Oxymoron; treat pain by INDUCING MORE PAIN ?

Can Pain Be Used to Treat Pain?

www.painnewsnetwork.org/stories/2019/4/6/can-pain-be-used-to-treat-pain

“Can you cure pain with more pain?” was the provocative question posed last month by National Public Radio’s Invisibilia podcast, “The Fifth Vital Sign.”  

The show features the story of Devyn, a 16-year old former gymnast living with chronic pain. Devyn broke the end of her thighbone and required surgery, but the injury never fully healed and her pain was spreading. She was diagnosed with “amplified pain syndrome” and enrolled in a rehabilitation program for children at a Kansas City hospital that combines intense physical therapy with psychotherapy.

Put simply, Devyn was taught to ignore her pain by being exposed to more of it.

The resounding backlash from the chronic pain and illness community was swift and fierce, blowing up NPR’s social media feeds with charges of endorsing torture and demands to pull the episode. An apology for “triggering” pain patients from podcast hosts Hanna Rosen and Alix Spiegel served only to generate more ire.

NPR’s Public Editor, Elizabeth Jensen, stepped in on March 15, publishing an opinion piece that parsed individual points of contention while somehow missing the main one: Patients were outraged that NPR provided free publicity to treatment programs that put children in tremendous pain on purpose.   

The original pain rehabilitation program profiled in the Invisibilia podcast operates out of Children’s Hospital of Philadelphia. It is based on founder Dr. David Sherry’s belief that we do not accept pain as a natural part of life anymore. We focus too much attention on pain and try to eliminate it — often making it worse.  

Is there scientific evidence to support the theory that paying too much attention to pain causes it to spread elsewhere in the body? I couldn’t find any. I believe Sherry’s idea is just woo and bunk. Widely accepted pain research shows that once nerves are sensitized it takes less and less stimuli to create more severe and widespread pain. It is important to break that cycle and to treat the pain, before moving forward with physical therapy and other treatments.

Sherry’s program takes the opposite approach. It rests on the unproven idea that flooding the patient with pain will reset her brain’s response to pain. Take away the patient’s pain meds, force her to engage in many hours of hard exercise each day, subject her to other painful stimuli, and her brain will no longer process pain as dangerous. It will become bored with pain.

Would you want someone with such an extreme view of pain to be in charge of your pain management program? Would you want him in charge of your child’s pain management program?

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On March 20, the Society for Pediatric Pain Medicine weighed in with an open letter to Cara Tallo, Invisibilia’s Executive Producer:

“(We) are deeply concerned that your episode promotes the misconceptions around pediatric pain and undermines the diligent scientific discovery by scientists, doctors and clinicians over the past several decades.

Pain is NOT simply a matter of attention and psychological state of mind. It does not just respond to putting children in intense/more intense pain and teaching them to push through.

Instead, it requires a clear understanding of its complex nature and treating the physical, biological, and psychological issues carefully and simultaneously, in a delicate dance that sometimes may be harder in the beginning.”

The Invisibilia podcast followed Devyn as she participated in the pain program at Children’s Mercy Hospital in Kansas City, where the goal was “to put Devyn in as much pain as they possibly could.”

Devyn and other patients are told to jump in and out of a pool as fast as they can for five minutes straight. One of the girls struggles to swim and jump in and out because she’s lost the use of one side of her body. She is cut no slack.

During the podcast we hear Devyn’s trainer deny her asthma medication when she has trouble breathing. The trainer tells Devyn to stuff a tissue up her nose and continue to exercise even when she springs a nosebleed. We hear Devyn vomit from exertion. Apparently, exercising to the point of vomiting is common; there are barf bags set up around the gym. Devyn is told to “push through” no matter what. 

The girls who enter this rehabilitation program have, we’re told, completed extensive medical testing to rule out underlying medical problems. But people in the pain community know how often diagnoses are missed. It can take years to find a doctor who even knows what to look for. We know how much harm can be inflicted by inappropriate therapy. 

The program claims to have precautions in place so that patients with Ehlers-Danlos syndrome (EDS), a condition that causes fragile connective tissue and autonomic dysfunction, don’t injure themselves. Having EDS myself, I know that the essence of this program — pushing people through pain — is inappropriate for anyone with EDS.

I have personally met and have spoken online to other EDS patients who have been through Dr. Sherry’s program and emerged from it with more injuries and pain than they had when they began. There are even reports of people who have come out of his program with PTSD. It is easy to understand how that might happen. 

Even if these programs worked some of the time for some people, they are bound to harm others. Pain is complicated. We are only beginning to understand its mechanisms.

Attention is not a switch that can be turned on or off. Attention can take many forms. Attention can be nonjudgmental. It can be loving. It can be kind. It can be curious. It can be gentle. Choosing the proper form of attention to bring to your pain can be a tool for dealing effectively with it. Attention is not the blunt, malign force that the podcast describes.

We have lived through decades-long diagnostic delays while enduring brutal and futile treatments. We have been blamed for our symptoms only to discover they were beyond our control. We know how easy it is to harm, how difficult it is to heal, and how much the larger community wants simple solutions to our complex problems.

The backlash against NPR from the pain community was actually a plea to “First do no harm.” Programs that deny pain have permanently, irreparably harmed countless pain patients and chronically ill people. Don’t present them as solutions. We deserve better and children with widespread pain deserve better. 

16 Responses

  1. QUESTIONS:

    WHERE THE HELL IS THE DOJ WHEN THEY SHOULD HAVE STORMED IN ON THIS FACILITY YRS AGO?

    WHERE’S THE JCAH?

    DENYING ASTHMA TREATMENT? ASTHMATICS DIE EVERY DAY.
    UNtreated ASTHMATICS HAVE AN EVEN GREATER CHANCE OF DYING.

    ONLY A 94% SUCCESS TREATMENT RATE???? IM SURPRISED THE SUCESS IS NOT 100% TO END ALL PAIN. PERMANENTLY…AND FROM SUICIDE BY EVERY CPP ENTERINGTHE ” TREATMENT” CENTER.
    WELCOME TO THE HINGES OF HELL AND DEATH WISH CHAMBERS.

    THIS POOR CHILD. GOD BLESS HER . I’M SURE THE ” MENTAL HEALTH” SYSTEM WILL BLAME HER FOR SOME CHARACTER FLAW, DEPRESSION…AND SHE’LL JOIN THE RANKS OF ENDLESS NUMBERS, BEING BLAMED FOR BARBARIC PAIN SHE HAD ZILCH TO DO WITH CAUSING. HORRENDOUS. ATROCIOUS. I HOPE THIS CHILD GETS AS FAR AWAY FROM ALL WHO SUPPORTED AND IMPLEMENTED HER PAIN DONT GIVE A DAMN VOODOO “TREATMENTS” AS POSSIBLE…

  2. waitaminit…is this only for girls? If so…either the originators of the program are the most sadistic misogynists that ever lived, or they believe the old “females have a low pain threshold; males are tough enough” BS.

  3. I can guarantee this child is scarred for life because of this.

  4. What kind of person would place their child in the hands of these barbarians?

  5. I read an article about a girl who was put through this program and was absolutely horrified by the whole thing! Thank you to everyone who took a stand against this, evil is flourishing all around us.

  6. You can see how they are not even distantly happy until the very most stupidest thing comes out of their mouths.

  7. Thank you again Steve for an excellent piece!!
    I haven’t heard of this and, of course, will be sharing!

    I try very hard to keep my temper and not join in the chorus of ‘Those people need to bit a hit by a car’ and such, as I personally wouldn’t wish lasting harm on anyone.

    That said…I could live the uninitiated having to live with severe pain fpr a week or two.

    This is just further proof of the torture & bias we deal with from the uneducated, and healthy, general public.

    That poor child!! This breaks my heart.

  8. “During the podcast we hear Devyn’s trainer deny her asthma medication when she has trouble breathing. The trainer tells Devyn to stuff a tissue up her nose and continue to exercise even when she springs a nosebleed. We hear Devyn vomit from exertion. Apparently, exercising to the point of vomiting is common; there are barf bags set up around the gym. Devyn is told to “push through” no matter what.”

    This infuriates me, as it is pure child abuse. If a parent was to force their child to exercise until they puked (esp. several times) and denied asthma medication to their child who was having issues breathing, CPS would yank that child out of the house in a hot second. One of these days, they’re going to permanently injure or kill a child taking part of this sick, barbaric program. Karma …

  9. I am speechless,,,this is beyond cruelity,,,,it is demented,disturbing,,cruel,,bullying,,wtf is wrong w/these ,”type” of people who truly think obviously they have the right to torture children who can’t defend themselves,,then too lie on the data as if to justify it..Lets talk to those kids,,,,,where is the video????maryw

    • Mary, I’m right there with you. It’s pure child abuse. I don’t know what in the hell has happened to the compassion within society to even think about allowing this sick, barbaric treatment of innocent kids who are unlucky enough to already suffer.

  10. I want to see the long term follow up on these kids in 10-15 years. I bet most of them will develop Fibromyalgia. That’s the diagnosis I see given to patients who “kept going and ignored the signs.” I believe the longer you ignore your pain signals the more the brain assumes it’s not getting the message through, so it increases the intensity like jacking up a stereo to be louder… until you crash and can’t keep up and can’t ignore it anymore… which is when Fibromyalgia gets thrown on you… and again you’re told to suck it up and ignore it… and about 5-10 years later we see this group of patients start being diagnosed with autoimmune disorders and immune-mediated peripheral neuropathy. The bill always comes due, sadly for the patients, not their doctors who gave them bad advice and even worse treatment.

  11. I am horrified that anyone, even NPR, would consider this some kind of medical treatment. Military boot camp perhaps.. and they kill and maim a good percentage of inductees. The ones who don’t make it are out.. only the “good” survive.

  12. I saw a news story about this where they said they claimed, I think it was 94% or so people reported the program worked. There’s just no flipping way that high of a percentage worked. There’s not a medicine, therapy, or device in the universe that works that well for any condition, much less one as wildly varied & complex as pain. The only way I could figure out they got that high an effectiveness rate was by only counting the people who stayed in it the whole time b/c they thought it was helping, so basically you get them saying “94% of the people who said it worked said it worked.” Ya gotta feel sorry for the 6% who went all the way thru and it DIDN’T work. PTSD AND more pain…too bad, suckers.

    This truly is The Age of Sadism.

  13. Excellently written response. Thank you!!

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