I suppose an 80/20 version would be to just load some books and resources into an LLM's context and tell it to be a good therapist who implements this stuff. I haven't tried this myself though, and without the context I think Claude got some things wrong when it tried to recommend me exercises to do.
I'm not sure if they've been tested, but other anxiety meds (Duloxetine especially) have been. In the short run though, I wouldn't expect benzos to work much better than having a relaxed day in a good mood. It seems to take more time or at least some deeper changes in order to reduce the pain a lot.
Neuroplastic pain involves established neural circuits that persist even when anxiety is temporarily reduced. These pathways form over time and need retraining to resolve. It seems similar to how established habits don't disappear after one relaxed day for people who have compulsive habits due to anxiety.
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.
1The IASP's recognition of nociplastic pain was formed by a task force assembled for this purpose, which also changed the established official definition of the general concept of pain itself. https://www.iasp-pain.org/PublicationsNews/NewsDetail.aspx?ItemNumber=6862 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00392-5/abstract
now whenever that sensation comes back, I’m not worried. I just think, “yeah, I know this one,” and it fades.
That's exactly what happened for me right on the day of the biggest single step improvement I experienced for my tendon pain. Observing the sensation get worse and better again a few times in a row, while continuously standing, was closely associated with the decrease in worry and pain.
This is great context. Though there is a relevant difference: in this case the WHO's recognition of nociplastic pain was triggered by the International Association for the Study of Pain (IASP) recognizing it. The IASP is the leading global professional organization in pain research and medicine.
I've added a footnote to clarify this.
This is interesting. Though companies are probably investing a lot less into cyber capabilities than they invest into other domains like coding. Cyber is just less commercially interesting plus it can be misused and worry the government. And the domain specific investment should matter since most of the last year's progress has been from post training, which is often domain specific.
(I haven't read the whole post)
Good points here.
Btw I sometimes think back to how your 3y old comments on this post have aged well.
It seems likely that process supervision was used for o1. I'd be curious to what extent it addresses the concerns here, if a supervision model assesses that each reasoning step is correct, relevant, and human-understandable. Even with process supervision, o1 might give a final answer that essentially ignores the process or uses some self-prompting. But process supervision also feels helpful, especially when the supervising model is more human-like, similar to pre-o1 models.
I didn't know about the poor 'blinding' for the placebo. PRT is new and hasn't been replicated yet, but it does consist of components that have some broader backing. The first main element is pain neuroscience education, which seems to have various supporting studies going back for a longer time. The second is somatic tracking, a type of mindfulness approach. I haven't looked into it much, but I think I saw somewhere that similar/equivalent therapies have been tested for chronic pain elsewhere - though I'm not sure if they were tested to reduce pain or just helping people live with pain.