Can Pain Be Used to Treat Pain?

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.

14 thoughts on “Can Pain Be Used to Treat Pain?

  1. Judith Hizer

    I did “push through” and learn on my own to ignore my chronic pain as a child, because nobody took my pain seriously. It was “just growing pains.” Until I was grown. I learned to “live with” IBS, too, as my doctor said… I adapted my entire life around when I can and can’t eat, and trips to the bathroom. For YEARS I pushed myself through horrid musculoskeletal pain with physical therapy that I now know was NOT the right therapy for my hypermobility disorder. I thought I was doing the right thing. But ignoring my pain and pushing through causing further damage and premature disability. Then when I injured my spine picking up something, and was unable to stand up, what was ordered? More inappropriate physical therapy. At age 54 I was finally diagnosed with Joint Hypermobility Syndrome/Hypermobility Spectrum Disorder. I am angry that ignorance of this condition in the medical field and being undiagnosed for so long forced me to “push through” until my body was damaged to the point of total disability. This has caused a cascade of other conditions including high blood pressure (I’m a 30 + year vegetarian, so it isn’t my eating habits, and my cholesterol is fine), hypersensitivities, autonomic dysfunction and mast cell disorder. By all means, if you want to hasten total and permanent disability, just keep pushing through and don’t adequately treat your pain.

    Liked by 3 people

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    1. Zyp Czyk Post author

      I hear your anger – it resonantes with how I felt right after being diagnosed with EDS. I blamed my strict parents and a stoic culture for encouraging me to ignore pain. I blamed doctors for not believing my pain when I reported it.

      But I never took responsibility for my own actions, for being so willing to believe the false verdict “there’s nothing wrong with you”. I knew darn well there was something wrong in my body, but what I wanted to believe I could push myself as hard as I was able to.

      After all, what is more American than trying to “be the best that you can be” and “just do it” and, most insidiously, “no pain, no gain”? I was a fool to believe such drivel.

      I happily pushed myself against pain to the point that I could barely function the next day and immersed myself in long intense workouts to compete in foot, bike, and horse races. It was fun while it lasted but, like you, I did considerable damage to my defective body, damage that I’ll have to live with for far, far longer than I enjoyed those activities.

      Liked by 3 people

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  2. Minion

    I’ve read horrifying testimonies from patients in this type of program. If I recall correctly: cost was over $5000, they had to dedicate so many days per month that they couldn’t keep their jobs, and that it was mostly psychological brainwashing. They were shamed.
    It’s just a scam. They will disappear your pain without a single Rx, if it kills you, your sense of self, permanent damage, who cares!
    I cannot believe this is still going on.
    There was one of these little cults right in downtown Chicago, close to me.
    It sounds like another Scientology offshoot, like Narc-anon.

    Liked by 2 people

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  3. canarensis

    Anyone else wonder at the apparent fact (I haven’t been able to determine this for sure) that the program is limited to girls? (all the stories talk about females, & “the girls” in the program). I’m one of the last people to be called a feminist, but this strikes me very strongly as ominous…are only girls in it because of the near-universal belief that females just have low pain thresholds & over-dramatize the little pain they have, so this program should work for them because their pain isn’t “real” in the first place? Or….?

    And I’ve seen elsewhere that they report a “success rate” as something like, “of the 49 girls who completed the program successfully, 46 report it worked.” First, I absolutely do not believe they have a 94% success rate; NOTHING works that well. The wording (sorry, don’t have the citation at the moment) sounded like “of the people who reported that it worked, 94% reported it worked.” Which really makes me wonder about the other 6%, plus all the unreported numbers who dropped out because they got hospitalized or PTSD (that was reported) or someone yanked them –hopefully before they got those outcomes &/or their pain was permanently exacerbated.

    At base, this strikes me as one of the most extreme examples of the institutionalized sadism that this country has embraced. Every time I see a story about this “program” I want to vomit and hurt someone…starting with the originators & perpetuators of this criminal travesty.

    Liked by 1 person

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  4. Kathy C

    NPR used to be a trusted source of news, but since they started taking corporate money, they are no longer credible. The editors only purpose in creating this episode was to get attention and build engagement. Dr Sherry was more than happy to get attention for his sick research, and possible more corporate funding. Denying pain, even in children is big business, creating doubt, or endorsing the false narrative of “no pain no gain” is incredibly attractive to the big corporate funders.

    When we look at all of the recent articles on childhood trauma, as if it is a new idea, and then come across something this disturbing, which supplies a justification for that trauma, it is even worse. What we have here is a miscegenation of advertising, misinformation, and attention getting for the attention economy. This is a justification for torturing children. If we look at NPR’s or other outlets coverage of the topic of pain, which is basically non existent, other than the speculative mind body nonsense, which they are also using to deny the existence of pain.

    Dr Sherries corporate fundraising in an NPR article, should have brought more scrutiny and perhaps an indictment for torturing his helpless small patients, but it was portrayed as beneficial, even the reporter had no moral or ethical questions. We won’t know by design, how this effects children in the long run. A lot of the children subjected to this in the past, grew up traumatized, and damaged beyond repair. Of course doctor Sherries “Research’ will include no long term outcomes, those are inconvenient.

    It is easy to do a search, and find out how NPR has re-framed pain, https://www.npr.org/tags/128568471/pain They tend to misreport and misinform, peddling “Holistic Therapy” and misrepresent with articles like this, https://www.npr.org/sections/health-shots/2018/07/23/626202281/words-matter-when-talking-about-pain-with-your-doctor The article makes it appear that there is a standard for discussing pain, and fails to warn that using words, can bring a false diagnosis of “Catastrophizing.” They tout mouse studies as relevant to patients. NPR has not covered how the CDC Guidelines negatively impacted pain patients and their physicians.

    In order for a society to accept torture and inhumanity, they need to be made insensitive to it. Most NPR listeners or readers, can’t tell the difference between news and content marketing. There used to be ethical guidelines and laws for physicians to follow, but they get around them with these kinds of attention getting research funding opportunities.

    Liked by 3 people

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  5. Kathy C

    Here is another expaple of misreported science.

    On the NPR Site, https://www.npr.org/newsletter/health. On the page to sign up for the health newsletter, ‘When Opioids Make the Pain Worse” an example of their health reporting. It is a click bait type enticement to sign up for their newsletter.

    “So how common is opioid-induced hyperalgesia? “This is the million-dollar question,” Stanford’s Angst answers. “We just don’t know.”

    Even at Stanford the prestigious medical research institution, “They just don’t know”, how common it is. Nearly every article on pain or opioids mentions this phenomena. Perhaps they chose not to research it, because it is more common among people on methadone or Bupenorpherine.

    Although the current research isn’t definitive, Angst says opioid-induced hyperalgesia strikes him as a serious problem. Addressing it may require adopting a new perspective on pain.

    It might draw a “new perspective” on who is funding the research. Opioid Induced Hyperalgia is just one of many excuses for avoiding the treatment or diagnosis of pain. Chronic pain patients on prescribed medication, might need higher doses of medications during surgery. They misreported this as opioid induced hyperlagia, so they could deny them actual pain relief.

    “This could be a major factor in the opioid crisis,” Arout says. “People have worsening pain, and so their dose is often increased because they are thought to be tolerant.” But the result is that some patients may find themselves taking dangerously high doses while their pain continues to intensify.”

    This sounds horrific, yet it is untrue. Of course there are people who don’t metabolize opiates the same as others, and might need more for pain relief. The good doctor of course will not put this into context. He conflates pain patients with people who are addicted to street drugs, or in treatment programs, who need large amounts of opioids to treat pain. This kind of misreporting of science, perhaps started in a pharma think tank, and repeated as a talking point in any article about opioids, has a purpose. It is a nonsecuiter, an outlier, used to undermine pain patients, and misinform the general public.

    Liked by 2 people

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  6. leejcaroll

    reminds me of when I was in the hospital and had to have my eye examined. I have trigeminal neuralgia which makes any touch in the affected are of the face excruciating. The doctor, who had an austrian or germanic accent (which made it even more bizarre) kept touching my face to examine the eye, despite my warnings to him and pleadings, please touch as little as possible. As he continued to provoke the pain he said “This is how yu do torture, make it so the least little bit of touch will cause tremendous pain” I wonder if this Dr. David Sherry was a student of his.

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  7. MyPainISReal

    I was horrified by this invisibilia podcast and immediately wrote them after listening last month. Every adult I’ve known with chronic pain learned to push through, most of us avoiding medication (even Tylenol) until absolutely necessary.
    Frankly- this method is dangerous.
    -I personally believe if widely adopted, this would lead to an increase in suicides.
    -Pain doesn’t go away in their examples, they a) get used to it (come to accept it as ‘baseline’ a term with which all patients are aware) and
    b) understand no help is coming for them
    -this method encourages parents and even patients to not acknowledge their child’s pain. I would love to see how many psychiatrists back this method, and if these kids are still functional 10 years later. What’s their mental/emotional health Iike a decade later?
    -Would these same doctors not treat someone’s pain post surgery?! This method is just disgusting.

    This method is akin to a movie scene with a war veteran on a mission continuing on with a gunshot wound or exhaustion while his younger and inexperienced partner is exhausted and overwhelmed right away. “Oh my gosh you’re hurt!” Says the Newbie “this? This is just a scratch!” Or “I cant go any further!” Says the newbie “this is nothing! we’ve got a long way to go!” Says the veteran

    The veteran in the cliche does have a better idea of just how bad things can be- and so is less likely to complain over the ‘little things’ that might blow someone else away. They have the will power to continue on in these movies despite it. That doesn’t mean that it doesn’t hurt or that we shouldn’t treat it- in these movies the veteran simply knows there is no help available, and if they want to get any they *have* to keep going. It’s a short term goal of getting to help, (and in the movie the ‘short term goal’ to continue to victory/mission success/returning home)

    The ‘soldier’ would be treated for his gunshot wound if he were in a normal situation, at home headed to an ER where his pain would be treated. Of course it would!

    REALITY: This isn’t a movie, and the ‘veteran’ doesnt have to keep it together just long enough to save someone – and then collapse just before the end credits to tears and cheers from the popcorn filled audience at their sacrifice. ‘Pain veterans’ have to keep going ‘long term’, to get dressed, to kiss their kids, to get groceries, to continue- day after day through the never ending battle of just living – with pain.

    We push ourselves constantly. We make choices about quality of life with every treatment. We don’t ‘get’ to collapse afterwards- we HAVE to keep going, and we need help.

    Most pain doctors expect us to function at the same pain level as someone with broken bones. That’s the ‘baseline’ many of us work towards, the baseline we *try* to get to EVEN WITH medication. All this method does is given these kids an idea of the baseline the rest of us have learned to live with, because no help is coming and we have to keep going.
    But guess what- it STILL hurts.

    Liked by 2 people

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    1. Zyp Czyk Post author

      You make an excellent point: most pain patients don’t take medication to make pain disappear, but just to make it bearable, to allow us to live even with its constant presence.

      And that’s why losing access to opioid pain relievers is such a disaster: it makes our pain literally unbearable.

      Liked by 2 people

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      1. Yasmeen Sulin

        Speaking of which- doctors are abandoning patients with complex needs like flies. Anyone have resources near Chicago?

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        1. EDSFamily

          I’ve already unsubscribed and left my review on invisiblia. I highly suggest others leave their review directly on the podcast and reach out to others to do the same (I’m not on twitter/social media so I can’t suggest it).

          Liked by 1 person

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