Michael Galinsky, a director of and a principal subject in a documentary about chronic pain titled All The Rage has written a wonderful essay (1) on the process of physicians changing their practice (or not) in response to research data. Any one interested in how treatment of chronic pain and other symptoms linked to psychophysiologic disorders will evolve (or not) in coming years will find it clearly written and edifying.
Underlying many ideas in Mr Galinsky’s essay are the several discrete steps involved in the progress of science. Science begins with observations that lead to hypotheses about what is going on that then lead to the design and execution of research to produce data that tells us something about the validity (or lack of it) of the hypotheses. Error and misinterpretation can creep in to any or all of these steps. (For example, John Sarno MD, also a principal subject in All The Rage who had numerous, accurate, deep insights in psychophysiologic medicine, hypothesized that the unconscious mind could not be quantifiably studied. But psychologists have devised numerous valid quantitative methods that shed light on unconscious processes.)
Next in the scientific process, as Galinsky eloquently describes in the case of medical practitioners, the data are processed into a narrative that will inform future practice. This is particularly challenging (2) if the resulting story is quite different from those to which clinicians are accustomed or would be contrary to their financial self-interest.
What to do? There is no law stating that the data must come before the story. At times in science a story appears that is compelling enough that researchers re-examine their observations, form new hypotheses and produce new data. This is now happening in the field of stress-related pain/symptoms that my colleagues and I call psychophysiologic disorders. The role of repressed emotions and psychosocial stress in the formation of these symptoms is gaining recognition. This overdue trend is given urgency by 25,000 deaths in 2015 from prescription opiates, by a new policy of paying for behavioral health as part of primary care in the U.S. and by the need to find better treatment for chronic pain. If, as I expect, the new data corroborates the repressed emotion and stress narrative that underlies so much chronic pain and so many unexplained symptoms, this will likely generate renewed media attention and a virtuous cycle will continue its progress.
I have worked in this field since 1983 and never felt that a tipping point was closer than it is now. I am grateful to Mr Galinsky’s film All The Rage (trailer is here) for providing such a compelling push in the right direction.
- When Evidence Says No But Doctors Say Yes by David Epstein, ProPublica