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Last updated: Sun, Nov 10, 2024
We have already seen several concepts current within the pain community that persist despite meager evidence. Psychogenic pain has become less and less supportable by scientific evidence, yet it persists. Waddell's signs found great popularity amongst those inclined to be suspicious of claimants, and persist despite findings that they are in fact consistent with pain phenomena. The idea of "proportionate" pain and normal healing times persist despite expert opinions that nobody can judge proportionality, and despite clear evidence of clinically occult mechanisms through which pain can persist (See The Question of Proportionality).
We sufferers, and more importantly, pain care providers, should bear in mind that they are not immune to cognitive distortions. One can look at scientific research as a sociological process. What motivates the research that is done, and what influences how results are interpreted and developed into medical treatment practices? In pain research, there seems to be a pattern of 1) looking for confirmation of theories, and 2) interpreting results in favor of support for non-physiological causes of pain. Why is this?
Of course this is an inversion of the view that the researchers take. They see themselves as objective searchers for truth. Nevertheless, I think that this inverted view may help to provide a balanced picture of the state of pain care.
It is also useful to consider treatment providers as social actors within a social system in which the sufferer is only a secondary actor within the life of the provider. The reality of pain is complex and it is incompletely understood. There is much opportunity for treatment providers to be guided by factors other than reality and the interests of the sufferer. Discussion of the active role of pain providers in the experience of pain sufferers is notable it the pain literature by its absence. (See, for example, The Pain Institutions.)
We saw in one earlier section (Scientific Understanding) that scientific understanding of complex things requires habits of thought that are rather unnatural, and that clear definition of terms is critical. In Folk or Cultural Understandings, I made the case that pain is culturally important, that the culture has its own language and its own model of pain. Since the scientific and cultural models of pain share subject matter and vocabulary, it is quite easy for the models to intermix, particularly where vocabulary is used carelessly. I devote a major portion of the last section of this book, The Experience of Chronic Pain, to discussing what I believe some of the effects of this are on your and my lives.
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Psychology Is a Residual Explanation (Last updated: Sun, Aug 4, 2024)
The Healthfulness Assumption (Last updated: Mon, Jul 3, 2017)
The Intentionality Assumption (Last updated: Sun, Aug 4, 2024)
Free Will, Self-determination, and Responsiblity (Last updated: Sat, Feb 22, 2025)
Physician and Patient (Last updated: Sun, Aug 4, 2024)
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A Rational Model of Emotion and Pain (Last updated: Fri, Mar 21, 2025)