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Explain Pain cited evidence – ref#6

Imagined movements cause pain and swelling in a patient with complex regional pain syndrome

Moseley, G.L. (2004), Neurology 62: 1644

Again, the full text is behind a paywall. Again, I can’t afford to buy it, poverty and all that.  And again, I say, FFS, if you’re going to use this as evidence that your method of treating chronic pain works, I do rather believe you should make the evidence available publicly!

This one costs $39.  That’s $58 in Aussie dollars.

Yes, it’s been a long day of (trying to) read evidence that pain education reduces pain…I’m tired. And cranky.  And am seeing the same issues, over and over again. 

It reminds me that the ‘haves’ are the ones with the power and I am most definitely a ‘have not’.  This is because I became seriously ill and disabled and I cannot work to support myself. I live on disability support and that is well under the poverty line. Which is no fun. I did not choose this, or cause my disease or pain. This is just how my life turned out, through no fault of my own. And that is not a fun thought, or very comfortable. However, that thought does not increase my pain. So let’s get back to the point…

This one is different!  This one sounds really cool!  And interesting.  But, even before reading it, the title (again) gives the game away:  “Patient”. Singular. This is a case study. A sample of one.  One patient’s experience.  Anecdotal, you might say.  So, as evidence goes, its more ‘interesting’ than ‘robust!’.

And for science to stand up, for it to get the point of being evidence for anything, it needs to be repeatable.  Is this repeatable?  Did they try?  Is this lady the only lady who can think about moving her hand and have it swell up, with out actually moving it?  Yes? No?

I would think that if Lorimer and Butler were really interested in providing ‘robust’ evidence, they would have done more study around this.  They would have repeated it.  Firstly, they would have repeated the experiment with this woman, to see if her hand always swells up when she thinks about moving it (but doesn’t actually move it).  They would have tried to nail down the causes, which poses and positions caused swelling. And do they correlate to the poses and positions that cause swelling IF she actually moved her hand into those positions, in real life, as it were?

Then they should have tried it out on other people, to see how common an effect this is.  Is this woman a rarity, or is this common in people with CRPS1.  What about CRPS2?  Does it happen there too?  And then on normal controls.  Can (some or all) normal people think about moving their hands into various positions and poses, and do they experience pain and swelling afterwards?

Which brings me to my next question. How long after imagining these positions did the swelling occur? Was it immediate or delayed?  Are they sure that the imaginings caused the swelling and pain?  How are they sure?  I mean, pain and swelling are a pretty big part of CRPS1.  Doesn’t she pretty much always have pain and swelling? 

I’m sure all that info is in the full case report. Alas, I cannot read it.

If this woman is the only woman who can make her hand swell by thinking about movement, well, then she’s a party trick. Sadly for her, not really a marketable skill. Sadly for Moseley and Butler, not really evidence of anything.

Also, does the fact that thinking about movement have anything to do with explaining pain reducing pain?  I don’t really see a strong connection there. One is an imagining movement causing swelling and pain.  Which is kinda the opposite of pain education reducine pain and disability.  Just because imagining one thing causes oain and swelling, does not mean that learning another thing can reduce pain and disability.  They do not relate to eachother at all.

I guess it IS evidence that one person’s thoughts can have a physical effect on her body. But its then a very long bow to draw to say that this means that everyone who has pain neuroscience explained to them experiences a reduction in pain and disability.

And that’s what they ARE claiming.

So, no. Fail.  This is not evidence that pain education reduces pain.

That’s 6 for 6.  We are halfway through the initial references and not one of these studies, so far, has provided a lick of evidence that pain education reduces pain and disability.

I’m not a scientist. Just a curious, interested person who’s been on the planet for a few decades. I have experienced a lot of pain in my life, more than most.  Much more than most. And so I have a very personal, very vested interest in this stuff.

I’m not trying to pretend I’m a scientist. I’m not saying “look at me, I’m smarter than lorimer and al those other scientists!” Nope.  Not saying that.  I’m just a person. Asking some pretty logical questions, I believe. I just want the evidence explained to me, because I’m not seeing it.

And given that a small group of people have made a fortune out of treatments that don’t work and that a lot of [people living with severe daily pain have intensely suffered because of this, I think these questions are fair to ask and should be answered.  If it takes a bit of sass and sarcasm, so be it.  Lorimer has a great sense of humour, I’m sure he won’t mind. He’ll see the funs. 

But the fact remains that these questions should have been answered long before anyone published this, or the seminars and webinars and trainings and ALL the rest of it was unleashed.  Because people have suffered. A great deal.  And I will get to that. How Explain Pain has caused incredibly harm to people living with severe pain.

and AHHHhhhh feck! I forgot to give you the ‘study’ info. Here ’tis:

Complex regional pain syndrome type 1 (CRPS1) is characterized by pain, swelling, and sudomotor and motor dysfunction. The affected limb is exquisitely sensitive, and gentle movements can exacerbate symptoms. Local or spinal mechanisms, or both, may mediate symptoms, including pain. Evidence of altered sensorimotor processing suggests that symptoms may also be mediated by cortical mechanisms.1 This clinical note reports on findings from one patient with CRPS1 in whom imagined movement of the affected limb, without local muscle activity or movement, increased pain and swelling.

Case report.
A woman aged 34 years sought treatment for CRPS1 of the left hand 17 months after an uncomplicated wrist fracture. Management involved performance of a motor imagery task in which she was shown 56 pictures of a hand in various postures (28 left hands and 28 right hands) and was required to imagine adopting the hand posture shown without moving her hand. After performing the task, the patient reported increased pain and swelling in the affected limb. …

Yep. I know. Not much there.  But I can’t read the rest, so all I can do is pose questions, then may be answered in the full case study.  Guess I’ll have to put up a GoFundMe to read ‘the evidence’.

Author: PsychosomaticAddict

Chronic Pain Patient Advocate. Pain Coach. Patient. Living with High Impact Chronic Pain and advocating for proper pain treatment, including opioids where appropriate. Busting the myths. Exposing the actual science.


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