I haven’t looked into this literature, but it sounds remarkably similar to the literature of cognitive behavioral therapy and graded exercise therapy for ME/CFS (also sometimes referred to as ‘chronic fatigue syndrome’). I can imagine this being different for pain which could be under more direct neurological control.
Pretty much universally, this research was of low to very low quality. For example, using overly broad inclusion criteria such that many patients did not have the core symptom of ME/CFS, and only reporting subjective scores (which tend to improve) while not reporting objective scores. These treatments are also pretty much impossible to blind. Non-blinding + subjective self-report is a pretty bad combination. This, plus the general amount of bad research practices in science, gives me a skeptical prior.
Regarding the value of anecdotes—over the past couple of years as ME/CFS patient (presumably from covid) I’ve seen remission anecdotes for everything under the sun. They’re generally met with enthusiasm and a wave of people trying it, with ~no one being able te replicate it. I suspect that “I cured my condition X psychologically” is often a more prevalent story because 1) it’s tried so often, and 2) it’s an especially viral meme. Not because it has a higher succes rate than a random supplement. The reality is that spontaneous remission for any condition seems not extremely unlikely, and it’s actually very hard to trace effects to causes (which is why even for effective drugs, we need large-scale highly rigorous trials).
Lastly, ignoring symptoms can be pretty dangerous so I recommend caution with the approach and approach is like you would any other experimental treatment.
Interesting to know more about the CFS literature here. Like you, I haven’t found as much good research on it, at least with a quick search. (Though there’s at least one pretty canonical reference connecting chronic fatigue and nociplastic pain FWIW.)
The research on neuroplastic pain seems to have a stronger evidence base. For example, some studies have ‘very large’ effect sizes (compared to placebo), publications with thousands of citations or in top tier journals, official recognition by the leading scientific body on pain research (IASP), and key note talks at the mainstream academic conferences on pain research.
Spontaneous healing and placebo effects happen all the time of course. But in the cases I know, it was often very unlikely to happen at the exact time of treatment. Clear improvement was often timed precisely to the day, hour or even minute of treatments. In my case, a single psychotherapy session brought me from ~25% to ~85% improvement for leg pain, in both knees at once, after it lasted for years. Similar things happened with other pains in a short amount of time after they lasted for between 4 to 30 months.
> Lastly, ignoring symptoms can be pretty dangerous so I recommend caution with the approach
I also fear that knowing about neuroplastic pain will lead certain types of people to ignore physical problems and suffer serious damage.
For what it’s worth, ME/CFS (a disease/cluster of specific symptoms) is quite different from idiopathic chronic fatigue (a single symptom). Confusing the two is one of the major issues in the literature. Many people with ME/CFS, like I, don’t even have ‘feeling tired’ as a symptom. Which is why I avoid the term CFS.
I haven’t looked into this literature, but it sounds remarkably similar to the literature of cognitive behavioral therapy and graded exercise therapy for ME/CFS (also sometimes referred to as ‘chronic fatigue syndrome’). I can imagine this being different for pain which could be under more direct neurological control.
Pretty much universally, this research was of low to very low quality. For example, using overly broad inclusion criteria such that many patients did not have the core symptom of ME/CFS, and only reporting subjective scores (which tend to improve) while not reporting objective scores. These treatments are also pretty much impossible to blind. Non-blinding + subjective self-report is a pretty bad combination. This, plus the general amount of bad research practices in science, gives me a skeptical prior.
Regarding the value of anecdotes—over the past couple of years as ME/CFS patient (presumably from covid) I’ve seen remission anecdotes for everything under the sun. They’re generally met with enthusiasm and a wave of people trying it, with ~no one being able te replicate it. I suspect that “I cured my condition X psychologically” is often a more prevalent story because 1) it’s tried so often, and 2) it’s an especially viral meme. Not because it has a higher succes rate than a random supplement. The reality is that spontaneous remission for any condition seems not extremely unlikely, and it’s actually very hard to trace effects to causes (which is why even for effective drugs, we need large-scale highly rigorous trials).
Lastly, ignoring symptoms can be pretty dangerous so I recommend caution with the approach and approach is like you would any other experimental treatment.
Interesting to know more about the CFS literature here. Like you, I haven’t found as much good research on it, at least with a quick search. (Though there’s at least one pretty canonical reference connecting chronic fatigue and nociplastic pain FWIW.)
The research on neuroplastic pain seems to have a stronger evidence base. For example, some studies have ‘very large’ effect sizes (compared to placebo), publications with thousands of citations or in top tier journals, official recognition by the leading scientific body on pain research (IASP), and key note talks at the mainstream academic conferences on pain research.
Spontaneous healing and placebo effects happen all the time of course. But in the cases I know, it was often very unlikely to happen at the exact time of treatment. Clear improvement was often timed precisely to the day, hour or even minute of treatments. In my case, a single psychotherapy session brought me from ~25% to ~85% improvement for leg pain, in both knees at once, after it lasted for years. Similar things happened with other pains in a short amount of time after they lasted for between 4 to 30 months.
> Lastly, ignoring symptoms can be pretty dangerous so I recommend caution with the approach
I also fear that knowing about neuroplastic pain will lead certain types of people to ignore physical problems and suffer serious damage.
That’s good to know.
For what it’s worth, ME/CFS (a disease/cluster of specific symptoms) is quite different from idiopathic chronic fatigue (a single symptom). Confusing the two is one of the major issues in the literature. Many people with ME/CFS, like I, don’t even have ‘feeling tired’ as a symptom. Which is why I avoid the term CFS.