Learned pain as a leading cause of chronic pain
Epistemic status: Amateur synthesis of medical research that is still recent but now established enough to make it into modern medical textbooks. Some specific claims vary in evidence strength. I’ve spent ~20-30 hours studying the literature and treatment approaches, which were very effective for me. Disclaimer: I'm not a medical professional. This information is educational only, not medical advice. Consult healthcare providers for medical conditions. Key claims This post builds on previous discussions about the fear-pain cycle and learned chronic pain. The post adds the following claims: 1. Neuroplastic pain - pain learned by the brain (and/or spinal cord) - is a well-evidenced phenomenon and widely accepted in modern medical research (very high confidence). 2. It explains many forms of chronic pain previously attributed to structural causes - not just wrist pain and back pain (high confidence). Other conditions include everything from pain in the knees, pelvis, bowels, neck, and the brain itself (headaches). Some practitioners also treat chronic fatigue (inc. Long-COVID), dizziness and nausea in a similar way but I haven't dug into this. 3. It may be one of the most common or even the single most common cause of chronic pain (moderate confidence). 4. There are increasingly useful resources, studied treatments with very large reported effect size, and trained practitioners. 5. Doctors are often unaware that neuroplastic pain exists because the research is recent and not their specialty. They often attribute it to tissue damage or structural causes like minor findings in medical imaging and biomechanical or blood diagnostics, which often fuels the fear-pain cycle. My personal experience with with chronic pains and sudden relief My first chronic pain developed in the tendons behind my knee after running. Initially manageable, it progressed until I couldn't stand or walk for more than a few minutes without triggering days of pain. Medical examinations reve
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.