I think this diagnosis is an important and true option. (And thanks for the write-up!) However, I find myself deeply wishing the treatment was focused more on something objective, rather than “convincing” yourself the pain isn’t from real tissue damage—especially since the diagnosis is so probabilistic.
What happens if you are wrong about the tissue damage? My own experiences with chronic pain have in fact all come after what I am quite sure was real and significant tissue damage (one exception). And I have had numerous other experiences in sports of assuming some small-to-medium pain was not significant tissue damage, then playing through it and aggravating it in ways I believe were also real tissue damage. There are also borderline cases—like right now, I feel moderately sure my knee should have healed from its injury long ago and the existing pain is “learned” in some sense, but also it literally swells up when I use it. So I’m guessing it’s more learned at the scale of the knee and not at the scale of the spinal cord/brain? Regardless, seems really important to be able to tell which is which, rather than just deciding to treat it one way and hoping you’re right!
A second big reason I wish it was more objective is that the subjective nature of the intervention seems very tangled. In particular, if fear is a problem, it can then be very easy to have an anxiety/fear response to having the fear, which obviously gets tricky quickly. (As well as the difficulties of talking about the fact that I don’t literally experience fear or anxiety at the pain, it’s more like some tiny nearly-unconscious fragments of concern/monitoring/flinching/protecting that are similar scaled-down reactions as one would have with fear.) Or, background stress in life that would have felt fine suddenly becomes stressful. And the belief barrier framed this way makes it seem like the default affordance is a weird self-coercion into believing something you don’t believe.
I think I’ll be leaning as far as possible toward objective treatments, to provide myself some grounding and minimize the tangledness. Seems like these mostly track the “traditional medical treatments” you discuss above. So e.g. PT and building strength/mobility back up is a clear win in both tissue damage and no-damage cases (and you can be a little more aggressive if you expect there isn’t damage). Capsaicin, NSAIDs, etc also seem pretty good in both cases. Some parts of the threat reprocessing, like actively engaging with the pain, seem robustly good if you’re focusing more on curiosity and less on convincing yourself it’s fine.
But also, maybe I’m too anti-coercion, that’s why I still have a bit of chronic pain, and if I just believed hard enough then I’d get over it.
I think this diagnosis is an important and true option. (And thanks for the write-up!) However, I find myself deeply wishing the treatment was focused more on something objective, rather than “convincing” yourself the pain isn’t from real tissue damage—especially since the diagnosis is so probabilistic.
What happens if you are wrong about the tissue damage? My own experiences with chronic pain have in fact all come after what I am quite sure was real and significant tissue damage (one exception). And I have had numerous other experiences in sports of assuming some small-to-medium pain was not significant tissue damage, then playing through it and aggravating it in ways I believe were also real tissue damage. There are also borderline cases—like right now, I feel moderately sure my knee should have healed from its injury long ago and the existing pain is “learned” in some sense, but also it literally swells up when I use it. So I’m guessing it’s more learned at the scale of the knee and not at the scale of the spinal cord/brain? Regardless, seems really important to be able to tell which is which, rather than just deciding to treat it one way and hoping you’re right!
A second big reason I wish it was more objective is that the subjective nature of the intervention seems very tangled. In particular, if fear is a problem, it can then be very easy to have an anxiety/fear response to having the fear, which obviously gets tricky quickly. (As well as the difficulties of talking about the fact that I don’t literally experience fear or anxiety at the pain, it’s more like some tiny nearly-unconscious fragments of concern/monitoring/flinching/protecting that are similar scaled-down reactions as one would have with fear.) Or, background stress in life that would have felt fine suddenly becomes stressful. And the belief barrier framed this way makes it seem like the default affordance is a weird self-coercion into believing something you don’t believe.
I think I’ll be leaning as far as possible toward objective treatments, to provide myself some grounding and minimize the tangledness. Seems like these mostly track the “traditional medical treatments” you discuss above. So e.g. PT and building strength/mobility back up is a clear win in both tissue damage and no-damage cases (and you can be a little more aggressive if you expect there isn’t damage). Capsaicin, NSAIDs, etc also seem pretty good in both cases. Some parts of the threat reprocessing, like actively engaging with the pain, seem robustly good if you’re focusing more on curiosity and less on convincing yourself it’s fine.
But also, maybe I’m too anti-coercion, that’s why I still have a bit of chronic pain, and if I just believed hard enough then I’d get over it.