The question exists at some pain clinics. Are we to have a dialogue or a monologue? The routine neurologic examination is NOT a dialogue, as it carries NO CONTENT either way about Central Pain. We are not deluded zombies at the pain clinic. We are patients.
We do not consider an exam a CP exam until we see the von Frey hairs. If they aren’t there, it is an exam for something else, NOT Central Pain. The reason of course is Boivie’s paradox, “One must lose some sensation in order to become a candidate for severe pain.” This consistent finding, loss of sensation in the areas of burning requires vonFrey filaments, since the sensory loss is usually too slight to be measured by a sharp saftey pin.
If we feel nothing with the safety pin, they will only be testing the areas where WE DO NOT HAVE CP, so why bother? The “one size fits all” neurologic exam justifies a fee in the doctor’s mind, but it is completely beside the point in evaluation central pain.
The routine exam is nothing more than a medical student can perform, is a flight of imaginary evaluation, does not match the literature on CP in any way, and is purely fictive as far as Central Pain is concerned. The exacerbation of pain is brought on by persistent occlusive light touch. This must also be part of the exam, directed at the areas where the von Frey hairs reveal we have subtle loss of sensation. Exceptions occur, but they can be dealt with.
We have observed rituals elsewhere thoughout history. There is nothing wrong with a ritual per se, as long as it has a point, hopefully a good point. In antiquity, people were taught the blindly do whatever the priest or leader said, no matter how stupid it was. For thousands of years, to give weight to this mindless obedience, statues were created, which were occasionally aimed at convincing people this workmanship of the hands was itself a god.
As silly as it sounds, this form of worship/education was the context for relating to higher powers on which most of our race was built. So pervasive was this mass hysteria that even the ancient philosphers felt obligated to pay respects to it so as not to run counter to the social order, and not to offend the old gods.
One-way monologue is not usually a dynamic that leads to truth. The revolution in medicine which was begun in America years ago at Johns Hopkins was started by the teaching of Sir William Osler, who said, “If you listen to the patient long enough, he will tell you what is wrong with him.” This method was part of what was termed “the art of clinical medicine”. This constrasts sharply with the resignation, the blind obedience, and the overawesomeness of ancient mythological paganism.
The ancient master required blind obedience, silent submission, and the general “wax on–wax off” of the Karate Kid. “Yours is not to question why, yours is but to do or die.” Well, guess what. We don’t buy it. We are not stoics. When the psychiatrist tells us the CP is all in our mind and we need merely change our behavior and the pain will go away. If we fall for that we are as loopy as our unfortunate ancestors who didn’t know any better.
We know where they get this drill. It even has its righteous roots. It is the routine speech given to low back pain patients. It goes best if the patient doesn’t argue, so the doctor adopts a rather imperious style. But even there, it is because back surgery usually doesn’t work. So the doctor/psychiatrist is being ethical in backing the patient away from a demand for surgery. Back pain does respond to pain medication, but people like to function and often do so better if they realize modification of lifestyle, lifting, etc, will usually cause the disc to shrink and the back pain to diminish.
Now just exactly NONE of this applies to Central Pain. We are not seeking surgery. Changing our behavior will not matter one whit as to how many excess Nav1.3 channels our dorsal horn will manufacture, nor will it give us an infusion of KCC2 so that GABA can do its work of pain inhibition. Therefore, stoicism is worth approximately nothing to Central Pain. For us, the psychiatrist must show us how to decrease our expectations, not to forge ahead, so we will have mental reserve to survive. He accepts our pain, and goes with us on how to address it. He does not scorn or belittle our plight.
Because ancient people were taught that only the mystics and holy men could hope to know religion, somehow this model was adopted by philosophers. The embodiment of this idea became what is known as stoicism. It means to accept what the great minds tell you, which information they derive from studying at schools of philosophy. In other words, it is the exact opposite of what Sir William Osler taught, wherein he made the patient an equal partner in arriving at the diagnosis.
We can only shake our heads at certain nutty professors who call themselves “pain psychologists” but degrade their noble profession by adopting an antiquated and superstitious, quasi-theological method of pain management: namely; SCORN. They are the intellectual descendants of the stoics, whom we here seek to discredit.
We have never met a person with low back pain who is faking to get out of work, but we can readily assume they exist. Real low back pain is a serious matter. We have met hundreds who try to work through the pain. We think this is the norm and a recent article in JAMA bears us out.
Significantly, bedrest and conservative management often helps low back pain, so often the rational and highly ethical surgeon is the one who is slow to overreact and slow to cut. He occupies the ethical highground, but there are counterfeit ethicists, vying for the same spot, who do NOT belong on that particular piece of real estate.
Conservative management does NOT improve CP, so we simply cannot endorse the tenets of Stocism where CP is concerned, nor do we wish to be lumped at all with the comparatively easier to bear low back pain although we acknowledge it can be very disabling.
What we say here applies only to severe CP, nothing else. CP is one of only a few life threatening pain states. Back pain hardly compares. Back pain is about disability. CP is about survival.
Stoicism is not the same as bravery and endurance–it is the false idea that God wills all suffering so resistance is futile.This notion finds its earliest records in the worshippers of Baal, whose descendants began Stoicism, which became the darling of Rome, and persists today in certain corners of the philosophic world. We regret to say some of the present-day adherents (we can hardly call them “modern”) work in pain clinics. It is the resort of those who do not believe science is going to succeed.
We believe precisely the opposite, that God delights in the happiness and well being of his children, and in any of man’s efforts to achieve this, but also that pain research should NOT be hobbled by insisting it be discussed only in theological terms. It is a disease and we prefer it be discussed in medical terms which promote further research, not in a paralyzing, stifling insistence it, or any disease, is God’s will. Curative research is God’s will. Acknowledgement of the science already know about CP is the obligation of everyone who touches a CP patient. Save the stern lectures about our pain behavior for someone else. They don’t have our ion channels. They have pain inhibition systems which the brain can work on. We do not.
We have endured much, and hope to be able to endure all things, but we do not plan to endure the abuse mouthed at us by angry, assaultive, ignorant employees of pain clinics who slice off the science and want to deal with us only as examples of bad behavior. They are the real delinquents, delinquent from the library, where they should be staying current on neurochemistry.
It truly breaks our heart to say a word, even a syllable, against psychology, since those who suffer from Central Pain owe so much to the great ones, like Ron Melzack, who showed that psychology could be hard science, where pain is concerned. Dr. Melzack is our personal angel, and we believe he is responsible for the traditions of neuroscience at McGill University, which has produced a truly awesome, completely out of proportion aggregate of solid experts in that field, in that Canadian center, where so much of the hope of those with Central Pain resides.
In deferrence to Dr. Melzack and his colleagues and progeny, we have avoided mention of the truly awful state of this field which persists at far too many institutions, which display an appalling lack of knowledge in brain science.
Likewise, such a debt is owed to the great neuroscientists at Toronto. It is hard to know which of these two great institutions deserves the greatest praise. We wish our remarks could be confined to deep expressions of thanks for these great scientists, but there are just too many oddballs to remain silent.
We are seeing truly benighted, fanatical, and harsh therapists infecting this field here in the United States and elsewhere. With the death of Patrick Wall, this group came out of the woodwork, and now we must fight back a horde of psychologists and psychiatrists who have managed to avoid the hard work of neurochemistry and think they are performing a service by giving us, “the speech”. Even the M.D.’s are not exempt from this stupor of thought, which can only be described as having a STRONG ANTI-SCIENCE BIAS.
This is completely unexpected in this day and time. It would be like discovering that alchemy has resurged as a significant force in the field of pharmacology. We hope to see this element exposed to the light of day and their utterly outmoded forms of stylized thought abolished, that all things psychological are behavioral, and none of them neurochemical.
It is so ironic. On the one hand, we have the highly expert work of psychiatrists like Roland Worz, who is using functional MRI to thread out the “cenesthetic pain” in schizophrenics who happen to have lesions in the thalamus.
We have Donald D Price, a psychologist of the first order, who is almost beyond complimenting, so astute are his observations and so dedicated is his science.
We are amazed at the ability of Ron Yezierski to handle the complicated clinical aspects of Central Pain. The list could go on and on. These are not just scientists, they are like Mother Theresa to those of us who suffer. Then, like some ugly creature crawling from the swamp, comes a resurgence of the “I don’t believe in neurochemistry” pain torturers.
These truly misguided professionals, who, when a pain state is encountered for which there is no treatment, instead of running for the library to review the neurochemical research, or opening the lab when they find their medicine cabinet is empty for us, turn on the patient. The imagined injury to their pride and the evident exposure of their impotence at treatment is not forgiven by them.
The old arsenal of accusations of weakness, exaggeration, and psychopathology which characterized the 40′s is back in full display, and while we respect elements of it in low back pain, since nearly everyone in America eventually gets that, we demand a separate perspective for CP, which is many orders of magnitude more severe.
The old blunderbuss is an impossibly poor firearm, but if you stand close enough, it can kill you dead, completely dead. The same is true of these OLD ideas. If you let them, they will destroy your ability to cope with the agonies of severe Central Pain. They will turn family against you, ask the impossible, and drain your pocket book, until life is unbearably miserable. We can only surmise how many people with severe CP they have pushed over the edge. We know this, that if our survival hung on their misguided idealogy, we would be in serious trouble. Their false doctrines are lethal. Therefore it is our obligation to take them on, while maintaining the deepest respect for the psychologists who are driving the battle against central pain.
They care enough about our pain to end it, thereby depriving them of jobs requiring a psychologist. May God reward them for their unselfish help and hinder those whose unknowing effect is to break our backs with their blind, brutal, sadistic, mythological ideas about pain.
We might let most of this pass, and just hope patients can find better places for care, but some truly troubling work is appearing in the literature, suggesting that ties are being formed, and reputations are being forged that will make life very difficult for those with CP for some time to come. We are easy targets and will certainly be harmed.
Since our lives, and the survival of our families are at stake, we cannot ignore them, but must either convert them by encouraging reading of the literature, or else hope they will be eliminated from the pain clinics by the eventual evidence of their ignorance.
In the mid 90′s a great meeting was held to honor the late Dr. Patrick Wall for a lifetime of work in treating pain. At the discussion session, some comments were made about pain fakery. Several participants joined in, and made semi-political statements about whether disability should be given. They were all cut short by a great scientist, Dr. Brad Galer, who stopped them with a short, but effective speech stating that if this philosophy were followed, it would end the means of support, destroy the family, and put such people on the street. We wish we could match his speech of conviction but even if we fall short, we wish to expose that group of fabulous fakes who think that “behavior modification” will stop central pain. We think such officious offhandedness has led to more than one finger on the trigger, which has ended a life.
They make the most fabulous constructions about pain behaviors, as if one could not figure out perfectly well, how a person in pain could be expected to act, especially if the pain were severe and continual. Rather than seeing this very predictable behavior as a natural consequence of pain, these cultish figures have concluded the predictable behavior is what is DRIVING the pain. This is a form of abuse. It is like the parent refusing to hear a sick child, and loosing patience, forcing the child to go to his room, rather than dealing with the problem. With the door shut, the noise ends, but the pain does not.
Nevertheless, the comfort of silence is what these people are really after, their own comfort. One of the main criticisms of psychiatry was humorously quoted by Peter Kramer, who said psychiatry was a field which helped people not feel guilty for behavior which should make them feel guilty. In the same sense, we can say that this branch, and this branch only, of psychology/psychiatry seeks to shut CP sufferers up concerning pain which should make them cry out.
This particular article is aimed at their completely false claim that their ideas are NEW, a REVOLUTION, a DISCOVERY. It is nothing of the kind. It is the ages old invention of false priesthoods, when science was either unavailable or rejected as a threat to someone’s influence..
The earliest record we have of mankind comes from Mesopotamia, a number of derivative cultures winding up on the eastern shores of the Mediterranean, now referred to as the “Middle East”. Their ancient culture was not without science, but a combination of merchant driven morals, and the opportunity for gain, led to an early combination between religion and power.
Pagan cults and dark superstitions were borne from this materialistic orientation wherever it appeared, whether in Asia or Europe. It is often hard to distinguish between kings and priests since both combined made for nearly unstoppable power structures.
Similarly, the early Viking religion is so dreary as to be nearly unreadable, and seems to have been aimed at convincing mothers they should send all their boys off to be soldiers, which act if it ended in death during combat, would guarantee salvation, which was said to be life in Valhalla. Odin and the others there continued the battles of mortals on a bigger and more deadly scale with endless fighting, like no heaven we conceive of today. This turn of bloodlust into heaven is counterintuitive, but not unlike the foolishness that passed for truth in the ancient times.
It reminds us of certain Stoic pain clinics who pretend to “treat” CP. We go in under hellish circumstances and go out with a bill and the advice that we have brought it all upon ourselves by failing to consistently deny to ourselves what our own brains know to be true. They have seen our moral weakness and it remains only for us to agree with them for the pain clinic to have done its job. What kind of treatment is this?
Returning to the ancient world of the Levant (eastern Mediterranean), the common man bowed easily before the mighty. No matter the cost, the head bowed. They were rewarded with license to do great wickedness so long as the priests of Baal were supported and followed. This meant doing whatever was ordered, WITHOUT QUESTION. There had to be demonstrations that true believers had surrendered any right to any normal sense of self, or separateness from whatever Baal had cooked up for them.
Those with power and money were clearly in God’s grace, while those who were not deserved to be slaves. This brutality was mirrored in the gods such men created. One such God was El, the chief God of the Philistines in the Bible, whom today we call Southern Phoenicians. The Phoenicians were the merchant class of antiquity, using maritime skills to become fabulously wealthy. They were also educated and skilled.
When Solomon sought to build a temple, it was engineered by the experts of Hiram of Tyre, a Phoenician city. Solomon’s fleet on the Red Sea was built by the Phoenician shipwrights, no Israelite possessing the skills to build a fleet to bring the fabulous gold from Ophir. Solomon married hundreds of women from the various cultures to cement political ties, including quite a number of Phoenicians.
Many religions were tolerated side by side in Israel and it was never quite clear who would win out. It still is not. Will it be the God of materialism, or the god of love, under whatever religion he be named. However El, a god so “great” that man worshipped solely by giving up everything he would naturally want, and was so far out of reach that one could never pray to him, approach him, implore him, or love him.
One could only demonstrate the utter and abject acceptance of all that Baal (the son of El) required, including anything your own brain would tell you was your own. Common sense and human dignity were not given high value in those days–it might offend the priests of Baal, (or today, the men in white).
This was symbolized by the requirement in this pagan religion of demonstrating complete surrender to fate. Baal required periodic sacrifice of children, of the virtue of wives, and every natural thing which man would seek to retain. In return, the Phoenicians could grant to the believer a share in their fabulous riches, based on their unique dyes (the purple secreted by Murex shellfish being their well kept secret) which led to the name we use for Phoenicians today, which comes from the Greek word for purple. Royalty was cloaked in purple as a sign of majesty for thousands of years.
But what about the fatalism of their pagan cult. Surely this would have been buried in the distant past. Surely modern man would be allowed freedom to feel as he naturally does, to protect his family and his own natural wishes, ie. life, liberty, and the pursuit of happiness. Not a word of it at certain pain clinics. You do as you are told and leave your own awareness at the door. That goes double for your spouse if she/he has the habit of beiing supportive.
If the severe CP pain patient should be so unfortunate as to actually mouth the words of his/her ineffable pain, all hell breaks loose. Legions of shocked psychologists swoop down, shrieking of blasphemy, covering their ears, and generally resembling some part of a horse. All of a person’s natural feelings at enduring terrible pain become the CAUSE of the pain itself. Some sort of sacrifice is required. Namely, an abject apology for ever suggesting that pain actually hurts, and the admission that it is only the patient’s WEAKNESS which is at fault.
PAIN BEHAVIOR, a psychological WITCH, is identified, and the courts of Salem witchcraft are open for business again. Torquemada, Robespierre, and Vichinsky have medical degrees now, and you had better not cross them.
Of course, the absolutely solid work of neurochemists and pharmacologists are not taken into account by such imposters of “pain treatment”. It is only the degrees, the pieces of paper on the wall declaring these people are secular priests, which is important. All bow to the sacred wisdom of the PhD’s, which in this case really does mean “Piled high and deep”.
What is so tough about neurochemistry that they hold their ears and act outraged at its mention? If we were to say “I really don’t think my behavior has anything to do with the pain. I think it is the explosion of sodium ion channels increasing the firing frequency in my pain nerves and the chemical disabling of GABA’s pain inhibiting function, which is behind all this pain” you would be convicted on the spot. That would be the most sacrilegious and offensive words we could utter. Baal’s mouth would widen.
Baal requires sacrifice, abandonment of one’s own instincts and natural intelligence. Baal requires that you DIE, of pain, all the while proclaiming your faith in their false religion, even as the fires of CP consume you. Long live Baal! Long live the heartless and uncaring psychiatrist who wishes to twist your pain into a floodlight to illuminate his great insight.
Now since this pattern has been with us forever, or least through recorded history, we might shrug it off as just the systemmatic occurrence of some unfortunate trait inherent in man. These people enjoy a reputation because they are draped under the cloak of some mighty researchers. It is so impressive to see the Worz’s and the Melzacks, that we forget the creeps are still around, in their robes of white coats, attempting to force us into Baal’s mouth; ie. to give up our own knowledge of what is going on and become blind automatons, abandoning our own truths to gain favor. (In antiquity, those to be sacrificed were place on a little platform and roped or chained to it, then fed into the idols mouth, behind which was a consuming fire.)
This kind of treatment calls for more than just ignoring it. It calls for exposing it. It calls for ending it. We have elsewhere suggested all these people inject themselves with capsaicin, which will inform them of what allodynia (pain from nonpainful touch) feels like. What a congregation of converts we would have, bearing testimony that pain hurts. Whoop de do!
Whatever this fabulously stupid set of ideas is, it is NOT new. Pain has until the last fifty years, always been uniquely attributed to some displeasing of God or moral standards, unlike other diseases. The treatment was to shame the patient, since little else could be done, UNLESS the pain happened to respond to opiates, in which case the pain was valid, sound, acceptable, and true, because the DOCTOR could treat it. It was therefore pain which VALIDATED the DOCTOR, and therefore VALID PAIN. (Just in case you missed a patient’s proper role at a pain clinic)
Now we know that severe CP does NOT respond to opiates. (Lighter cases may respond). CP is therefore in danger of being cast as INVALID pain, and indeed we find this to be the case, making our pain not valid in some people’s minds.
We had thought that the discovery of the ion channels and the GABA misfunction would bring us safely back into the fold of VALID PAIN, but this apparently is not yet to be the case, due to the resurgence of the Baalistic psychologists, who see our misfortune as clear proof of our unworthiness and psychopathology. The idea that some of us may have so many new ion channels and so little KCC2 that we are in life threatening agony does not program. In their scheme of ideas, ALL PAIN IS THE SAME, OCCURS IN THE SAME AMOUNT, AND ANY MEASURES OR DEGREES OF DIFFERENCE ARE AN ILLUSION. All that differs is that some people deal well and some stink at it. Those who DO NOT deal well, probably weren’t listening, since the degree of pain is roughly equal in all. At least, that is the underlying assumption on which their “your behavior is what is causing chronic pain” is based.
Since we are known to have excess substance P at work and since Capsiacin will give the psychologist a taste of Substance P to remind him the pain business has nothing to do with our poor attitude, and provides an excellent chance for the skeptical psychologist/psychiatrist to test his OWN attitude about Substance P, we see no point to continuing the argument.
We have absolute proof, but so far these people are NOT stepping forward to HAVE ANY capsaicin. After all, they have their framed pieces of paper on the wall, AND a white coat! Their secular “religion” is ABOVE science. Nothing we say will convince them. It is a case of the evil CP patients deceiving them through our evil power. They will not put themselves into the “trap” of our evil trickery. They will discharge their load of ink, like the octopus, and then sit and skulk in the corner where they cannot be attacked.”
This constitutes the craft of these Baalistic savages. If you find one in your pain clinic, like finding Agent Smith in the Matrix, “do what I do, RUN!” You are about to lose your sanity, your spouse, your money, your hope, and maybe your life.
Above all, do not let them characterize their delusions as a NEW discovery about pain. It derives from the very oldest philosophies of paganism, from an era where man’s attitude was blamed for everything, because if things are bad, you must have offended Baal, you must have a bad attitude.
This notion travels practically back to the beginning of recorded history, when everything was attributed to unknowable “gods”. This attribution was easy on the “experts”, who were after all the ones in power. Blaming the victim is much easier for the “expert” than saying “Man, am I ignorant. I have nothing to offer this person.”. In other words, just like today.
It elevated stupidity to a religious state, which somehow seemed more self complimentary to the experts. Remember that our ancestors followed these experts. You, yourself could be taken in, if you are not careful. One of my favorite cartoons shows a man, not such a good sculptor, whose idol is sort of gradeschool level art, and his wife is saying, “If you want me to worship that, you are out of your mind”.
We know we will be accused of getting off the point by mentioning the ancients, yet none other than Sigmund Freud himself, attempted to analyze the behavior of the peoples in the middle east, and hence us, by the philosophical legacies begun by Ekhnaton, an Egyptian. If Freud can analyze society from an Egyptian heritage, cousins to the Phoenician idea, so can we. Now, we would not waste any of your time dragging you through boring and pathetic history, were it not for the fact that today’s psychologists somehow missed the record of the last six thousand years, and flatter themselves with their latest version of the false god, a construct of their own hands, as being NEW
Their plan calls for punishishing Central Pain patients and this idea they actually find to be “revolutionary” (see below), when in fact, there is no philosophy older than this. Pain patients have supposedly brought it upon themselves, and their disease is all imaginary. Yeah, RIGHT! By the way, Sigmund Freud, often worshipped in psychiatric circles, committed suicide over chronic pain he suffered. No doubt, he really had problems with his bad attitude, which was generating his pain. If ONLY he had had the benefit of today’s behaviorists.
Let us use an example of what passes for scholarly analysis, the ever popular, “Handbook of Clinical Behavior Therapy” by Hersen. We go back to the 1985 edition, since it hard to find a textbook today where the pain chapter refuses to endorse the neurochemisry of pain. The chapter on Pain (beginning at page 353), bemoans the fact that physicians have little or no luck treating chronic pain.
So far, so good, We can all agree with that fact. But then they go through the bend and wind up with this amazingly benighted statement:
“Behavioral psychologists began analyzing the problem, and the REVOLUTIONARY idea that resulted was to look at PAIN as a SET OF BEHAVIORS rather than a neurological state.” (caps are ours, for emphasis)…
In other words, neurochemistry does not exist. Sorry, “revolutionary” experts, you just didn’t get it at all. Neurochemistry is practically the whole story.
Let us reword this appallingly ignorant and blockheaded declaration in ancient Phoenician terms, which gives a clearer perspective on the self delusion of the writer. “The doctors being unable to treat chronic pain, the Priests of Baal began analyzing the problem and the revolutionary idea that resulted was to look at pain as a set of behaviors which had offended the gods, requiring some sort of human sacrifice”. Of course, the time of Phoenicia was much less humane since the person to be sacrificed was only a child; whereas today, the priest, excuse me, the psychologist merely wishes to make the patient suffer humiliation, letting our children off easy. In fairness, we have no idea whether the author of that particular chapter in 1985 would eagerly eat his words today, or whether his own writing has locked him away into everlasting ignorance.
Continuing with this quasi-Phoenician analysis, the Handbook states, “..a good assessment is a prerequisite for successful remediation of chronic pain”.
Assessment SOUNDS good, until we discover that what is being assessed is NOT the pain at all, or any of its components, locations, or evoking stimuli. What is being assessed, is the patients BEHAVIOR. No need to waste all that valuable time assessing the pain. We may stereotype it at will. It is the behavior which needs treatment. WE HOPE YOU ARE BEGINNING TO SENSE THE COLOSSAL HUMBUG OF THIS APPROACH.
Chances are the behavior of someone with severe CP is not going to be Grade A, because this patient has enough PAIN to cause him to spend several thousand to come to the clinic, and fill out the reams of forms which every facility requires in our computerized, efficient age. He may also have enough pan he doesn’t want to wear clothes, eat, move, or talk to another blind guide.
The author continues:
“The evaluation helps to identify problem behaviors…”. For pain patients the problem would seem to be obvious:pain [No duh!]….pain is of SECONDARY IMPORTANCE [or really, then what pray tell is of primary importanceat a pain clinic]. The idea, then, is to obtain specific information about problem behavior…define the pain…operationally in behavioral terms.
Table 1 of the chapter then lists several of these behaviors which must be exorcised.
1. Current problem behaviors
2. Pattern of behaviors
3. Avoidance behaviors
4 Handicap “conceptions”
5. Denial of other problems
6. Goals of treatment
8. Communication skills
9. Possible related problems
We think this redundant list splits hairs, but pretty much boils down to one idea, even if they wish to milk it to death. The problem is supposedly US, not our PAIN.
We also learn that “target behaviors should be selected BEFORE observation takes place. (In other words, no observation is necessary to anticipate our bad behaviors, very scientific)
“As a rule, chronic pain patients are QUITE CONVINCED that their pain is caused by organic processes…if so, it may be VERY DIFFICULT to start treatment.”p. 368
Then we are warned in the text that most patients possess a “disease model orientation to their problem” and we also learn that many of these patients want the doctors to help them, rather than accepting “responsibility for treatment” rests with themselves. And, we read that things will not go well, unless this “attitude can be altered” This sounds a lot like “Pay money to be told to get lost”.
Strangely, the book then launches off into a discussion of “treatment gains”. Then comes the coup de gras, “The only possibility here is to sever…” [the connection between the patient and] the pension. Oh yes, poverty and privation is such a well known cure for ineffable pain. However did Dejerine, Roussy, Riddoch, Tasker, Bonica, and Wall ever miss all this revolutionary stuff. Wonder how well this line of thinking would sell if we tried to replace surgical anesthesia with it?
Moving a little more forward in time, let us look at “Abnormal Psychology” by Barlow et al (1995) (caps ours) Here we find:
“The EXPERIENCE of pain is not, BY DEFINITION, a physical disorder…” Now this is a sentence of extraordinary construction. Since the author has NO IDEA what pain is at the chemical level, he hedges by writing only of the “experience” of pain, which presumably gives him some wiggle room. Next, we must ask by WHOSE “definition”, His? The preface lists absolutely no qualifications in neurophysiology which would suggest Barlow is qualified to define anything in that realm.
Finally, we ask, on what basis, (Barlow certainly isn’t saying) has he ruled out a physical component to the whole affair.
It is certain that the action potential, the firing of a nerve, is a physical experience. We can evoke it in a rat with any noxious stimulus we can invent, poking them, burning them, or whatever. We can easily measure this pain as action potentials (voltage spikes in the nerve) on an oscilloscope with patch clamping, and although the voltage spikes are small compared to the city power plant, they are definite events, carefully timed and bear every resemblance to a physical phenomenon.
These physical events also result in a change in blood flow to various parts of the brain, which can also be measured and SEEN on PET scans and functional MRI, and other imaging devices. It is harder to detect the physical attempts of the brain to INHIBIT pain, but we know through Saab’s work that this occurs. The brain itself is, of course, a physical organ, and central pain can be measured there as well as firing at certain frequencies in the thalamus. Therefore, to say something is NOT physical, we must ask how “physical” is defined. If voltage changes and electrical signals are not physical events, then surely Barlow has some definition of the material world which is different from the rest of science.
It seems likely that although the behaviorists MIGHT be persuaded that pain is physical after all, once he SEES it on fMRI and in the ion channels of the dorsal horn, that he woudl then ask why an injured person may not feel pain, at first. The answer is that the body has an elaborate pain inhibition system, which is ALSO physical. This was shown by Carl Saab in the vermis of the cerebellum on brain imaging studies. So we have a physical event causing pain, a physical event inhibiting pain. Two physicals together DO NOT ADD UP TO SOMETHING WHICH IS, “BY DEFINITION” NOT PHYSICAL. By definition, they add up to something which is physical twice over.
Now you might think that having swooped down to grab what appears at all account to be physical, the electrical signals of pain, and pronouncing it to be NOT physical, for the sake of their argument, they would remain, at least verbally, in the nonphysical realm. But this is not to be the case at all, because as it turns out, even the psychologists cannot start, let alone finish, an intelligent discussion about what is non-physical. It is just fancy words to make them sound like they are operating on a plane which is beyond what the clinician can see. To discuss their methodology they must return to the mundane physical world and talk about behavior.
Therefore, in a conspicuously inconsistent, if not hypocritical sleight of hand, they make their pronouncements, based on what is completely obvious as a physical phenomena, our BEHAVIOR! Thus, we see that all the talk about “non-physical” was but a cover for denail of the reality of our pain, and a slightly more polite way of saying they don’t believe WHAT THEY CANNOT SEE! Which is of course why they prefer looking at behavior because they really have no idea what non-physical pain might actually be.
You might think these authors are hopeless, but you must remember evolution. These experts are hominids, and someday they may learn to use tools, such as fMRI.
It is hard to imagine a less helpful approach and attitude by a pain clinic. Let us take the patient, who had the foresight to pay insurance premiums for many years, and let us SEVER HER PENSION. The Priests of Baal strike again. This will not cure her by any means. It will merely add more poverty. Poverty is self perpetuating and human dignity can be stripped away with amazing rapidity. That initial shove should not come from the pain clinic.
What is missing from this atrocious and vicious bit of human sacrifice is the fact that what the CP patient wants most is to be normal enough to resume work so that the fear of starvation and privation of the family can be relieved, since insurance companies can be difficult to deal with.
A recent article from the Journal of the American Medical Association (Nov.2003) found that the vast majority of Americans attempt to work even when pain is present. We know CP patients would love to be able to do this, and do so as long as possible. If the pension then kicks in, God bless the insurance company, it is doing what it has promised to do.
What is also missing is the awareness of the neurochemistry which underlies Central Pain. It is real, the disorder is real, Central Pain IS a disease, and since the severely affected patient is exhausted from struggling against suicide and the pain, has loss of working memory, has pain with movement, cannot eat or have the bladder fill without extreme discomfort, and probably cannot tolerate normal temperatures or the touch of clothing, they NEED the pension to keep the family from starving.
The bloodthirsty, savage attitude of some of these dogmatists is beyond any comment. It certainly presumes that actual chronic pain does not exist as a reality; or, if it does, may be willed away by starving the patient, moving them onto the street, and ignoring the plight of this MOST needy segment of society.
It is not exaggerating to compare this ruthless and willful destruction of a person and the family with the sacrifice of infants before the ridiculous idol of Baal, built so tall only a fool of the day would have questioned Baal’s power (PAIN CLINIC, 12th Floor). Now are we really so stupid that we plan to ignore what has been learned about central pain from the animal models, the neurochemists, and the neurophysiologists?
Those little CP rats chewing their legs off to try to escape CP don’t KNOW about Baal. They don’t know about psychology. They DO know that the pain is so severe, they willingly commit a minor form of suicide, the self amputation of their limbs. Surely they must know the prospects for survival will not be good without their limbs (See Knight of the Holy Grail, elsewhere at painonline). If this isn’t an animal form of attempted suicide, nothing is.
Therefore, we ask the obvious question, who let these lethal critics into the pain center? Could they not be locked up in an institution, with others willing to harm society, if necessary, to maintain self esteem. Now that we have seen the idiocy of what they promote, let us consider the emptiness of this idea that we should simply accept whatever happens to us as fate, and never attempt to do anything scientific to solve it.
Again, may they never be permitted to flatter themselves with the advertisement that they have made a new discovery. One need only begin with the Phoenicians (known in the Bible as the Philistines), and their progeny at the Phoenician city of Carthage, from which came the Stoics, such as Zeno, of Greek and Roman fame.
So it is clear, stoicism is the enemy of scientific research and modern medicine. It formed the basis for Medieval asceticism, but we intend to have no part of it now. We BELIEVE in science. We BELIEVE in the scientists, and NOT THE FALSE GOD OF BAAL who wants only sacrifice on our part, and none on the part of the pain researchers. Actually it is rather interesting to learn pain neurochemistry, so we ask no sacrifice of them at all.
Because these psychologists stupidly believe their ideas are “revolutionary”, we have chosen the oldest civilization we can find, to show that “DO NOTHINGNESS” is a stupid religion, and a stupid science, and actually not really a religion or a science, but forms today a pathetic rationalization for “neurotransmitter phobia”, a self imposed condition seen most commonly among behavioral psychologists who think CP patients don’t really hurt.
As we have said elsewhere, they all deserve gallons of Capsaicin, on a daily basis for about fifty years, or until they say, “I didn’t mean it. I am sorry” in which case we sentence them to all go get PhD’s in neurochemistry so they never perpetrate such a cruel hoax on society again.
Steven Hawking, the great mathematician, perhaps the brightest man of his time, contracted amyotrophic lateral sclerosis, and could move only his fingertips. Yet, in some unimaginable way, this freed him, as it were, to worry about fundamental truths of the universe. The clearest evidence of his rejection of stoicism and the fatalism which flows from it, came in the “postcards from the edge”. He said, “When your expectations are reduced to zero, you are really happy about what you do have”.
How is this not stoic? The answer is, that the stoic accepts the implacable declarations of fate, but the non-stoic does what can be done and counts it for the good.
After Carthage was destroyed by Rome in the last Punic war, the government died but the philosophy did not. Zeno, a Carthaginian is credited as the founder of Stoicism. The Phoenician way was made famous by the Greeks. Homer’s story of Troy concerned the abduction of Helen of Troy by Paris, a Phoenician. The Romans knew Homer as well, and they quoted from it, as they burned Carthage, after Hannibal failed to take Rome.
Carthage was defeated by the cruel Scipio, who repented at the moment of doing so, quoting from the Iliad. Two hundred years later in Rome, at the time of Virgil, Phoenician philosophy was positively the rage. This led to the worship of Baal and Tannit (another Phoenician god) at Roman altars. At Homs in Syria was the largest Roman temple dedicated to the Phoenician religion, where orgies continued. Zeno of Citium, the Phoenician who started Stoicism, did not believe in a personal god, but in a “remote ruler of life and nature”. As Gerhard Herm analyzed his ideas of god, “It was pointless to beseech him, pointless to depend on him–he was immovable fate itself…The stoic therefore concludes that he will gain nothing by living according to godly precepts, but only according to those of the intellect….The stoic ideal is inhuman and of such stern grandeur that is arouses the suspicion that behind it lurks Baal, who demanded children as sacrifices and expected them to be smilingly offered.” As a good stoic, Zeno starved himself to death when he was 38 years old.
Stoicism means resignation where suffering is concerned, with attention only to the self intellect. Why do we bring it up, only to condemn it. It is because this false, pagan religion of “do-nothing” is the prevalent dogma of certain psychologists regarding pain. A look at one modern text on psychology confined the role of the psychologist in treating the pain patient to “limiting the gain of the pain”. Of course, there is no gain in CP, only loss. The acquisition of unbearable burning, lancinating pains, kinesthetic dysesthesia, and visceral dysesthesia, is no gain at all. It is like calling day “night” and night “day”.
This is the purest stoicism, and its barbaric nature is as wrong as such ideas ever were. What happened to comforting the patient instead of “limiting the “gain”? We reject stoicism by whatever name, and choose instead the “do something” scientists who are aggressively identifying and analyzing the chemical cascade of pain chemistry.
We cannot think of any earthly good a “priest celebrating himself” could do in a pain clinic. We suggest the pain clinics either fire or reeducate all such individuals, who give vinegar to the thirsty, who give bitter, unripe fruit to the hungry, who sew seeds of sorrow where comfort is needed. We are grateful that this idea is not the predominant one, but we have zero tolerance for such mistreatment of patients. Central Pain is a disease, not some far out theological issue, and certainly NOT theatrics. We want it treated like any other disease and let the doctor keep his theology to himself, or else demonstrate its vitality by learning some neurochemistry and finding us a cure. A pox on stoicism in pain clinics.
And now we close this article somewhat incongruously with a sincere thank you to the psychiatrists who took care of us, and simply said to us, “It must be difficult. Would you like to talk about it”. We did not realize how lucky we were to have such care, until we read some of the articles now coming out in print. Surely these “discoverers” do not really believe what they are saying. If pressed, they would have to admit the obvious, that they really cannot measure pain, and therefore cannot tell if the patient is exaggerating or not. And we do notice their hesitation about picking up the syringe of Capsaicin. What if the patient is telling the truth? The therapist could then be both WRONG and in PAIN. “On second thought, maybe they will pass on the capsaicin”.