A built-in 'off switch' to stop persistent pain
161 points
13 hours ago
| 15 comments
| penntoday.upenn.edu
| HN
delichon
12 hours ago
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I'd like to give an off switch for pain to every adult. Here you go, just turn it off if you need to. But if someone gave one to me I'd be in trouble, if not dead. When my back pain got severe I may well have killed the messenger, ignored the pain, and not have made the lifestyle changes that eventually gave me relief by fixing the problem. People with congenital insensitivity to pain usually have multiple damaged joints by adolescence. It's not very enviable.
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SadTrombone
12 hours ago
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As someone with back pain, what were the lifestyle changes?
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ZeroGravitas
1 hour ago
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I recommend McGill's Back Mechanic book, which is an end-user focused distillation of his academic work.

It suggests simple tests to discover exactly where your pain is coming from and then appropriate exercises to mechanically strengthen the right area and a few workarounds to avoid stressing that area in regular life e.g. alternate ways to pick up light items from the floor.

McGillcs big three are three simple exercises that are generally good for those with no patience for ordering a book and intros to them can be found all over YouTube.

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le-mark
7 hours ago
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I’ve been on a year plus journey with this. My back pain was lower back and every few months I’d “throw out” some part around my shoulder blades and be flat in my back for a day or two. It got pretty bad.

I went to physical therapy for two months because that’s all insurance would pay for. My spine was weak and lacked stability. They had me doing stretches for back mobility and core strengthening. I continued that when insurance ran out and added in a lot of walking and other light weights and calisthenics.

It’s been a long journey and I’m only half way to where I was. The worst part is I did it to myself by becoming sedentary for to many years.

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j_bum
3 hours ago
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Best of luck for your continued recovery. Keep at it.

I can’t tell you to do this because I don’t know your medical history, but slowly working your way up to medium weight training can also be a game changer. Re: squats, Romanian deadlifts, pull ups, dead hangs.

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kulahan
11 hours ago
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Upper back and neck pain for me. Went to a Phys. Therapist and got a set of exercises. It was largely muscle weakness from bad posture - something many, many people will likely suffer in the coming years thanks to staring at screens on handhelds.

Mine was because I have the posture of a lump of VERY wet clay.

Also, losing weight helped a lot - less to carry around and hold in the right places.

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eurekin
11 hours ago
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Prolonged sitting deconditions the gluteal muscles, and other muscles often compensate, which can overload them and alter hip/pelvic control. When tissues are strained, the body initiates repair via inflammation—a normal phase of healing. Routine NSAID use can blunt aspects of musculoskeletal healing in some contexts, so it’s worth using judiciously and with clinical guidance. With reduced movement, fascia can lose glide and become stiffer, limiting mobility. Over years, chronic abnormal loading may contribute to osteophytes (joint margins) or enthesophytes (at tendon/ligament insertions). Targeted strengthening, mobility work, and load management from a PT typically help.
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daydream
8 hours ago
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Doing heavy barbell squats and deadlifts worked wonders for me. Three sets of five (with appropriate warmup of course).

Eliminated my back pain and led to a bunch of other non obvious life improvements.

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vasco
5 hours ago
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There's no need to do them heavy for health purposes. The problem with most back pain is people do nothing. Capping them at around 100kg is probably more than enough and will also prevent other injuries.
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beAbU
1 hour ago
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The nice thing is that it's _very_ easy to get to a lifting weight that's considered super heavy in normie reckoning, but a warmup weight for folks that lift regularly. In other words, you can get to squatting 50kg/100lb (one 15kg plate on a side) in a couple of months where you won't even think twice about that much weight, but it's still a huge weight to be squatting. Stopping there, and not chasing the gains is a perfectly good way to work your body out on a regular basis.

The absolutely liberating feeling that comes with the noob gains is incredible. Knowing you can lift those weights, safely, without injury, was an incredible experience for me. I topped off at a hair below 100kg squats before life got in the way.

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Baeocystin
4 hours ago
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When I turned 50 I started capping my max weights because I was more worried about long-term joint and ligament health than ultimate strength. I no longer lift above two plates (225lbs) for anything, even though that is well below my deadlift, squat, etc.

It's been a couple years, now, and honestly I wish I'd made the change sooner. I haven't lost any functional strength, and my recovery is a lot smoother. Haven't had any injury since, either.

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gadders
1 hour ago
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I'm over 50, and I am back chasing the 1,2,3,4 plate standards at a lower bodyweight than when I first achieved it.

The only change I've made is two train only twice a week, rather than three or four times. Thinking of doing the split in Radically Simple Muscle, though, where it is 2 heavy compound lift days per week and a 3rd bodybuilding/machine day.

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j_bum
3 hours ago
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I’m almost 30 and made this change about a year ago.

I now rotate between high rep (sets of 20 rep max) and medium weight weeks (sets of 8-12 reps). My joints haven’t ached in a while and I’ve become much less prone to random muscle tweaks. Mike Isreatel has an excellent intro to high rep training [0]. It produces pumps and mind-muscle connection like nothing else!

I actually went too far into the high rep/volume training direction for several months, but realized I needed to reincorporate medium weight lifts when I started losing a bit of grip strength. I am now super content with my current rotation cycle!

[0] https://youtu.be/HzFHAHOOA4A?si=avUNYahKGPoHbYph

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gadders
1 hour ago
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I think you could put the cap a lot higher than that, depending on the exercise. Strength is like IQ - higher is better.

I admit, though, unless you compete killing yourself for 6 months to go from 250kg deadlift to 252.5kg is probably not worth the effort.

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warrenmiller
4 hours ago
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goblin squats helped my persistent lower back pain almost immediately.
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vrc
1 hour ago
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Goblet? Or is this something new? Deep goblets are great for opening the ankles and hips/SI area in ways that have helped my back. Some combination of improving mobility in other reasons prevents my back from overcompensating I guess
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busymom0
7 hours ago
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Deadlifts if done right also helps tremendously with improving posture.
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anitil
5 hours ago
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For me it was the combination of deadlifts and couch stretch, because I found my hip flexors were fighting to tilt my hips forward. That combination essentially 'cured' any back pain I had. It's not a real cure because if I'm inactive it comes back but so long as I'm moderately active I have no pain
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delichon
10 hours ago
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Daily whole body motion, for me usually in the form of yard work. I am driven to it by the threat of torture, but it works.
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sarchertech
9 hours ago
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2 kids under 4 (and another due next month) fixed my back pain. Turns out that constantly picking up babies and toddlers is the exact amount of exercise my back needed.
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Al-Khwarizmi
3 hours ago
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Be careful, I'm currently in treatment for a shoulder that has given me significant trouble and I suspect it was due to picking up my (bigger and heavier than average) son. Not that I have hard evidence, but it was pretty much the only frequent physical activity that could strain my shoulders when the problems started, as I didn't exercise apart from long walks.
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__turbobrew__
6 hours ago
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Swimming 100%. I was injured far enough I had problems even with walking and load bearing activities, but I was able to swim which enabled my recovery.
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1shooner
9 hours ago
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Aside from resolving the cause, I had to use a foam wedge knee bolster to stabilize me while I slept for an unrelated injury, and I was amazed how much that almost immediately also reduced my lumbar pain.
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vhcr
8 hours ago
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Swimming and Jefferson curls.
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rcpt
4 hours ago
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Reading Dr Sarnos book "Healing Back Pain" was an off switch for me.
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cmoski
4 hours ago
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Swimming and weights.
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SkyPuncher
6 hours ago
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Oddly enough, basically strengthening your stomach/core.
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maccard
11 hours ago
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Lower or upper?

Lower: lose weight, get moving, strengthen hips, glutes and calves.

Upper: lose weight, get moving, strengthen chest, lats, core

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matt_heimer
11 hours ago
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Core should be included in lower as well.
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SoftTalker
10 hours ago
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Strong core is fundamental.
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busymom0
7 hours ago
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For upper, I'd highly recommend adding rear delt flys and face pulls at twice the frequency of any chest or shoulder workouts. Most people have overdeveloped front delts and underdeveloped rear delts and that can cause severe imbalances.
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teaearlgraycold
7 hours ago
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I recommend L pull ups as a general back saver.
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nerdsniper
8 hours ago
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Rear delt flys.
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bluGill
6 hours ago
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You are lucky that lifestyle worked. I had to have surgery, otherwise that tumor (not cancer) would have put me in a wheelchair.

so see your doctor

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themafia
6 hours ago
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We live in a busy world and time is money. Someone else's money usually. So better find that off switch if you want to stay prosper in the land of the free.
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Paracompact
12 hours ago
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> The drive to look deeper into these neurons grew out of a simple observation Betley and his team made shortly after he joined Penn in 2015—hunger could dampen long-term pain responses. “When it came to chronic, lingering pain, hunger seemed to be more powerful than Advil at reducing pain.”

This in itself is a very interesting observation. I've always been inclined to fast during times of pain and anxiety, and honestly it kind of works? Could well be part of meditative fasting's popularity throughout history.

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pkoird
6 hours ago
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If you think about it, this has evolutionary advantages as well. No time to feel pain when your life itself may be in peril due to starvation. Finding food for sustenance easily supercedes recovery.
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chubot
10 hours ago
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Yeah I fasted for the first time last year, and it pretty much immediately turned off a pain response due to an overactive immune response

I got the idea from a book, and it worked

When I ate again, it came back, but I was definitely relieved of pain for awhile. Thankfully the whole episode subsided after about 6 weeks, but it was comforting to know that I could turn it off by fasting.

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DenisM
7 hours ago
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How many hours of not eating does it take to kick in?
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Paracompact
3 hours ago
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For me, it has to be long enough for me to notice the hunger, and then for the hunger to subside. Between that point and lethargy/dizziness is a pretty zen place for me.

(Disclaimer: I am not a doctor, and I have no experience with eating disorders.)

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m463
9 hours ago
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I wonder how many problems are solved in a more common sense way than pills/etc

For example, most headaches I have - drinking a glass of water usually fixes it.

Maybe feed a cold, starve a fever. And now starve lower back pain?

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pedalpete
12 hours ago
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This is very interesting, and I think points to the psychosomatic elements of pain, which is probably usually dismissed as "it's all in your head". But really, all pain is "in our head", it just tells us that the pain is elsewhere.

The bigger opportunity here may be not to dismiss pain as being in the head, but recognizing that when it is, treating the suspected source is not the best route, or maybe not in isolation.

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jkestner
6 hours ago
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I’m currently reading a book, The Way Out by Alan Gordon, on his research into this neuroplastic pain, which is when neural pathways carved by the pain remain after the cause is gone, and how he’s treated it in patients with mental exercises.
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alinajaf
5 hours ago
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Many of the comments here talk about lifestyle changes, and I think those are key, but there are some, (perhaps rarer) conditions that unfortunately won't be improved.

Trigeminal Neuralgia is one of them. The condition is just... pain. Lot's of pain. More pain than anyone should ever have to go through. When I have episodes, I often feel awe that it's even possible for someone to feel such an incredible amount of pain.

Challenges in life help to shape you, make you who you are. But I do feel that this particular challenge was one where it would have been nice to have learned the same lessons some other way. I hope sincerely that treatment based on this research can help.

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cmoski
4 hours ago
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Remember when you could measure pain on a scale from 0-10? Then you had to change the scale to 0-1,000,000. Oh my. I'm so glad that's behind me and so much compassion for those that experience it.
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olly994
1 hour ago
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With impinged nerves in my neck, arm and rear delt, limited (painful) spinal movement so bad I struggled to walk from one part of the house to the other.

My (painful) solution was to get a chiropractor to force movement into my spine and other areas. Pain level 11-10. Slowly thing changed but not enough for my satisfaction. Today I play 2 hours of badminton once a week, train with weights every day and do Dragon Flags to few days a week, go out into the mountains twice a week. Now I'm almost totally pain free and at 67 I can't expect perfection but you never know. By the way this is all done with no medication or painkillers.

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instagib
3 hours ago
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It makes me think some of these special breathing exercises can reduce pain for a bit similar to meditation. Include exercise. Fasting as mentioned but it can aggravate other symptoms. Fear inducing scenarios usually reduce pain but it’s short lived. Searching for fear sounds like a terrible idea to calm chronic pain.

I keep coming back to cervical disc issues that don’t heal and continue to worsen. Exercise like jogging can worsen things. Lifting, pt stretching, walking, and no improvements.

I could take a pill but it wouldn’t let me know my limits and I would definitely overextend myself then probably make things worse at a faster pace.

[This research also suggests that behavioral interventions such as exercise, meditation, and cognitive behavioral therapy may influence how these brain circuits fire, just as hunger and fear did in the lab.

“We’ve shown that this circuit is flexible, it can be dialed up or down,” he says. “So, the future isn’t just about designing a pill. It’s also about asking how behavior, training, and lifestyle can change the way these neurons encode pain.”]

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OptionOfT
7 hours ago
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I recently got a new hip (at the old age of 36).

Due to said age it was VERY hard to find a doctor willing to replace my hip, EVEN THOUGH I had 2 failed repairs, and had to resort to opioids to sleep.

And long-term opioid usage (not abuse!) can cause higher the risk of persistent pain after a total hip arthroplasty.

Thankfully this is not the case for me. But it was a big concern in this journey.

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monster_truck
4 hours ago
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I've had cluster headaches my whole life. As a kid I would describe them as "a 40 foot tall giant hammering an ice pick through my skull into my eyeball". Tried a lot for a long time, nothing worked. Sometimes standing in the hottest shower possible until I inexplicably throw up and then feel perfectly fine works, sometimes it doesn't.

There's really no understating the pain, it is not "2 dimensional", which is what I would use to describe every other form of pain I have experienced. It has a shape with immense depth and detail.

Then I got a pretty severe concussion and I mentioned to my doctor at one of the checkups months afterwards that I haven't had any since, they casually threw out "it's entirely possible you're still experiencing them and you just can't feel them now". Scared the hell out of me, but what're you gonna do? They did eventually come back. If we figure it out in my lifetime I'll be damn impressed.

All that said, I wouldn't want to turn pain off. It's important to learn to live with and through it, whatever the source might be, if it cannot be fixed.

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theturtlemoves
3 hours ago
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I also experienced stabbing sensations like that, although not that severe. For me the root cause turned out to be my diet. Fixed the nutritional deficiencies and accidentally discovered food intolerances. Still have some neurological issues but much better now
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aiiizzz
4 hours ago
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That makes no sense. Why would you consider debilitating pain to be important to live through? What is the gain?
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jacquesm
3 hours ago
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It is not like you have a whole lot of choice in the matter so learning how to cope with it is pretty much imperative, besides, the GP may have dependents or other big responsibilities.
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mhb
12 hours ago
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"The current work started when Nitsan Goldstein, who was a graduate student in Betley’s lab at the time, found that other urgent survival needs such as thirst and fear can also reduce enduring pain. That finding supported behavioral models developed in collaboration with the Kennedy lab at Scripps, suggest filtering of sensory input at the parabrachial nucleus can block out long-lasting pain when other more acute needs exist.

“That told us the brain must have a built-in way of prioritizing urgent survival needs over pain, and we wanted to find the neurons responsible for that switch,” says Goldstein."

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supportengineer
12 hours ago
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I suffer from frequent headaches, as one way to deal with it I sometimes try to find something that will cause me a different type of discomfort, such as walking several miles. Usually works, eventually.
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farrelle25
11 hours ago
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That's interesting about walking. I've done longish walking pilgrimages lasting several weeks (Camino etc.) and some stomach problems and joint problems improved a lot. I usually walked about 25km a day - I realise that's longer walking than what you mentioned.

There are some books about walking putting illness into remission. A famous one is "The Salt Path" where someone with "corticobasal degeneration" brain disease was positively impacted by their walk. (Although the claims are in doubt now because the main author wasn't truthful about other aspects of their walk)

Anyway walking probably a real positive overall!

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aspenmayer
11 hours ago
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I wonder if more light exposure during walking is also a factor? Many folks don’t get enough vitamin D, and light therapy for SAD and other conditions has shown promise as well. I’ve also noticed that 25km+ of daily backpacking for a few weeks continuously helped my overall fitness and wellness, though I don’t have any chronic conditions or ailments at all to speak of. I do question whether many folks would invest the time and effort to do the work, even if they desire the benefits of the exertion.
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themafia
6 hours ago
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Which is what I assume Moxibustion is attempting to do.

https://en.wikipedia.org/wiki/Moxibustion

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mmaunder
5 hours ago
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Very interesting. I’ve been battling a herniated disk. It’s the most pain I’ve ever been in. Debilitating. Stuart McGill’s “Back Mechanic” is an illuminating read. The “big 3” exercises have become my staple and they seem to mask the pain long before the underlying injury heals, which takes about a year. So the ideas in this article resonate with me. In particular pain itself becoming self perpetuating, and mechanisms to block pain like hunger. My issue is temporary, but it’s introduced me to the reality that some have been handed a lifetime of non negotiable pain. So this is important work.
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unixhero
6 hours ago
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Impinged ahoulder and other shoulder pains

---

I have another. Hanging (dead hang) from a pullup bar or staircase. It fixes it. 30 seconds every day, or 3 sets of 30 seconds

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ElijahLynn
12 hours ago
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Pain Brain Film (dot com)

"A documentary that follows the largest fMRI randomized controlled trial challenging conventional wisdom about chronic pain, and revolutionizing treatment for millions."

Explains how these neurons get wired to fire when there is no physical stimulus causing the pain. Similar to phantom limb syndrome.

There's a book called The Way Out, which documents the technique used in the study featured in the Pain Brain Film above.

I can fully attest to this technique. It 100% works. I had chronic neck and back pain for 20 years. I thought it was my desk, I thought it was my posture, thought it was my chair. Nope, it was my mind.

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mhb
12 hours ago
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Can't throw us a bone and give a hint what it is? Also, there's no reason not to put the actual link. Unless that's also your email.
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andrewmcwatters
12 hours ago
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Pain reprocessing therapy
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EA-3167
12 hours ago
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Anyone who's experienced or knows someone who has experienced chronic pain appreciates how desperately the world needs a major breakthrough in this arena. Pain management has evolved, there are steady improvements, but unfortunately a lot of people are effectively left behind and the choice becomes a series of profoundly mind-altering drugs... or profoundly mind-altering pain. The way that pain can erode your personality and your life is hard to express quickly in words, but it's both invisible and endlessly corrosive.

I certainly hope that this or another path of research leads to a new generation of therapies that don't depend on opioids and are more effective than current alternatives.

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tpmoney
12 hours ago
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Yup. Treatment these days for chronic and severe pain amounts to your choice of:

1) Ever escalating doses of NSAIDs / acetaminophen and the associated long term health effects of that.

2) Long term opioid management which will leave you treated like a drug seeker by anyone who isn’t your pain doctor and may or may not also require long term escalation and has its own health concerns and complicates your use of other medications. And god help you if you don’t like your pain doctor because changing them is a whole different world of suspicion and poor treatment.

3) Various physical interventions like nerve ablations or back surgery or steroid injections which come with a host of other risks and also tend to be both expensive and temporary.

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noir_lord
11 hours ago
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I’d love an alternative to gabapentin while accepting that it is what keeps me functional enough to be functional, it is for me a remarkable treatment except for the side effects.
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empressplay
3 hours ago
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If you can tolerate pregabalin (Lyrica), it's better at masking pain while causing less brain fog
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vjvjvjvjghv
6 hours ago
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The company I work at does spinal cord stimulation for chronic pain patients. The stories of the patients are just gut wrenching. Chronic pain is just horrible and very hard to understand and treat.
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petesergeant
8 hours ago
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Fingers crossed for suzetrigine
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hackable_sand
8 hours ago
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Nah. I'm good.
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hackable_sand
4 hours ago
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Maybe I should clarify because my previous comment comes across as dismissive.

We need societal frameworks for empathy and care.

Nothing is ever so easy as just, just, just do this one thing.

I see through people who treat me different because of my pain.

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solomonb
11 hours ago
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I would be hesitant to turn off some physical pain like that of an injury I don't want to overextend, but for something like a chronic headache this would be a godsend.

My most effective treatment for headaches is imitrex but you have to time it correctly and I really hate how it makes my body feel.

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pathartl
8 hours ago
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If areas could be targeted, it could be a massive quality of life improvement for those with endometriosis.
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cluckindan
12 hours ago
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The question is whether the fire is truly out, or whether the chronic pain is a product of socioeconomics.
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