Body mapping study suggests chronic pain comes in nine distinct types

https://www.sciencealert.com/large-body-map-study-suggests-chronic-pain-comes-in-9-distinct-types

by lnyan • 5 years ago

172 54 5 years ago

dade_7• 5 years ago

At the time Covid lockdown started, my entire foot had become inflamed, and I couldn’t walk on it. It’s happened before, doctors, physiotherapists and immune specialists couldn’t find a disease or condition to blame it on. They could only offer pain killers and anti-inflammatory meds. It passed, as it has before. One thought was overuse, or some reinjury from the past.

I happened to find a personal trainer that was educated by osteopaths and the last year with him has been shocking. In my mind, I didn’t have any pain issues, though some areas were stiff, getting things from lower cabinets was becoming a chore, and the end of the day at work the back of my head and neck would get stiff. A cocktail or beer could solve the latter.

It has been over a year of discoveries. It turns out, muscles all over my body were very tight, for whatever reason, many major movements were no longer using the major muscle, but instead the brain had recruited minor muscles for the movement - perhaps a compensation for a past injury. I’ve learned that I have psoas muscles, and how to use them (though that journey continues) and that pinching feeling in my hip no longer happens when I am sitting.

I was already aware that so many things happen in our bodies that we aren’t conscious of, but the depth of it now astounds me. First, I did have pain and problems, but I had somehow shut off awareness. Second, all of those problems were being still having the effect of making me feel tired and worn down. Third, all of these compensatory movements that the brain does all by itself were probably great for simple survival because they allow us to keep going even though the best way to move is lost. Thing is, the brain doesn’t seem to have an automatic ‘service restoration to primary’. We have to do it consciously, intentionally, and with practice.

Pain is in the mind. There can be pain where there is no physical problem, and there can be no pain where there is a serious problem, but there can also be pain because we have lost awareness of our body and so pain manifests all over the place. There is an idea that the mind and body are separate, this is wrong and the idea needs to be burned with fire. Until then, people will continue fighting with these phantoms. We can group pain together, slice it apart, but I think that in many cases there isn’t much more to learn from pain, except that in many cases it is a symptom of a body trying to communicate to a mind that stopped paying attention.

elric3• 5 years ago

It's fascinating, isn't it? It's also frustrating. You see a doctor because something hurts, they look at the something -- often in isolation -- and if they can't figure it out, you're pretty much on your own.

I had constant foot pain in one foot for nearly a year. Doctors told me to rest. I walk a lot, and walking less wasn't really an option. Saw an osteopath, with more than a healthy dose of skepticism. They gave me exercises which were both baffling and ridiculous, which basically taught me how to use my big toes, then graduated to strengthening those muscles. At some point during this process, the pain went away, and it hasn't come back. Why couldn't my doctor identify this apparent muscle weakness in my foot? I don't know. But I'm glad the osteopath did.

bishoprook2• 5 years ago

You see a doctor because something hurts, they look at the something -- often in isolation -- and if they can't figure it out, you're pretty much on your own.

A quick Old Man(tm) rant.

Concerning healthcare, you have to be your own project manager. They're a lot better at curing things they can see (ie. surgery), GPs have crude tools for analysis and mostly serve as gatekeepers to specialists and pharmacists. Also, GPs work mostly from flow charts and you are just one of 1000 patients they see that year. Communications between hospital departments, independent contractors like specialists or ER personnel, GPs, etc. are poor. Continuously audit procedures and drug regimes. Sci-Hub is your friend but don't overestimate the value of studies.

nradov• 5 years ago

If something hurts then why should the default reaction be to see a doctor? It makes more sense to start with a trainer or physical therapist first. Then if you're not seeing improvement after a few weeks move up the continuum of care to a physician and investigate medical treatments. We can't fairly criticize doctors for not knowing absolutely everything about the human body.

dade_7• 5 years ago

Ha! Exactly that, he has named all of his exercise with humorous names.

Worst result is the referral to a podiatrist for expensive insoles that IMHO are snake oil. Huge waste of time and money. It turned out that the primary problem they were trying to fix was an issue with glute activation, nothing to do with the foot itself.

xyzzy21• 5 years ago

Doctors tend to be shockingly "analytic" and siloed in how they approach things. Easily 99% in my experience. Problem: the human body is a system rather than a "bag of parts"!

If they know bones, everything is caused by bones. It's a variant of "if your only tool is a hammer, every problem looks like a nail". Each specialization has only one tool: a hammer or screwdriver, etc. and that's the only lens most have.

None know how to holistically look at things or, for example, consider that bones are connected to tendons to muscles so all three are likely to be involved in certain common pathologies.

The other issue I have with most: they are both shallow and gullible AF. It's far too easy to "suggest" an ailment and get them to only focus on that. Objectivity is not part of their methods in my experience. That does not build trust either.

So both of these combined to create a lot of "cookbook medicine" - like the old pizza commercial: "I go to the fridge and get the box!" which is everything they do.

At least in America.

I've had better experiences with doctors overseas sometimes. Not always but sometimes concierge/resort medicine does better. More time. More focus.

theNJR2• 5 years ago

How did you find your personal trainer?

I have a chronic neck pinch, coming from a weak lower trap (I think), that I’d love to fix. I make it worse multiple times a year from lifting and have to take at least a week off the gym.

I bet I am doing what you did with using the wrong muscle.

Tagbert• 5 years ago

I’d suggest starting with a physical therapist. They are trained to look at you whole body and how it moves and suggest exercises to address issues.

A good trainer might have this kind of outlook and training but most don’t.

dade_7• 5 years ago

I was stuck on my couch and fed up so I kept searching the web until I found someone that could help. He had an amazing website which is very unusual for small businesses. It described an experience of having our fitness achievements and habits disrupted by injury. The frustrations of traditional physio, but also the importance of integrating training to accelerate healing instead of avoiding the area. It resonated with me, I called him and learned more.

The part I like the most is that I have a bunch of solutions for my problems. I don't need to call him, he taught me what I need to do.

meroes• 5 years ago

I've had a similar experience in Covid with muscle tightness. It's unbelievable how much our bodies compensate.

It started with a muscle injury to my upper back. Well to heal it, unbeknownst to my conscious awareness, almost an entire half of my body tightened to allow that one area to heal. Like you said it's as if whole sections of my muscles were numb as well, and only after repeated stretching did I "activate" those dormant areas.

And it took being in a very calm and relaxed state (not trivial to do with tightness and/or pain) to "sense" these areas and being stretching them out. Turns out I had to find stretches for all the way down to my big toe to the top of my head and everything in between.

The lessons of body to mind are overflowing suffice to say.

wpietri• 5 years ago

This definitely resonates for me.

Like many developers, I grew up thinking of my body more as a tedious, irritating burden; the whole brain-in-a-jar/live-in-the-matrix thing seemed kinda appealing. So I was proud of how long I could spend coding or reading and ignoring my body. That gave me a lot of bad habits.

Then I made a friend who's a yoga teacher. Out of curiosity I started attending some of her classes. In her yoga tradition, the root purpose of yoga is to free the mind for meditation. That really resonated for me. Instead of ignoring my body, I could work with it to do better at the things that mattered to me.

In the years since, I've come to think of my previous relationship to my body as like somebody running a large software system with poor instrumentation and observability. Somebody who ignored monitoring alerts until there was downtime. In that framing, I could see it as obviously the wrong approach. That instead I needed to pay attention, take care of maintenance, debug problems, and generally to understand and improve the system over time. Especially as I get older, it really pays off. My only regret is not starting sooner.

dade_7• 5 years ago

I was reading up on improving my rock climbing skills / movement, and a book about better movement was directly mentioned. Looking back, it was what started me down this journey. Being stuck on the couch in searing pain finally pushed me to make the investment of time and money.

https://www.goodreads.com/book/show/22847203-a-guide-to-bett...

maxerickson• 5 years ago

Was CRPS mentioned as a possibility?

dade_7• 5 years ago

No, and thank you for the suggestion. I've never heard of it, but I had more than half of the symptoms listed on the Mayo clinic website. It exactly describes my experience and also the words of my many baffled practitioners. It was a response completely out of line to any possible injury. Pure agony. Doesn't look like there are cut and dry answers, but I'll look into it further. Thanks again.

void_mint3• 5 years ago

Pain is in the mind. There can be pain where there is no physical problem, and there can be no pain where there is a serious problem

My left shoulder was mostly unusable after a subaccromial decompression surgery that was meant to make the shoulder less-unusable. Doctors told me to see PT, PT had me do the same waste-of-time banded pull aparts and subscap work. Imaging suggested there wasn't a structural problem and PT never really listened to anything I had to say. So, as do most, I stopped going.

Eventually I got tired of being immobilized and I just started doing what I wanted to do. I lifted weights and just clenched my teeth during the periods of extreme pain during various movements. Lo and behold, the issue was mostly related to lots of muscles being very weak from the changes in movement patterns to accommodate the extreme pain. None of the PTs allowed me to do any movements other than rotator cuff band work. Bench pressing for 2 weeks had me largely out of pain.

The state of doctors/phsyiotherapists/physical therapy is a joke. At this point I would consult a bullshit crossfit box owner before going to a doctor for movement deficiencies.

dade_7• 5 years ago

My rotator cuff was also on the list of problems. We used the bands, but also a squash ball and rolled out the 4 muscles. Lie down on it with your arm pointing upward for the rear one. On your side under your arm pit for lower, between your pec and shoulder for the front and think of a bull with the ball between your shoulder and the wall.

It is one of my favourites because shoulder pain is so annoying to reach, and all it took was a simple ball. Lots of sites on the Internet have better detail on the steps, but releasing tight muscles can work wonders.

justicezyx• 5 years ago

That's when traditional medicine like traditional Chinese medicine come to be helpful. Although traditional Chinese medicine lacks preciseness and reasoning of the modern medicine, they possess a truly whole body methodology of treating ailment and diseases.

It's under major criticism nowadays, although mostly for the wrong reasons. Because like so many once beloved and respected professions, they become the unfortunate prey of the capitalism frenzy and being used as the tool for profit.

Practitioners now use the inherent fuzziness to hide their ignorance. Putting the ineffectiveness of their treatment on some seemingly plausible "theory" that was never proclaimed by their ancient predecessor.

Even worse, the herbs used in traditional Chinese medicine are now toxicated by the industrial wastes grow into the soil. Merchants are now more than happy to adopt modern agriculture techniques to improve their quantity and cases nothing about the effectiveness.

Alas, sadness is now upon the ones who truly see and feel the greatness of the traditional Chinese medicine.

agumonkey2• 5 years ago

it's partly why I think physical exercise and education should be mandatory with a focus on higher performance floor and well being.

It's like your car.. if one part fails the system will compensate globally by absorbing the issue in every possible way but it leads to what you had. Tiny issues spread everywhere. When you restore balance your life gets so much easier.

yosito• 5 years ago

Better title: study picks 9 categories and assigns chroinic pains to one of those categories, proving that data can be sorted into arbitrary categories.

refactor_master• 5 years ago

The agglomeration method that we adopt is Ward’s method, which aims to min- imize the total within-cluster variance. At each step in Ward’s method, the algorithm finds two clusters that will result in minimum increase in total within-cluster variance after fusing. The number of clusters was narrowed by cluster size and similarity to 9 total groups through review of dendrograms and heat maps by non-clinician investigators (A.G. and N.A.).

1. Pick an algorithm.

2. Get a number of clusters. Preferably below 10, because otherwise it gets too messy for publication.

3. Justify algorithm based on its first paragraph on Wikipedia.

IshKebab• 5 years ago

"study suggests height comes in 9 distinct types!"

specialist2• 5 years ago

I'm much more enthusiastic. (see other comment)

More over, picking new categories is a great application of "big data".

Real example:

Imagine catalog for fashion retailer. Time to add color picker & filter. No agreement on color names, how many shades of gray, etc.

So one of our big data gurus figures it out. Gather dozens of palettes. Social cognition style guessing game. Slice & dice our product catalog 100s of ways to get best fit.

Result was a thing of beauty. Truly novel. The analysis worthy of a PhD.

DaveSapien• 5 years ago

Yes, this!

I am by no means an expert, but I have spent time and experience enough with chronic pain to state that this rather one dimensional. Meaning their group although big was narrow in scope. For example, no chronic head pain? We have been working on a VR body mapping app(https://www.hatsumivr.com/), I'm the art lead on it. And you quickly find that there is an ocean if different experiences out there, and thats probably the biggest obstacle to helping people with chronic pain. Its is often treated (at the policy level) as one condition with a select few options for treatment. Studies with conclusion like this reinforce a reductionism in medical spaces and leave the people that don't fit into their pidgin holes out in the cold, alone, and in pain.

chrisdhoover• 5 years ago

As I suffer from relentless chronic pain, I was hoping to read something insightful. What I saw might as well been on reddit/r/coolguides. Your post gave me a chuckle.

specialist2• 5 years ago

I'm excited to adopt these new categories.

Discussing pain with my care providers is very suboptimal.

The 9 categories from this OC are far superior to our respective current vocabularies.

martini333• 5 years ago

Nothing about headache or migraine...

mxd3• 5 years ago

Yeah, it's odd to see that omitted, especially for headaches that are related to muscle and joint issues.

syockit• 5 years ago

Was about to comment the same. I had a severe headache this week, the second headache episode for this year. It's not chronic so it's off-topic, but I was wondering if the reason headaches are not catalogued here is because pain management clinics don't handle them.

arpa2• 5 years ago

This is probably due to their definition of chronic, as migraines and headaches are usually episodic.

tuatoru• 5 years ago

Or trigeminal nerve pain.

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Educat...

binarymax• 5 years ago

For anyone suffering from Type A or Type C, I urge you to check if you have LSTV (Lumbosacral Transitional Vertebrae). It is estimated to effect 12% of the population.

This diagnosis (only 6 months ago) got me out of a spiral of pain. Knowing it was not a disc or other soft tissue gave me the confidence to stretch and exercise appropriately and I’m now mostly pain free. I expect in another 6 months I won’t notice it at all.

If you see a chiro then ask for imaging (X-rays are typically covered by insurance after 6 visits with your doctor). This diagnosis literally changed my life, and I wish I’d had it sooner.

m3kw9• 5 years ago

Had shooting pain on my thighs and thought it was sciatic nerve issue but turns out I needed to stretch my it bands and ligaments and it went away. I mean it could still be sciatic nerve issue but at least I didn’t need pain killers or anything to fix it.

I find a lot of pain we have could be due to muscle overuse, misuse, underuse causing tightness. Everything seem to link and if you relief a kink in a different area, it could solve a pain in another area.

slfnflctd• 5 years ago

Weightlifting can also be a huge help in this area-- among other things, it forces you to stretch less used muscle groups. You should be prepared to care for yourself on off days, but decent nutrition and massages every so often are more affordable than you think.

candyman• 5 years ago

I think our healthcare system (in the US) is very poor at helping people figure something out. If you know and it's clear the system is great at fixing it. I had all kinds of knee pain and saw every ortho I could. Knees were fine. It wasn't until I visited an osteopath in France (by coincidence) that he was able to diagnose it just by feel - it was my hip. After having it replaced I was good as new. I have friends having similar chronic pain problems and they have been to medical centers all over, had tons of tests and yet there is no real diagnosis. Each doctor looks at it from their own point of view - nope, no cancer - nope, no MS, etc.

Body mapping study suggests chronic pain comes in nine distinct types

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