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naraburns  nihil supernum  1yr ago (text post)   33350 thread views

Culture War Roundup for the week of February 27, 2023

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Crackpot theory time: It would be possible to significantly reduce the burden on chronic pain by doing something like the following:

*Experienced debilitating, chronic pain for some period of time

*Changed something plausible about their lives

*Immediately after making the change, noticed something that was an obvious consequence of making the change

*Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

I don't really understand this - can you give a concrete example?

For some examples, see the comments of the link posted upthread. For example, pjeby's comment on that LW post:

1. Experienced debilitating, chronic pain for some period of time

I used to have wrist pain a lot, and tried a ridiculous number of things to deal with it

2. Changed something plausible about their lives:

until I discovered the trigger point concept. Over time I've learned to identify which trigger points produce what symptoms for me, and what postures or behaviors set off the trigger points. [...]

3. Immediately after making the change, noticed something that was an obvious consequence of making the change

My dentist referred me to an oral surgeon twice for things that later turned out to be trigger points: my teeth had gotten sensitive after dental work, but it turned out that I developed trigger points from having my mouth open for hours during the procedure. Now I know where to massage my neck and jaw to prevent tooth sensitivity from arising in certain areas of my mouth after dental work

4. Now mostly find that, while they do sometimes experience pain, the pain is no longer continuous, is usually telling them something specific, and usually does not interfere with their ability to function

Anyway, my prior now for "mysterious chronic pain" is "check for trigger points creating referred pain". Most often this consists of following the nearest muscles, nerves, or blood vessels in the direction of the spine or brain, checking for tenderness. A sharply sensitive spot is likely a trigger point, so I press deeply on it for a minute (as in 60 seconds) and see if the original pain is made worse or better. If nothing happens to it, it's probably not the trigger point. (Pressing on a trigger point can make the pain temporarily worse, but the pain will reduce again when the trigger point releases or un-knots.)

So pjeby mostly reconceptualized what the pain meant. If you have a job that involves a lot of typing, and your wrist starts hurting, a natural hypothesis might be "the typing caused the wrist pain", which suggests the action of "reduce the amount of typing you do until the pain goes away". The idea of "trigger points" gives an alternative hypothesis of "I am feeling referred pain", and suggests the action of "look at the chart and massage the indicated areas until the pain recedes".

Now obviously, if the "trigger points exist, and pressing them causes the pain signals to diminish" model of the world is just factually correct, that would explain why pjeby saw such good results. But even if the world-model is not fully correct, it might still be less wrong than the original world-model where pain was caused by strain and should be solved by using rest. And in the case of chronic, debilitating pain where the sufferer has rested for an extended period and the pain is not improving, there is fairly strong (not insurmountable, but fairly strong) evidence that the "rest will make the pain go away" model is not helpful, and replacing it with a different plausible model is likely to be a good idea.

For the sake of clarity, there is a thing which sounds a lot like what I am saying, but is emphatically not what I am saying. That thing is "trigger points are bullshit placebos, and they only appear to work because chronic pain is fake". If that is what you are getting from my post, please let me know and I'll try to come at it from a different angle.

Think of a certain sort of televangelist.

  1. Find someone with debilitating but nonvisible illness

  2. Loudly invoke the power of the LORD

  3. Patient experiences one of the socially expected consequences, like speaking in tongues or collapsing

  4. wow pain is gone

And then there’s step 5: televise this for awareness and/or profit.

It doesn’t have to be religious, but that’s probably the most visible narrative that deals with life transformation. I guess you could make a similar narrative for gender dysphoria…

I will note that it is an important part of my world model that people with chronic pain, or with gender dysphoria, are in fact experiencing sensations which they interpret as aversive. And, while there exist humans who can execute the mental motion of "recontextualize your experiences such that the pain is not suffering", I don't think telling people to do that directly is likely to be a winning strategy.

"There is no such thing as an unmediated experience" is a true fact about the world (one that people in our particular corner of the internet are particularly bad at acknowledging - see all of the "I didn't fall for that optical illusion" types). In isolation, is is not usually a helpful fact about the world. However, rephrasing it as "here are some different lenses you can view your experiences through, keep trying out different lenses until you find one you like" is an approach that I expect will work more often.

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