quackery

Pain cures from history


Grabbed from the internet over the past couple of days…some things have not changed. Humans seem to have a fascination with magnets, colours, electricity and traction.
First up, the Faradic Electrifier – apply the electrodes to the painful part, press a button and – hey presto! an electric shock. Not exactly sure what that did about the pain, apart from distract from it, but it sure looks cool.
faradic-electrifier

The Electreat was a device that is probably the forerunner of the modern TENS – if you head over to here you’ll find the whole history of it…

Ouch!

The one that really got me was this specially designed treatment for men only (don’t worry ladies, we have our own treats coming right up!).
electric-belt

The history of traction as a treatment for back pain goes back far further in time than I realised.  If you thought torturers needed inspiration, I’m sure they took a look at some of these drawing for some.

medieval-traction

But if you thought it stopped there – this is available today, for use in your own home…

I did promise you something specially for women – well, here ’tis (and it’s only one of hundreds of such potions and compounds)…

lydia-pinkhams-pills

…and I haven’t even started on the rest of the ghastly herbals that were mixed together and thrown down the throat.  Perhaps that’s for another day.

Why am I doing this?


This is not a whining post, just that I thought it was time I mentioned why I write this blog.

I looked on the internet for ages to find a resource that gave me good information about nonmedical approaches to managing chronic pain and other chronic disorders.

If you use a search engine to look for ‘chronic pain’ or ‘back pain’ you’ll find endless listings for organisations (I used Google just now and found 8,320,000 in 0.34 seconds!)  and many of them are designed for patients, but not a lot for the nonmedical treatment providers who work with them! And we need to remember that the majority of health care providers working with people with chronic pain are nonmedical. We don’t prescribe!

You’ll see I also wrote ‘good information’.  The problem isn’t so much the amount of information available, as the quality of it. When I searched using Google, the advertisements on the right hand column of the search field included: ACC’s page, Ehlers-Danlos, Quantum Touch, biomag, natural health, craniosacral therapy, herniated disc relief, electrotherapy… a bit of a mix.

I also found the same lack of good quality information for nonmedical health providers when I searched using Yahoo.

I enjoy working in the field of pain management, but I’m worried that with so many nonmedical health providers and so little nonmedical health information that is based on science (and what is there is relatively inaccessible) that the field is wide open for well-meaning but misguided people to tout treatments that simply don’t work. OK I’m being charitable, the field is wide open for quacks, ‘alternative’ therapists, and lazy health providers who don’t have time or skills to delve into the scientific literature.

In my own field of occupational therapy (all right, I’m heavily warped by psychology), I find therapists gladly prescribing adaptive equipment including vehicle modifications and ‘ergonomic solutions’ for office settings for people with chronic pain with not a scrap of evidence that this is effective in the long term.  Therapists suggesting ‘pacing’ is all about working within your pain limits (therefore progressively reducing activity tolerance).  Therapists being unwilling or afraid to ask people with pain to develop skills to tolerate pain while they carry out activity, and as a result unwittingly supporting pain-related anxiety and avoidance.  Teaching people that there is one ‘correct’ way to lift items or they may risk ‘injury’. (more…)

Hippocrates


Now I’m not going to post a lot about Hippocrates himself, but I want to start todays post by quoting something that he is supposed to have said: ‘There are, in fact, two things, science and opinion; the former begets knowledge, the latter ignorance’.

Hippocrates proposed that if a new treatment was to be tried, we should use science to decide whether or not it works rather than relying on somebody’s opinion.

What makes science different? Apart from its reliance on experiments, observations, trials, argument and discussion – and its supposed adherence to objectivity – science continues to question what is accepted and assumed just in case it has got it wrong.

And this is important for us as clinicians – instead of relying on big budgets for advertising, incredible sales talk or persuasion, or even ‘received wisdom handed down the ages’ – we are encouraged, in fact required to maintain a critical eye on what we do, why we do it, and how we do it, to learn from our outcomes, and to endeavour to be objective about what occurs.

Of course this doesn’t happen nearly as wonderfully well as Hippocrates wanted, but it is an aim for us all. It means we need to know something about scientific method or how to systematically investigate our outcomes, and it means we really must know something about how to measure what we do, and some of the confounds that get in the way of being ‘objective’.

There are some hot debates about the place of objectivity in many parts of health care – especially nursing, occupational therapy, social work – areas where individual experience or constructions are important, and where the context of what happens is seen as influencing both the event under observation and the observer.

Actually if you look up constructivism in wikipedia, you are greeted by a whole page of different links (take a look!).
In some ways, hard science, such as empiricism where experiments and facts and statistics have held sway, has been given a bad name in circles where constructivism has been emphasised.  I think you can be both a constructivist and an empiricist – and later this week I’ll show you why.

Why would it matter to us as health care people? Well to me it’s important to know that what I do with a person is less about me personally and all my wonderful charisma, and much more about the methods and skills I have learned. Otherwise I’m concerned that once I’m not here the world will be soooo much less able to manage and I’ll have to live forever doing what I do!!

I may joke about this, but seriously, I want to know what is working in the mix of inputs I provide to someone, so hopefully I can learn to do it more effectively, and have the results last longer.

I’m also keen to know that the effects are not temporary ‘feel good’ effects – and I don’t want to find that the effects are all about natural remission, or ‘regression to the mean’ or reducing distress, when I think it’s something completely different!

If you’re interested in some of the things that do influence treatment effects that aren’t necessarily about the treatment itself, this paper although old, and on a site that has been criticised heavily (check it out for yourself and make your own mind up), has some good information.

More tomorrow!
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