Pain is subjective. It is highly personal, different for every person. Hospitals have pain charts with number scales and facial expressions as indicators of pain for verbal and nonverbal patients. If you’re intubated (a breathing tube down your throat) you can’t speak. Though uncomfortable, you may or may not be medicated enough to experience pain. You will want a nonverbal pointing chart to tell your doctors to increase or change the meds. When people ask if getting tattoos hurt, I tell them no. Not really. But I know people who found getting their tattoos excruciating. Why? Pain is personal. It is this very subjectivity that confuses people when talking about sCAMs (Complimentary and Alternative Medicine). “Acupuncture took my pain away!” is a frequent anecdotal response. The data is clear – when done in a proper, double blinded study, acupuncture performs no better than placebo or sham acupuncture (twirling randomly placed toothpicks). Someone who practices acupuncture obviously doesn’t understand or care about modern medical practices (or more likely they willingly reject facts). If the practitioner believes in ancient magic (nonscientific), then they don’t necessarily understand or embrace germ theory (scientific). Why risk having them stick needles in your body if you get the same effect with toothpicks?
A good friend of mine had both of his legs broken when he was run over by a car. For personal reasons he didn’t want opiates or other narcotic painkillers in his recuperation, so he relied on a meditation practice he learned as a teenager. When he talks about what he used to mitigate his pain he says that white light healed him. When I go on the attack against sCAMs he is often the first person to point out his personal experience with acupuncture and meditation. He says that it healed him. What is very hard to teach is that healing is different than pain. The human body evolved a hardy immune system and a self-repairing mechanism that work very well. As such, the body itself does most of the healing. Pain is different. Pain creates stress, stress causes the release of cortisol by the adrenal gland, cortisol inhibits healing. If we can lessen pain we can create better conditions for the body to heal itself. Now, there are all sorts of things that the body can’t heal, or if interventions aren’t done will result in death. But as a general statement if those emergency interventions or stabilizing methods are successful the body repairs itself. Skin stitches back together. Organs resume function. Waste is processed, antibodies produced, white blood cells do their job, and so on. Pain has nothing to do with healing other than getting in or out of the way.
Accepting that this is how things work, “What’s the harm?” is the answer the believer gives to going to acupuncture, certain chiropractors, or other sCAM practitioners. There are a number of harmful things. The first harm is that because the modality is based on the placebo effect, if the treatment doesn’t work the practitioner blames the victim for its failure. Because there aren’t replicable mechanisms there isn’t any reason they will work. For most people just being talked to nicely and made comfortable is a way to mitigate chronic pain. It’s the failure of a lot of doctors that they do not have time or the inclination to listen to the needs of their patients. That’s bad bedside manner and diagnosis, not a failure of medicine. The sCAM practitioner comes from a background that teaches listening. The whole body approach is something often missing from modern medicine. But just because a practitioner lights some candles or spends a few minutes listening to the client detail their pain history is no reason to assume their modality is effective. The data shows it’s not. If the modality fails to have an effect the practitioner doesn’t know why, so it must be the patient’s fault. They should come back again and see how the next session goes. There’s a lot of money to be made in promising “maybe the next time will help”. And because there isn’t an actual mechanism at work the practitioner just keeps trying different guesses until the patient gives in, leaves, or convinces themselves it’s working. That is the placebo effect at work.
The second harm is that the sCAM practitioner believes that what they are doing is healing, as opposed to placebo effect to mitigate pain. This means that all too often you will find sCAMs being touted as a panacea. Take a look at a sCAM practitioner’s menu of cures. It’s amazing what they say it will fix. Some countries have laws about the language that can be used when making these claims so the advertisements are a careful dance around “cure” and “treat”. The rundown for acupuncturists, chiropractors and their ilk often looks like this: Low Back Pain, Headaches, Neck Pain, Shoulder Pain, IT Band Syndrome and Knee Pain, Shin Splints, Carpal Tunnel, Tennis and Golfers Elbow, Sciatica, Plantar Fascitis, Migraine, Digestive Pain, Poor Sleep, Obesity – the list goes on. What these things have in common are chronic pain that can be induced by repetitive motion, lack of physical strength or complimentary exercise, lifestyle choices, or completely subjective interpretations of pain and injury.
Let’s take migraine for example. A migraine is a specific neurological event with a cardiovascular component. There are drugs (tryptans) that only work if someone is in a classic migraine because these chemicals operate strictly upon brain chemistry. “Excedrin Migraine” is not an anti-migraine drug. It’s caffeine and acetaminophen. If taking Excedrin Migraine alleviates your headache, you weren’t having a migraine; you had a headache. However, caffeine is a vasoconstrictor, and a migraine can be the result of dilated capillaries. Dilated capillaries lead to headaches, which can trigger a migraine. It is possible that taking Excedrin can prevent a headache from becoming a migraine. Calling it a migraine formulation is misleading. Anyone who has experienced a full-blown classic migraine can tell you – an Excedrin isn’t going to cut it. Can acupuncture treat migraines? Only by a stretch of the imagination. If getting an acupuncture treatment helps you to relax, then sure, maybe it will prevent you from getting a migraine that day. An Excedrin is a hell of a lot cheaper and you know how it functions. Acupuncture? Not so much.
Obesity is another area with which I’m familiar. Obesity is more often than not the result of lifestyle choices. Chances are if an obese person goes to a sCAM practitioner they will be given some sort of “treatment” and told to adjust their diet. “Oh, you should cut out wheat and sugar because your Chi is blocked by those substances.” Well, no shit. Cut out wheat and sugar and you’re carving out most processed foods and high calorie items. This isn’t rocket science. Eat less, move more. The needle pricks at $150 a session aren’t the reason you’ll drop weight.
The confusion of magic and mechanism are a rot in the mind. This rot spreads into other areas of thinking like politics, religion, and lifestyle. I believe this rot leads to cognitive dissonance, the discomfort of holding two conflicting ideas at once. I had a friend with a deeply religious background who, for a time, believed in both the Adam and Eve bible story as literal truth and the evolution of man from primitive forms. She grew up taught that young earth creationism was true. As an adult she learned about evolutionary biology. But there were many years where these conflicting ideas battled in her mind and for some time there was a chimera of both realities existing at once. This is cognitive dissonance.
I believe in reason championing over magical thinking. I don’t think the way to convince people is to hammer them with facts and figures, statistics and data. We’ve seen time and again that people will reject facts when it doesn’t fit their worldview. Someone who believes that sticking needles into their skin somehow creates healing isn’t going to suddenly change their mind because they read a study showing it has the same effect as being poked with a toothpick. Instead, the key is to locate the source of their cognitive dissonance and amplifying that discomfort. For example – someone who believes in magical healing is probably likely to trust the scientific method unconsciously when it is a convenience. They may take aspirin, or a cholesterol-lowering drug. They use chemistry in their kitchen, or they use a cleanser product to clean their home. These are all things where we didn’t just stumble upon a method or solution. We discovered them, tested them, and re-tested them. The believer has drawn an arbitrary line somewhere in their mind and that line can slowly be moved. They move the line when asked to make a choice, and those choices are different for every person.
Science vs. belief is a false dichotomy; science is a process, not a belief system. I find most scientists to be more open minded because they are used to the strange feeling of new data reshaping their worldview. To be a scientist one must be open to new theories challenging held assumptions and, if proven, altering the field and their own work. (In fact, in order to earn their PhD scientists must, in a sense, alter their chosen field.) The science of sport has changed dramatically over the decades as new tools are developed. Witness the fundamental shift and achievements since the adoption of periodization. (And now digest the absurdity of the Church of Christ, Scientist, which does not believe sickness and death are real. Great magazine, dangerous and deadly belief system.)
Your personal experience is not a data point. Anecdotes aren’t facts. They are beliefs, they are memories, and they are flawed because you are human. In order to test something we must be able to isolate it and discover its mechanism. There must be a reason for change to occur. It’s even possible to see change without understanding the mechanism, but if it’s not replicable or falsifiable, it’s not real. Pain is real, but it is subjective. That is why it is an exploitable target for the con artists, frauds, and outright enemies of progress towards real treatment.
When I say that your pain means nothing to me, obviously I am lying. Your pain means everything to me, which is why I fight for evidence-based treatments that will stop pain – forever.