The idea that most chronic pain has no physical cause is a myth. A lie told by people with a vested interest in treatments and interventions and courses and seminars and webinars and of course books,
Neen I’m one of those people who think the level of chronic primary pain is a massive proportion, and I extrapolated that data from the most recent Deloitte report on chronic pain in Australia using a chart which categorised types into segments such as “psychological” (quite small by the way), and back pain persisting long after injury. It seemed to match up with with other data from other organisations, and handily at the time matched my experience in the pain clinic in terms of response to treatment (I only worked with chronic primary pain, having no expertise in chronic pain with sufficient explanatory pathology).
Christine, could you point me to that report? I thought I'd seen another Deloitte report in my travels, but I just can't find it now!
I do agree that with back pain, most of it is non-serious or primary pain. There are a lot of people out there who are literally terrifed that any twinge means serious damage. I originally wrote in the article, my opinion that this statistic about the vast majority of all chronic pain being primary was possibly extrapolated from back pain...but I took it out, to put in another article...lol
I am most definaltey biased, I guess because most people I associate with have secondary pain and are being misdiagnosed and mistreated as having primary pain. Your experience is different, and you may well be right! Maybe most chronic pain is primary. But it does underline that we just don't know for sure. And its very harmful to just assume that all chronic pain is primary. Not suggesting for a second that you make that assumption, to be clear!
But a lot of physios, especially in Australia, do automatically assume. and that leads to some very poor outcomes. For the physio as well as the patient. Worse for the patient tho!
One of the biggest problems in pain treatment (and a lot of research and theorising) is the incompetent conflation of very different types of pain. This has led to incredible damage done to pain patients, as you’re unfortunately all too aware.
I’ll dig it out and pull out my commentary explaining the statistic I came up with. You know I sympathise very much with the suffering caused by current attitudes and treatments for all chronic pain patients.
And I also believe that pain due to fear is so rare that we can almost say never. It does seem that real pain signalling doesn’t need damage to get triggered. Just look at the weirdness that is allodynia for a pretty dramatic example.
The Pain/Addiction fight is reminiscent of Europe's reaction to what we now call PTSD: A mental disorder in which the person remembers a repressed memory of trauma and reacts emotionally as if he is right back in his foxhole watching his two buddies become a cloud of pink fog, just before the fragment from the shell that killed them, shattered his left wrist.
Europeans called it Shell Shock.
The proximate cause is war itself.
But seeking abstruse explanations for it, for military families, became a diversion.
Freud wrote books and articles theorizing about how excessive maternal affectjon caused homosexual tendencies which in turn led to shell shock.
The first pain specialist I saw sent me to a Pain Clinic as a one afternoon a week for 8 weeks at a hospital in Brisbane in 2019. At that stage my pain issues were not as serious as they are now but ME/CFS and Fibromyalgia flares saw me prescribed 20 Endone every 2-3 months as I was allergic to codeine and nothing else helped enough so they wanted to make sure I had other options other than reaching for medication 🙄 (I did, I always had a massive internal debate before I took a tablet)
I did the program even though it was a shit to get to from home. We did a lot of small group activities and the two people I got grouped with also had chronic secondary pain; one had been in a car accident and needed back surgery and the other had facial neuralgia (and I have since thought I hope she was offered Radio Frequency Ablation like I have been when I also got that diagnosis myself not just Pain Clinic to think the pain away). So we all had secondary pain but it most certainly wasn’t explained to us. We learnt how primary pain works, coping techniques, light exercise sessions, tai chi, hydro therapy, met with an occupational therapist, a psychologist, a nutritionist or dietitian. I had to keep reminding them I had ME/CFS when they wanted me to exercise 😣 so I’d just have to go super slow on the bike. In the end I don’t really remember anything much from the whole course now.
Neen I’m one of those people who think the level of chronic primary pain is a massive proportion, and I extrapolated that data from the most recent Deloitte report on chronic pain in Australia using a chart which categorised types into segments such as “psychological” (quite small by the way), and back pain persisting long after injury. It seemed to match up with with other data from other organisations, and handily at the time matched my experience in the pain clinic in terms of response to treatment (I only worked with chronic primary pain, having no expertise in chronic pain with sufficient explanatory pathology).
Christine, could you point me to that report? I thought I'd seen another Deloitte report in my travels, but I just can't find it now!
I do agree that with back pain, most of it is non-serious or primary pain. There are a lot of people out there who are literally terrifed that any twinge means serious damage. I originally wrote in the article, my opinion that this statistic about the vast majority of all chronic pain being primary was possibly extrapolated from back pain...but I took it out, to put in another article...lol
I am most definaltey biased, I guess because most people I associate with have secondary pain and are being misdiagnosed and mistreated as having primary pain. Your experience is different, and you may well be right! Maybe most chronic pain is primary. But it does underline that we just don't know for sure. And its very harmful to just assume that all chronic pain is primary. Not suggesting for a second that you make that assumption, to be clear!
But a lot of physios, especially in Australia, do automatically assume. and that leads to some very poor outcomes. For the physio as well as the patient. Worse for the patient tho!
Hi Neen, I reference the report in page 6 of my paper (showing my extrapolation differentiating non-malignant chronic pain without adequate explanatory pathology, which you refer to as chronic primary pain). That’s at https://www.researchgate.net/publication/341997591_A_Sad_State_of_Affairs_A_Review_of_All_Current_Treatments_for_Non-malignant_Chronic_Pain_without_Sufficient_Explanatory_Pathology
The Deloitte Report itself: https://www.painaustralia.org.au/static/uploads/files/the-cost-of-pain-in-australia-final-report-12mar-wfxbrfyboams.pdf
One of the biggest problems in pain treatment (and a lot of research and theorising) is the incompetent conflation of very different types of pain. This has led to incredible damage done to pain patients, as you’re unfortunately all too aware.
I’ll dig it out and pull out my commentary explaining the statistic I came up with. You know I sympathise very much with the suffering caused by current attitudes and treatments for all chronic pain patients.
And I also believe that pain due to fear is so rare that we can almost say never. It does seem that real pain signalling doesn’t need damage to get triggered. Just look at the weirdness that is allodynia for a pretty dramatic example.
The Pain/Addiction fight is reminiscent of Europe's reaction to what we now call PTSD: A mental disorder in which the person remembers a repressed memory of trauma and reacts emotionally as if he is right back in his foxhole watching his two buddies become a cloud of pink fog, just before the fragment from the shell that killed them, shattered his left wrist.
Europeans called it Shell Shock.
The proximate cause is war itself.
But seeking abstruse explanations for it, for military families, became a diversion.
Freud wrote books and articles theorizing about how excessive maternal affectjon caused homosexual tendencies which in turn led to shell shock.
The proof? None was ever found.
The first pain specialist I saw sent me to a Pain Clinic as a one afternoon a week for 8 weeks at a hospital in Brisbane in 2019. At that stage my pain issues were not as serious as they are now but ME/CFS and Fibromyalgia flares saw me prescribed 20 Endone every 2-3 months as I was allergic to codeine and nothing else helped enough so they wanted to make sure I had other options other than reaching for medication 🙄 (I did, I always had a massive internal debate before I took a tablet)
I did the program even though it was a shit to get to from home. We did a lot of small group activities and the two people I got grouped with also had chronic secondary pain; one had been in a car accident and needed back surgery and the other had facial neuralgia (and I have since thought I hope she was offered Radio Frequency Ablation like I have been when I also got that diagnosis myself not just Pain Clinic to think the pain away). So we all had secondary pain but it most certainly wasn’t explained to us. We learnt how primary pain works, coping techniques, light exercise sessions, tai chi, hydro therapy, met with an occupational therapist, a psychologist, a nutritionist or dietitian. I had to keep reminding them I had ME/CFS when they wanted me to exercise 😣 so I’d just have to go super slow on the bike. In the end I don’t really remember anything much from the whole course now.