Can Pain Be Used to Treat Pain? — Pain News Network – By Jeanne McArdle – Apr 2019
“Can you cure pain with more pain?” was the provocative question posed last month by National Public Radio’s Invisibilia podcast, “The Fifth Vital Sign.”
The show features the story of Devyn, a 16-year old former gymnast living with chronic pain.
Devyn broke the end of her thighbone and required surgery, but the injury never fully healed and her pain was spreading.
She was diagnosed with “amplified pain syndrome” and enrolled in a rehabilitation program for children at a Kansas City hospital that combines intense physical therapy with psychotherapy.
Put simply, Devyn was taught to ignore her pain by being exposed to more of it.
The resounding backlash from the chronic pain and illness community was swift and fierce, blowing up NPR’s social media feeds with charges of endorsing torture and demands to pull the episode.
An apology for “triggering” pain patients from podcast hosts Hanna Rosen and Alix Spiegel served only to generate more ire.
NPR’s Public Editor, Elizabeth Jensen, stepped in on March 15, publishing an opinion piece that parsed individual points of contention while somehow missing the main one:
Patients were outraged that NPR provided free publicity to treatment programs that put children in tremendous pain on purpose.
The original pain rehabilitation program profiled in the Invisibilia podcast operates out of Children’s Hospital of Philadelphia. It is based on founder Dr. David Sherry’s belief that we do not accept pain as a natural part of life anymore. We focus too much attention on pain and try to eliminate it — often making it worse.
Is there scientific evidence to support the theory that paying too much attention to pain causes it to spread elsewhere in the body? I couldn’t find any.
I believe Sherry’s idea is just woo and bunk.
That’s exactly what science would say too: bunk.
Widely accepted pain research shows that once nerves are sensitized it takes less and less stimuli to create more severe and widespread pain. It is important to break that cycle and to treat the pain, before moving forward with physical therapy and other treatments.
Wait a minute… Most of the pain programs I’ve heard about take our opioids away as soon as possible – no doubt because they don’t believe our pain is severe enough to require opioids in the first place.
Only then, when they’ve set our pain free to run amok without medication, do they start teaching us how to deal with it and training us to use new coping mechanisms and “alternative” modalities (which haven’t been proven effective through clinical trials).
I think this is backward:
- First, they should teach us alternate methods to soothe and/or cope with our pain.
- Then, if those methods are truly effective, our pain will decrease and we will need less opioid medication.
Without medication to shield us from our pain, we are extremely motivated to make our very best effort. But If we find none of the offered methods significantly relieve our pain (at least as much as opioids did), then we are blamed: for “failing treatment” due to psychological problems, like “catastrophizing”.
Sherry’s program takes the opposite approach. It rests on the unproven idea that flooding the patient with pain will reset her brain’s response to pain.
- Take away the patient’s pain meds,
- force her to engage in many hours of hard exercise each day,
- subject her to other painful stimuli, and
her brain will no longer process pain as dangerous. It will become bored with pain.
This statement is absolutely absurd: pain is a primary biological alarm system, designed to save our lives by avoiding injuries, and operates even in the most dire circumstances.
Sherry advocates letting pain “wind up” into excess and remain at a high level, which the science says will result in central sensitization.
Would you want someone with such an extreme view of pain to be in charge of your pain management program? Would you want him in charge of your child’s pain management program?
On March 20, the Society for Pediatric Pain Medicine weighed in with an open letter to Cara Tallo, Invisibilia’s Executive Producer:
“(We) are deeply concerned that your episode promotes the misconceptions around pediatric pain and undermines the diligent scientific discovery by scientists, doctors and clinicians over the past several decades.
Pain is NOT simply a matter of attention and psychological state of mind.”
Devyn and other patients are told to jump in and out of a pool as fast as they can for five minutes straight.
During the podcast we hear Devyn’s trainer deny her asthma medication when she has trouble breathing.
It seems bizarre to deny even non-opioid medications used for non-pain-related purposes. Would they also deny epinephrine for a person who suffers from life-threatening allergies? Or insulin for a diabetic? Where do they draw the line?
The trainer tells Devyn to stuff a tissue up her nose and continue to exercise even when she springs a nosebleed.
We hear Devyn vomit from exertion. Apparently, exercising to the point of vomiting is common; there are barf bags set up around the gym.
Devyn is told to “push through” no matter what.
The girls who enter this rehabilitation program have, we’re told, completed extensive medical testing to rule out underlying medical problems.
But people in the pain community know how often diagnoses are missed.
I didn’t know I had EDS until I was 52, after decades of hard physical “exercise” because I was a competitive runner, bike rider, and horseback rider. I kept at it for years after my pain started because I assumed it was normal, that everyone hurt like I did, but just didn’t complain.
When I was sent to physical therapy, I pushed myself hard to make it “work better” because I assumed the immediate pain was necessary for long term gain.
I began to notice that certain exercises caused deep long-lasting pain (usually from irritating the sacroiliac joint in my lowest back) but that others seemed to “reset” painful joints (back “bridges” fixed my knee pain), so I started forming an exercise program of my own around these experiences. Without realizing it, I had created an exercise program specifically for a person with EDS.
Unfortunately, the best and most highly recommended exercises for pain added to my pain: walking irritated my hips from the repetitive motion and swimming hurt my low back due to the twisting (freestyle stroke) or sway-back (breaststroke).
The program claims to have precautions in place so that patients with Ehlers-Danlos syndrome (EDS), a condition that causes fragile connective tissue and autonomic dysfunction, don’t injure themselves.
Having EDS myself, I know that the essence of this program — pushing people through pain — is inappropriate for anyone with EDS.
I have personally met and have spoken online to other EDS patients who have been through Dr. Sherry’s program and emerged from it with more injuries and pain than they had when they began. There are even reports of people who have come out of his program with PTSD.
We have lived through decades-long diagnostic delays while enduring brutal and futile treatments.
We have been blamed for our symptoms only to discover they were beyond our control. We know how easy it is to harm, how difficult it is to heal, and how much the larger community wants simple solutions to our complex problems.
Programs that deny pain have permanently, irreparably harmed countless pain patients and chronically ill people. Don’t present them as solutions.
Author: Jeanne McArdle lives with Ehlers-Danlos syndrome. She administers a regional support group for people with EDS in Central NY and has served on the boards of several nonprofits. Jeanne is a former technical writer and earned an MPS in Communication from Cornell University.