Saturday, March 27, 2010

Chronic Pain - Largest Investigation Ever

In 2000, the Workers Compensation Board of Ontario (now the Workplace Safety & Insurance Board) released a set of final reports under the project title of Chronic Pain Initiative. This was a huge investigation and to my knowledge, the largest ever done.

Over 11,500 scientific studies were reviewed. This, on its own, tells you the scope of chronic pain as a serious health problem. Ten years ago, there were already over 11 thousands investigations done. Today, with the increasing awareness in public and scientific circles, that number has mushroomed. There are still many scientific questions regarding the exact mechanisms underlying chronic or long-term pain. But, no one can credibly deny its existence. (Sadly some still try, however).

The Chronic Pain Initiative resulted in 3 final reports. I believe that they are still available from the Workplace Safety & Insurance Board ( One report summarized the overall findings. A second report reviewed conclusions from the expert scientific panel. A third report emphasized policy recommendations.

As a psychologist, I was especially interested in the expert panels review of potential psychological causes of chronic pain. My personal views were, and still are, that any psychological causes, if they exist at all, are very rare. After reducing the 11,500 studies to only those with credible methodology, the panel was unable to find any clear evidence for psychological causes. It is clear that chronic pain can cause additional psychological injuries, such as depression and anxiety. But, these psychological injuries are caused by the patients long-term pain and widespread losses. Not the other way around. This is not only true for chronic pain, but for any long-term medical problem.

There is a long history of psychological and psychiatric theories, which try to explain the origins of chronic pain. There are theories of long-term migraine pain, back pain, neck pain and even multiple schlerosis. Understandably, these serious medical problems can cause depression and anxiety. There is no evidence that they have any psychological causes, however. The Chronic Pain Initiative has provided evidence to support this view and made an important contribution to this field. Congratulations.

There is a whole chapter, on these studies, in my book, Unbelievable Pain Control: How to Heal and Recover from Chronic Pain & Fibromyalgia (see details at ). Go have a look.

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