Playing in Pain Is No Fun

[devellis]

Jerry -- You make a good point (not so much about a failure to understand the effect as to communicate it accurately). Literally, demonstrating a placebo effect means that the same state exists after being given an inert remedy as when given an active remedy. How "beneficial" it is depends on the outcome measure that's used (i.e., the effect that is under scrutiny). Placebo effects can, indeed, be a good thing if the outcome for which the effect is assessed is important and enduring. Actually, the sham arthroscopic knee surgery study (New England Journal of Medicine, July 11, 2002) had a 2-year follow-up that revealed no significant difference between real and sham surgery and the point was more to question the value of the "real" treatment than to tout the effects of the sham procedure.

 

On the other hand, some placebo effects may be demonstrated only for short-term, subjective outcomes. A subjective sense of improvement may preclude or delay more appropriate treatment. Doing something that provides temporary symptomatic relief is not necessarily a bad thing in and of itself. But if it replaces some more effective alternative, it can be a problem. As a specific and relevant example, volatile solvents will often give transient symptomatic relief for joint pain because, as they evaporate, they cool the joint. It doesn't necessarily matter what the composition of the solvent is. People report that spraying joints with WD-40 gives them relief. With respect to temporary relief, this treatment may actually out-perform something that isn't quite as fast-acting (like aspirin). This isn't strictly a placebo effect because there is an actual cooling that probably accounts for the subjective improvement. The problem arises when one treatment that provides symptomatic relief or a belief that symptoms have improved (which can be hard to distinguish, of course) precludes seeking some alternative that might result in a more complete remedy. Another home remedy for arthritis is bee stings. People will induce a bee to sting them and claim that it provides symptomatic relief. Not sure what that's about but perhaps the sting mobilizes endorphin production. Or, it may just provide distraction. But it doesn't strike me as an effective remedy. One common attribute that a lot of folk remedies seem to share is that they entail some readily-perceivable quality. They have a strong smell, a bad taste, or produce some clear physical sensation. Rarely are colorless, odorless, tasteless liquids, for example, used as folk remedies. My suspicion is that that's because placebo effects are more likely to happen when the inert substance is imbued with "power" in some way. When it's dispensed in a clinic, the environment gives it power (and, thus, it may actually be a tasteless, odorless pill). In other settings, that power may have to come from strong stimulus properties, like odor, taste, feel, etc. Thus, I've heard more about people pouring gasoline on their sore joints than about pouring ice water on them (although maybe that's changing with current gas prices), even though the cooling effect is probably the source of any benefit in either case.

 

One man's "true benefit" is another man's "hoodwinked," of course, and it can be tricky to sort the two out. If somethi9ng is benign, brings relief,and doesn't displace some more effective treatment, I really have no problem with it. In fact, I'm all for it. But, as someone who has been involved in arthritis research for about 30 years, I worry that personal testimonials -- including those regarding medical intervention, as the sham surgery study demonstrates -- don't constitute a very reliable basis for determining what will work for any given patient. Much more gets said about perceived benefits than about any side-effects or other disadvantages to many of these remedies. Things get even less trustworthy when they're based only on anecdotal reports and when profit motives may underlie some of the available information.

 

My intent isn't to be critical of anyone's motivations. People who find something that works are eager to share their successes. Also, I'm not claiming that people's successes mean that they've been hoodwinked. Just because we don't know how something works doesn't mean that its benefits are any less real. But, when things produce powerful effects, it's important to have some sense of all the effects they're capable of producing -- both good and bad. The advantage of remedies that have undergone more systematic scrutiny is that there's a greater (though not perfect, by any means) chance that any harmful effects are known and that some formal weighing of good and bad effects has been applied.

[nodehopper]

I have been dealing with nearly 2 years of throbbing pain in my right hand, arm and shoulder. I have been to 2 G.P's (numerous times) - 1 Neurologist - 1 Kinesiologist - 1 Chiropractor - 2 Physical Therapists and 2 massage therapists. I have gotten diagnosis of Tenosynovitis - Tendinitis - Carpal Tunnel - Cubit Tunnel Entrapment - Thoracic Outlet Syndrome - Adhesive Encapsulitis. The two G.P's ....as soon as I said I do IT work and play guitar ...you could see their minds shut down and the words Carpel Tunnel automatically come out of their mouths and that was that! When I finally got angry and convinced the GP that the problem was in my upper torso he took about 2 minutes to examine my shoulder and said...."You have Adhesive Encapsulitis and I will RX Physical Therapy, but you will also have to have surgery". What a moron! I don't need surgery.

 

I have a huge disrespect for much of the medical community, but out of all of this I have finally gotten to a Physical Therapist who 1) listens to me 2) really understands and knows the mechanics of the body 3) is really helping!

 

Sorry for the rant, but for your issues, which seem quite complex my suggestions are to:

 

**Demand Physical Therapy with a general enough RX that the Therapist can look at your hand, arm, shoulders, and even your neck/spine to find the entire set of issues. Much of my issues come from nerve entrapment and misaligned joints up in my neck and shoulders due to poor posture and a shoulder injury I had back in 1989. The first therapist couldn't look at that part of my body because the doctors RX to her was for my hand and carpel tunnel. All of my symptoms are due to weak supporting muscles which have made the entire upper torso structure misaligned!

 

**Really really learn the anatomy so you can talk intelligently with the therapist. It can really help not only because instead of saying it hurts in this general area you can itemize by name joints and muscles that are in pain. It also shows that you are invested in your treatment. Many patients don't even do the recommended stretches and exercises the PT suggests.

 

**Check out this book -

 

**You say you have no strength in your thumb, but strength and flexibility go together. A weak muscle that gets used, but isn't "nurtured" with the correct stretching and exercise can spasm and cause pain. A muscle that is strengthened correctly will simply work better. I will assume you also "guard" that hand which can further weaken muscles from your hand all the way up into your shoulders. The PT will hopefully manipulate you in ways to get ROM back and will give you stretches and exercises to increase strength. The hope is that strong flexible muscles will help to support the "repaired" structures that are causing you pain.

 

**Learn that your health is your responsibility! You will need to be your best advocate in dealing with tired, over-worked, uninterested, burned out and sometimes simply money grubbing health care workers. You will need to do the prescribed stretches and exercises religiously. Look at and read that trigger point book since if a muscles is stressed and has knotted up, some simple self massage may mean that you learn to help yourself long term. Also try Glucosamine and Chondroitin.

 

A year ago just typing a long post like this would have meant days of soreness and no guitar playing, today I may have a touch of soreness, but that is about it!

 

Good luck in your search for pain relief and just keep fighting and working so you can play guitar!