Thread by @prof_goldberg

I've been studying chronic pain for going on 15 years now. I have some thoughts on this, many of which I've articulated elsewhere and for some time now:

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The Quiet Scientific Revolution That May Solve Chronic Pain nytimes.com/2021/11/09/wel…

The headline and the article fundamentally misconstrues the primary causes of the devastating and highly inequitable undertreatment of pain in the US (and globally, but that's another conversation).

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The primary causes for our failures in treating people in pain humanely and effectively are not connected to lack of technical, clinical, or scientific knowledge.

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If we stopped all pain research today, we have all the tools we need to substantially ameliorate most of the pain that most people suffer.

Our failures in treating people in pain are not even mostly a function of scientific or clinical ignorance.

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The reasons why we fail to treat people in pain humanely, equitably, and effectively have everything to do with our attitudes, practices, and beliefs towards people in pain. They are a produce of what David Morris called "cultures of pain."

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Please do not misunderstand me. I welcome any and all therapeutic advances that can help people in pain. But there is overwhelming evidence that we fail people in pain because of how we stigmatize and invalidate their experiences.

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We treat pain so poorly because of its subjectivity, and our insistence in the West on objectifying illness experiences according to the iron rule of the anatomoclinical method (#ClinicalGaze).

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We treat pain so poorly because of all sorts of structural violence and oppressions, e.g., racism, sexism, ableism, and ageism. We do not have such terrible racial and gender inequalities in effective pain Tx b/c we didn't fully u-stand the role of glial cells.

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We treat pain so poorly because we systematically invalidate and subject people in pain to profound #EpistemicInjustice. We accuse them of #Malingering. We strip all social policies and supports away from disabled people in general, incl. people in pain.

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Our laws and policies intensify stigma against people in pain. This is not because policymakers do not fully appreciate the role of glial cells in mediating pain.

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The major issue here is that conceptualizing the root causes of our failures in treating people in pain humanely and effectively on the physiologic and molecular level suggests that as the priority level for intervention.

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This is #medicalization and #MethodologicalIndividualism to boot. We don't need to fix our oppressive and stigmatizing structures, laws, and institutions. We just need better drugs that individuals can take.

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This is a dangerous mistake we have repeatedly made, a category error that has contributed to an epidemiologic situation in which chronic pain is arguably worse than it has been. More people are suffering. Inequalities are expanding.

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Finally, this category error also conceptualizes pain purely as a clinical prob. It IS a clinical prob. But pain is also a public health problem, and I have been begging anyone, everyone, to think about what we might do differently by regarding pain as a public health prob.

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We would attend to the structural determinants driving prevalence and incidence of pain, as well as inequities in that distribution along social strata like race, class, gender, and age.

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This is one of my mantras: "Health is a social problem, not a technical one. It will be solved socially and politically, or not at all." This is absolutely, 100% true for chronic pain.

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#ChronicPain #PainStudies #PainStigma #StructuralStigma #PainIsAPublicHealthProblem #PHEthx #PHLaw #Disability #PainStudies #DisHist #StructuralStigma #StigmaStudies #ScholarTeacher

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cc @national_pain