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Treating Pain is Simple: You Just Need More Pain

Updated: Aug 24



In March 2019, the NPR-affiliated (and Gautam-approved [side note: check out the Emotions broadcast ]) podcast Invisibilia released their premiere of their 5th season entitled “The Fifth Vital Sign” (you can also read the analog article here). 


Much of the podcast’s exposition has been talked about on this blog before, so I wanted to focus on the therapy that Devyn, the teenage subject vehicle of the story who I hope is now one of the millions happily grooving to TikTok dance trends. 


The crux is this: Pain is how your brain interprets alarm signals from various parts of the body. Normally, there is an underlying issue or deviation from the norm, such as when you go too fast on a longboard to catch the hourly bus that always tends to be 4 minutes early while carrying an entire guitar hero controller set, a canvas bag full of clothes while precariously balancing a glass mason jar with homemade strawberry jam with just a little bit too much sugar in it (only 2 cups too much), a full bookbag, and then you end up hitting the curb, flying 20+ feet across the street, waking up next to your items all over the street with speckles of glass sparkling more than your favorite mumble rapper’s grill (side note: why do their mouths open wide when they are showing off their jewelry, but not when they are rapping?), and the end of your elbow cleanly snapping off.


The alarm signals are supposed to tell the brain something is wrong and saying, “don’t you dare move that arm”, until it is fixed further or else risk more damage to the body. Once the bone-shaped lego pieces are back together and the healing process is done, fewer alarms are sent to the brain and the pain should subside.


However, for many people that deal with chronic pain, and especially those like Devyn with Amplified Musculoskeletal Pain Syndrome, there is no clear underlying issue that can be resolved. This means pain follows a negative feedback loop where it can stop an individual from moving or performing daily functions and potentially isolating them, leading to anxiety, mental health disorders, and more that may make the problem worse. As the brain adapts to this new lifestyle, when the person tries to return to normal movements, the brain overreacts and interprets even higher levels of pain.


Intensive Interdisciplinary Pain Treatment can come in many forms such as yoga, acupuncture, physical therapy, and exercise. It usually involves a patient exacerbating the pain and performing physical movements that should increase his/her ability to help perform daily tasks as “normal”. Part of the theory is that if the body continues to push through certain movements even though there is pain, the brain will pay less and less attention to those specific alarms, causing the pain to slowly diminish. 


Understandably, there was a good bit of pushback (like this, this, and this), with much of the criticism falling on the normalization of gendered narratives and presentation of the story rather than if the treatment was effective. NPR apologized and provided more context as well as answers and multiple sources to show the efficacy of such programs (I highly suggest you check those links out).


I’ll end with a couple of questions. 


Why do we think that a treatment has to work for everyone to be valid? Even relating to the ongoing coronavirus situation (it is 7/30/20 as I write this) it has unfortunately been politicized whether hydroxychloroquine + zmax might actually help certain patients, but it won’t work for every patient and whatever “cure” like your mother-in-law is telling you such as gargling salt water or a potential vaccine that might work for some people and won’t work for others (Just to be clear: I am in no way equating a vaccine with gargling salt water; we have to evaluate solutions as gray areas and likelihoods rather than black and white. A vaccine will have 90%+ efficacy but still won’t be the perfect solution for everybody. Gargling salt water might actually help others and I’m not going to say that it’s evil to even exist because it is still up to the patient and provider to use a subset of tools from the entire toolkit.) 


How do people like David Goggins become successful and determined by leaning into pain?



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