am...ong experts, a very touchy subject. So touchy that I haven’t ever done an interview on this topic. I have avoided it. I just study and write, study and write. But this was worth it. It was interesting and fun talking to an audience that consists mostly of massage therapists. The conversation was high quality, friendly and chatty but also substantive. We covered a lot of ground. Hope you find it useful. The interview: https://www.facebook.com/theMTDC1/posts/4295084783836673 This article covers much of the same ground as the article: PainScience.com/trigger_point_doubts

I have rebooted and expanded my stretching article to cover several new sub-topics. It’s such a beast, at 34K words, that I think it’s a book now. https://www.painscience.com//20-years-of-writing-about-str

An amiable chat with Todd Hargrove about my odd career, with a substantial detour to climb down one of the most interesting rabbit holes in the science of pain. It was interesting to try to talk about neuroinflammation after writing about it off and on for the last year. Challenging material! If you want to read more about it, see: https://www.painscience.com/inflam#neuroinflammation

Another in an ongoing series of total article reboot/expansions is now complete, this time for the tennis elbow guide. Length is way up (3 to ~15k words). Many citations added. Most beefed up topics: etiology, risk factors, recovery time, steroids, denervation, strengthening. Here's something important I had been wrong about for many years:... During my massage career (2000-2010) I fell prey to a classic example of sampling bias: I had many clients who were computer workers with tennis elbow, probably because I was working in downtown Vancouver, so I came to believe the condition should probably be called computer elbow more than tennis elbow. That belief that computer use defined the condition went unexamined for a long time. Oops! Turns out it’s not at all clear that computer use constitutes a significant physical strain on these tendons. It might be. It’s definitely a WORK injury more than tennis injury by the numbers, but it’s only CLEARLY linked to truly strenuous use of the arms and hands (e.g. meat packing). Keyboards and may not be strenuous enough! Which is not to say computer users don’t get lateral elbow pain! There are so many, and some usage habits so extreme, that there probably are many computer-use cases. But the RATE? Likely much lower than work that takes much more arm-oomph. P.S. This update was quite bucket listy for me. The previous version of the page was, um *searches for gentle words* basic. It did not live up to my normal standards, and it has been bugging me for ages. It just took a long time to get around to it. Finally! https://www.painscience.com/tennis_elbow

A surprising new topic for the PainSci library on International Women’s Day #IWD: vaginismus, vulvodynia, and vaginal penetration pain disorders. I needed help with this! Kirsten Loop of @Unravelled_Self kindly shared her story and knowledge in an extremely deep interview. As usual in the Land of #chronicpain, it gets weird/fascinating. The topic is TRICKY and IMPORTANT. Women with vaginismus (and other pain and function issues down there) seem to face every possible health...care barrier, a perfect storm of stigmas, prejudices, and ignorance. A sample from the interview: We’re still told we’re frigid far more often than you’d think! I was told sternly that I’d be a spinster as though I didn’t already know that. We’re still constantly instructed to get drunk or high, as though we haven’t already tried that. We’re also told to use more lube or to try this position or that position as though we haven’t already tried all that too! By the time we seek help, we’ve generally tried everything. The online support forums for vaginismus, vulvodynia, vestibulodynia are filled with complaints about unsupportive and dismissive doctors who suggest we are immature, stubborn, or sometimes even outright lying about the pain or the ‘wall.’ It seems to me not much has changed in the clinical encounter in 30 years. Read much more: PainScience.com/vaginismus

I rubbed a nasty pain, and it went away. Just an anecdote, but experiences like this have a LOT to do with why I am still interested in #massage as a pain treatment, after all these years, and after so much skepticism and, yes, even a lot of cynicism.

[Trailer Guy voice] "IN A WORLD without chiropractic, physiotherapy, or any kind of 'medical' massage" In that world, would there be less back pain? Or more? Ooooooh. Tricky!... This was a 2-interview week. I chatted with Evie Martin of PhysiosOnline UK for quite a while about many things. In this part of the chat, we had fun with a hypothetical question. (The other parts will be along soonish.) https://physiosonline.co.uk//in-a-world-with-no-manual-th/

A chat with Matt Phillips of Run Chat Live in which I actually discuss "trigger points" publicly. I have written a great deal about this topic, but I have not DISCUSSED it in interviews, on social media because it's gotten so polarized in the last few years. I expect to ruffle a few feathers on both sides of the fence here but not too much, I hope. It all felt amiable and level-headed as I was saying it!

I did a short interview for Austin Frakt on TheIncidentalEconomist.com. Here, I’ll give you all the good bits here, no pesky nuance and detail: Q. How did you hone your craft? A. My craft wasn’t so much honed as thrown into a volcano, melted down, and ejected at high velocity.... Q. What are the top few things people get wrong about pain? A. Pain is weirder the people realize, even in seemingly simple mechanical problems like runner’s knee or frozen shoulder. The nervous system is volatile, glitchy, prone to false alarms. There can be huge disconnects between pain and what’s actually going on in the tissues. Q. Who should we trust? A. Trust the doubters. The field is polarized: hype and myths are mostly either being busted or perpetuated, so the absence of obvious skepticism and citing the science is a red flag. Q. What is on the cutting edge of pain science? A. The cutting edge of pain science is dull and rusty there’s just too much that we still don’t know. There are always headlines about potential breakthroughs, but they all remind me of news about battery tech: there are always major caveats. Did we mention this only works in a vacuum? But seriously, read the whole thing it’s not like it’s huge. In fact, it was all a bit rushed compared to how I usually work which is probably a good thing. Given more time, I would have just carried on agonizing over my answers indefinitely, with dimishing returns. Really, I’ve been trying to figure out how to answer these questions for 20 years, and I’ll probably never stop. https://theincidentaleconomist.com//the-dull-and-rusty-sc/

You get a nasty knee twinge while you’re being sporty and physically intense. It’s nothing terrible, just a niggle really, not enough to stop you but maybe you SHOULD stop? What do you do? Get off the field or the track? Turn around and make for the trailhead? What if that niggle was a red flag? What if you knew that your risk of an injury that day just TRIPLED?

Poor quality sleep and insomnia are probably major causes of morning back pain. Yes, some people sleep just fine and STILL have morning back pain but poor quality sleep and pain definitely tend to go together, and mornings can be roughest part of that link. The more interesting question is the chicken/egg thing: which comes first? Pain or sleeplessness? Once you have both insomnia and pain, they surely cause each other, but one side of that equation is probably more importan...t than the other, like a cyclist pushing much harder on one pedal than the other. In 2017, Gerhart et al. studied the which-came-first question of pain and insomnia in 105 chronic low back pain patients. Their subjects bravely filled out five detailed questionnaires per day for two weeks that’s quite a lot of paperwork tracking and rating many aspects of their pain and sleep quality. The goal was to study lagged temporal associations: what tends to happen after what? Are bad sleeps often followed by bad days with back pain? Are rough days with back pain followed by lousy sleeps? YES and NO to those two questions. ===================================== Read more! My morning back pain article has been updated with a new section about poor quality sleep (which was strangely missing): https://www.painscience.com/articles/morning-back-pain.php

Interview with Mike Matthews for his Muscle for Life podcast: "on the Art and Science of Staying #Injury-Free" while #lifting heavy things. Not that I lift all that many heavy things, but I lift enough to have a clue. It was a fun, wide-ranging talk. See also on iTunes, Spotify: https://podcasts.apple.com//paul-ingraham-on-/id671863400... https://open.spotify.com/episode/1rozUN849v3iUrGx0O5cFG

A thunderclap #headache is exactly what it sounds like and just as nasty. In 2014, these researchers reported ONE HUNDED NINETEEN causes OTHER than the only usual suspect (subarachnoid haemorrhage). Yikes! Thunderclap headaches are a genus not a species. Pathologies are often part of larger, more diverse groups than we know. We often make the same mistake with critters! For instance, the anglerfish is not just one mean-looking species, but a family of hundreds (hat tip... to Cara Santa Maria, who talked about this on a recent episode of the The Skeptics' Guide to the Universe). Thunderclap headaches are one of my own #chronicpain demons indeed, probably my single worst symptom. The specific cause remains undiagnosed. A neurologist once overconfidently asserted that we’d already eliminated the only possible serious cause of my symptoms. O rly? Please see Devenney 2014 https://www.painscience.com/bibliography.php?devenney14

The myth of feminine fragility over time Olden times: Ladies in athletics? Ho ho, don‘t be absurd old chap! The fairer sex is simply not designed for the manly arts. If God wanted women to play sports, he would have made them tough as old boots, but then who’d want to marry them?! Today: Women can be fine athletes, but obviously they have some more injury risk factors because of their biomechanical idiosyncracies.... Progress. But not enough of it. Sexism is baked right into in the paradigm of biomechanical quirks as injury risks. Click through for more (and some fresh research about women lifting heavy things).

Shut up and take my money! Monthly study summaries, from a trusted source (I know these guys well) ooh, lovely, wish I’d had this looong ago. I have seen similar, none this good. I got a sneak peak, and I’m hooked. It’s ideal content for pros AND keen patients, just like I aim for on PainSci: rigorous but readable. Launch sale now through Fri, deals on yearly and lifetime prices. Subscribe with this link to give PainSci a referral reward: https://examine.com/refer/painscienc...e Some people are annoyed by affiliate marketing (because a lot of it is annoying), so I’d like to get out in front of that: I am plugging this because it’s EXACTLY what I would create and sell for my own readers... if I had nine expert heads. You know when you see an advert and you realize that advertising isn’t obnoxious when it’s actually RIGHT for you? Affiliate marketing is like dating: kinda gross and annoying until you find the right match, and then you’re like, This is the BEST! Examine has always been a bit of a sister site to PainSci, and now more than ever. If you can’t beat ‘em and I can’t beat them at this, not without an entire smartypants team of my own add them to your own ebookstore!

This recent meta-analysis (Alves et al.) confirms a serious side effect of the fluoroquinolone class of antibiotics: 2.5 greater risk of Achilles tendinitis in healthy folks, and a 4 greater risk of rupture. And all worse if you’re older, because of course it is. And if you’re on corticosteroid drugs (much in the news lately because of dexamethasone for COVID-19, which is actually really promising, as a happy aside really good clinical research showing a strong benefit ...for the right patients). If you’re thinking that it’s weird that an antibiotic can do this to people I know, right? It’s downright creepy, if you ask me. This side effect is one of the best single examples of how musculoskeletal and sports medicine, although seemingly all about biomechanics to the uninitiated (and plenty who should know better too), is actually much more about physiology and biochemistry. Because we are basically just ugly bags of mostly water organized by chemistry, miraculous but messy.

A reader (just one) is outraged because I publicly declared that #blacklivesmatter. Chronic pain has no politics, he declared. O RLY? In this post, I make the case that it is VERY political. And good riddance to that reader. Begone! Evanesco!

A failed attempt to replicate the dramatic, promising results of a previous study of methylene blue injection for spinal disc pain. The original study was astounding, unprecedented and unrivalledif the results are true. That was a big ’if.’ This is an old story in medical science: initial results are promising, people get excited perhaps it even spawns an empire of clinics offering the evidence-based treatment but eventually follow-up research establishes that it w...asn’t quite so great after all. The failure of most treatment ideas is an obvious pattern in medical science over the decades. In scientific terms, betting against the null hypothesis is like betting against the house.

Exercise in the Goldilocks zone is probably genuinely protective against infection. What the most active people often don’t realize is that intense exercise might actually undermine your health in the short term it’s stressful, and monopolizes biological resources while you recover.

PainScience.com is still open for e-business. As of Apr 9, I am still healthy (knock on wood), minding the store, taking calls, answering emails, and working on updates as hard as I ever have. For about 10 days now I have been offering a 50% rebate to anyone un- or under-employed because of this pesky plague. See my books page for details. The response to my plague rebate has been quite beautiful. Only 10% of customers are claiming itand every email has been poignant,... personal, earnest, brave And the 90%? Every sale says something equally nice: Thanks, I’m goodhappy to pay full price. And so every sale means more than usual. https://www.painscience.com/

The close of 2019 marked NINETEEN YEARS of writing for PainScience.com, THIRTEEN YEARS since I first started selling books, and NINE YEARS since I started earning enough to make a living from it. Nine! Almost a decade of making a living one of the hardest ways I can imagine. This thing might just work out. Maybe. This post summarizes content and technical highlights for PainScience.com over the last year: 2 new books + 8 new or like-new articles + 70 major updates + 90 blog posts + dozens of technical upgrades = my most productive year ever.

Two years ago I announced that I had become a chronic pain patient, and now it’s finally time to publish an update on how that struggle is going. The good news is that I have improved a lot. The bad news is that it’s not nearly enough. Click through for a more detailed progress report, some of the lessons I have learned, and my best guess about what the @$!&^!!% happened to me in 2015.