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I felt like I was dying at 35 years old, my body was completely betraying me, exhausted, constant pain, no life as absolutely no energy on days off and still exhausted starting the next week. Even years in the Army never left me feeling like that

I had no idea it was the misery of the IT job that was causing most of my pain and suffering, and it had nothing to do with the job itself, it was the endless insanity of everyone else around me doing exactly what they were informed would cause problems instead of having discussions with people that actually knew how shit worked. I was endlessly picking up everyone elses mess and treated worse than a pile of shit all because people were incapable of having a speck of respect for other people since all their hatred for computers fell on me

I GTFO of the career of misery and took half a decade to finally start feeling better

I have now spent years and countless hours working on software and I greatly enjoy doing this work again and find I get even more done than I used to simply by doing life the way I need to instead of how some backwards/abusive control freak "needs it done"

I ended up in a similar situation last year. Amazing job, but typical startup stresses combined with some situational stuff in my personal life (moving, new jobs for partner, kids, day-care changes, etc, etc, etc) left me completely broken. I ended up leaving my job to take care of my family (thought I was done with my career, but it ended up being a sabbatical - back at the old job and doing great now)

It took about 6 months for the brain zaps to start fading. Then another 6 months for me to start feeling capable of really doing my job well. I'm 18 months into "recovery" and I still think I have another 6 to 12 months before I feel like my old self again (so about 2 to 2.5 years in total).

Time is really the only solution. You can't just think your way through it. You have to left your body's rewards systems re-adapt and re-learn how to be a healthy, happy human.

Brain zaps?

I thought it was a somewhat common medical term, but all of the sources are from SSRI withdrawl (which is likely still the same symptom, just a different reason). My apologies for leaving it ambiguous.

For me, it basically felt like my brain was misfiring when it'd respond to some sort of external stimuli (often basic work tasks). It was almost like my brain was getting a muscle cramp combined with a dose of adrenaline (think getting scared). It was almost like a thought would fire off in my brain, cascade around a bit, then never find anything. I could feel my brain searching for connections, but never making them.

My best guess is I was essentially in fight or flight mode so severely that all of my thoughts were firing off my lizard brain type reactions. My brain was reacting as if I were in a deadly situation, just trying to keep me surviving.

BTW I can relate but to me this was the savior:

- taking sport seriously

- regaining control over my life (which I did by creating a startup)

- moving to a city that cares about walking pedestrians and social life (moved from SF to New York!)

Stress is so damaging to our bodies. Glad you got relief!

My grandfather said he experiences stupidity as physically painful. I suppose pain is an indicator that some kind of damage is actually occurring.

That's my experience at least, that it's not healthy to be in environments like that for any length of time. In such a place, my regret is always not leaving sooner...

I was thinking Lyme disease caused fatigue from the lead in sentence

What do you do for a living post-escaping the IT career?

I did part time work as a mentor which was way more fulfilling than the IT work. I eventually found my way back to programming my own project

Roaming a labyrinth and savaging young Athenians might seem like a positive change in the short term, but ultimately it’s probably just as unfulfilling as corporate IT.

The mentoring was amazing when I started, but unfortunately the company was bought/sold and things unfortunately went downhill from there (corporate profits rarely coincide with providing actual help and is more designed to make paperwork/justify spending the precious numbers. I was great at the actual job, sucked at the medical paperwork)

I am thrilled I got to help some kids in need of help/understanding/acceptance at least and seeing the joy/results first hand is something I will never forget

Do you have any more universal stack ranking / ruling out re: career paths? Bonus points for more epic phrasing: it didn't really hide that the subjective opinion is objective fact, but, I think there's a better chance I'm fooled into living someone else's life if you do it again.

Can you tell us how you recovered?

overall it took time away from all that to recover, I also changed careers for a while to more fulfilling part time work

I have always had a passion for computing so I eventually found my way back with a project of my own

Sometimes it requires taking a step back to move forward. Healing takes time. There’s so many odd jobs, side hustles, or simply - working a no-brainer warehouse job, for you to find yourself again.

I'm kind of in the middle of this phase. Chronic stress and pressure leading to autoimmune disorder, insomnia, etc.

Completely getting away from software dev will make it hard to support a family.

experienced something very similar. thought I would leave my field permanently out of frustration and despair. I like my work now, but faced with that burnout again do not think I could power through it a second time.

Apropos, I had chronic pain throughout this experience. I thought it was just aging, irreversible, and something that compounded my hopelessness. It's very surprising to be 10 years older now but feel 20 years younger. Books like "The Body Keeps the Score" or "Healing Back Pain" used to seem woo to me, but now I am convicted that health comes from within as much or more than it does from without.

I had sciatica for years and inflation in my hips so bad I could barely walk 500 meters while in college. Basically only kept going by iboprufen, naproxen and paracetamol. I tried everything. Acupuncture/LSD/ultra sound/kiro/physio/yoga had mri’s/xrays/you name it I had dr. Sarno’s healing back pain for 2 years on my shelf before I took a holiday and read the whole thing in one go. Fell asleep for 4 hours and woke up pain free for the first time in 7 years. Started to come back a few times but I would just read the book again and go for a run. Been smooth sailing for 10 years now.

what exactly was in the book that relieved it for you? I’m curious

Healing back pain - by Dr. John Sarno.

So you went back into software development after 5 years? Maybe you had a burnout and just needed to rest

I read it that OP has left IT and rested then got back to some freelance/co-op/own softwate development.

I am on the same fence, just on my notice period in the shit show called corporate IT where there is 90% time spent on toxic politics.

Now dreaming to burn some savings, detox and then play with Raspberry Pi projects.

I have worked with computers for decades, I love it, and for me to not even want to look at a computer was impossible for me

I made it through the Army (decades ago), I ran my own company, handled employees, etc. I have no problem with hard work and stress. My joy for computers was destroyed for a while, and it had nothing to do with the work itself, it was due to targeted intentionally malicious discrimination from the top

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the owner instructed everyone not to talk to me, I found out years later

if it was a me problem then they would not have let the then president of the company go for working with me

I was not the one with communication problems but people are really good at blaming me for their own problems

That is the same problem I had in my most stressful position.

I was working for a consulting company:

The first project I worked on was great, some of the most enjoyable work I've done at a company.

Then the second project came (same company, same client). Things weren't going so well, so I started talking about the problems that everyone was having, and started talking about how we could fix the problems...

... and that's when the real problem revealed itself. The project manager on the client-side was secretly trying to replace my consulting company with another consulting company (where he had friends). However, my consulting company had ties with higher management at the client company, and my consulting company didn't want to abandon the work, because they wanted the money, of course.

In the end, it was revealed that our team of programmers was surrounded on all sides by people that didn't care about solving the same problem, they only cared about the political games.

It was extremely stressful. I got shingles, and was diagnosed with celiac disease in the same week. It's hard to say for sure, but I think the celiac disease was activated by the stress--I still have it to this day obviously.

My advice to others:

(1) Identify the problem (2) Communicate with the people that are needed to fix the problem (3) Work towards fixing the problem

If at any point communication breaks down, or you realize management is not trying to solve the same problems you are trying to solve, then you need to GTFO.

As a consultant there's no point in being so personally involved in the project outcome that you let it impact your health. Follow management orders, do the best work you can, and let the chips fall where they may. Whether the project succeeds or fails, you'll get paid either way and eventually you'll get reassigned to another client.

overall I felt my biggest mistake was believing that I would be fired/let go if there was ever a problem with my work

I never realized there was such malicious people out there incapable of basic professional respect and tell me to f-off

And vaccinate your kids against chicken pox. Don't intentionally expose them repeatedly. Get yourself vaccinated for shingles, if it's not too late.

"the owner instructed everyone not to talk to me, I found out years later".

The guy was a sociopathic narcissist. I have been in similar situations a couple of times, thankfully not for too long.

The way I knew it wasn't a me problem, was that they later turned on other people in even more damaging and toxic ways. Also I have had a long career in many different environments where I was very appreciated.

I think they felt threatened by me first because I was quietly confident and independent minded. Not sure though.

If you come into an environment with a narcissistic and charismatic leader but you are an independent thinker, watch out...,

What a bizarre and unnecessary comment.

I have to admit it annoyed me for a moment, but it is an honest thing I have to have ask myself as part of my analysis of a situation, ie. AITA, in this instance, not at all

Why do all such articles never talk about the meat of the solution? Why do I always feel like I'm being sold something.

Why is it so hard to explain the solution briefly, or directly present it to me upfront. Why does it need so much of mystery around it?

In this article the OP does not even mention "Pain reprocessing theory" which is what they seems to be talking about (based on the study they have linked)

Hey algo_lover, OP here.

Just woke up and this post's traction has surpassed my wildest imagination.

Similar to what pedalpete has said, I'm looking to release this in parts to ensure:

1. I am not overwhelming people and losing their interest

2. Quality remains as high as possible (I invested only a few hours into this last week as an experiment). I want this blog to be the most easily accessible, engaging + factual source for chronic pain sufferers. That requires sufficient time to nail (and it seems like I've struck a chord so far).

3. Get signals from readers week by week and tailor to the audience which is forming.

This will help me helpfully reach the most pain sufferers.

RE feel like you're being sold something. This series will cover what is needed to recover from chronic pain and be offered for free. I am looking to build a product eventually (why wouldn't I want help as many people as posssible while building a career which does good - I don't believe they're exclusive), but the information in this blog will remain free.

RE not calling out Pain reprocessing theory/therapy - I'll go through the post today and see if it makes sense to add this into #1 (or if it's better for #4). It's not something I consciously omitted when writting this post last week.

Thanks for the comment!

Thanks for wanting to help, but:

1. You've lost my interest with no "meat", as the GP stated.

2. There is no "quality" in using a couple thousand words of text to say "I'll be writing about what helped with my chronic pain over time".

3. Here's the signal: I am not in for "weekly" sessions. I do have chronic pain, but what you want to be producing is utterly incompatible with what I need.

here is what helped reduce my chronic neck pain: red meat (beef) with no side dish, eating healthy in general (and I mean truly healthy, not "oh one small candy bar every two days is proably okay..." no, it actually isn't. It's poison.) and exercise, a foam roller, bench press. Also definitely don't eat leafy greens, if you do that then you should stop in my opinion. I can't emphasize enough how important it is to truly eat perfectly. You can't make a single mistake or it will start the sickness cycle again. Not immediately but even a single piece of chocolate will make it so that the body is susceptible to further damage the next day. Then if I eat another piece the second day I'm really risking it and the damage left a hole in my health. I've had multiple instances where I ate a piece of cake and a donut and I was getting sickly with a hot head within 2h. I think it's hard to emphasize enough how important health is, it should be your top hobby to be healthy and eat healthy. It should be your nr.1 pasttime to research health and draw joy from doing health related things.

What kind of "health" is just red meat and no green leafy veggies???

TBH I couldn't tell what the condition was or what general kind of treatment it was from the article without making big assumptions. Chronic pain is a symptom, viz. pain that doesn't go away after a short time. What was your disease? Or was it never given a name but the pain was treated?

Then I had to click a link "a landmark study" to get an idea of what the treatment is. Why not put the title of the treatment there?

Finally, that article is about back pain. But you had tendon pain. Obviously a psychological technique can be applied to multiple diseases, but you might say something about that.

Your reply seems disingenuous, like marketing-speak. You're telling people "I have a solution to your chronic pain" and then they read the article only to find out "tune in next week for the next bread crumb".

Chronic pain drives people to suicide. You're toying with people's emotions.

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Hi algo_lover, I also noticed that about the post. The approach being discussed is "pain reprocessing therapy". It was described in a book called The Way Out, by Alan Gordon and Alon Ziv. Here's my short summary of the book:

- Chronic pain is often generated by the brain, not any actual injury. Not always, but often. Especially if it gets worse during stress or high alert, and especially if the feeling of pain becomes connected to your fear of that same pain.

- In periods when pain is high, you need to kinda nurse it. Lie down, put warm water on it, whatever it takes. Don't try to power through the pain. Avoid situations where you have to power through.

- In periods when pain is moderate or low, take short sessions to examine it. "Ok, this isn't a threatening injury, this is just a sensation. Where is it located? What shape? Hot or cold? More dull or more like tingling?" Etc, etc. Don't hyperfocus, just explore the feeling in a light and curious way.

This sounds LLMlish

I'm a human and was just trying to write the most helpful reply to parent, but now that you point it out, yeah.

Don't feel bad, I've been failing Turing tests since MS Messenger days.

I am also a fellow human.

Me too, really...

I found that a lot of advice for working with LLMs is based on asking good questions. This is also good advice for working with people, and for working with yourself.

As someone who has overcome chronic pain, and frequently foils acute pain from turning into chronic pain, I started daily joint-mobility exercises from Kelly Starrett's Supple Leopard book (and his MWOD videos on YouTube) to achieve this. Physical therapy needs daily, incremental progress, which you can do yourself.

Agreed.

Yes and: Kelly's freq collaborator Jill Miller (author of The Roll Model, TuneUp Fitness, etc.).

I've been guilty of this myself for our neurotech sleeptech company, and I still owe HN a better blog post clarifying our positioning.

I think there are a few reasons you see this in health/medical community.

1) just helping people understand a different view of the problem is often enough for one blog post. Stuffing new way to look at solution and new solution together can sometimes be a bit much.

2) we have to be cautious from a regulatory perspective about what we say, and sometimes in being too cautious don't give the people who REALLY want to understaned the processes enough to go on. For our company, I used to say things like "we can increase the synchronous firing of neurons which results in reduced 15^% drop in early night cortisol, and 14.5% increase in hrv....".

But prior to regulatory approvals, we can't point directly to neurological or physiological processes, which means we kinda end up talking around the solution a bit.

3) in marketing, they want to connect and build an audience, so they are dripping more information over time. One post gets feedback and interest from one group, then you do another, and another. It's about building the community and connecting with people, not just a "here's a problem, do the thing, thanks". If you are trying to build a business, you probably need to get in front of people 7-8 times, particularly if you're taking a new approach to a problem, to build trust and brand recognition.

It's not the best, but it is the way the world works.

As someone who has been mitigating and managing chronic pain for 25 years, with respect IMO your expectation is unrealistic.

There isn't a "solution" - you're looking at a life-long mitigation and management strategy that will not be "brief".

The time commitment typically goes up as one ages. I could spend 40 hours a week on nutrition, exercise and relaxation if I was trying to optimize for chronic pain reduction.

But then nothing else would get done.

> Why do all such articles never talk about the meat of the solution? Why do I always feel like I'm being sold something.

The topic itself is broad, but I agree that posts like this (please subscribe to my substack so you can get the info…) are almost always a prelude to some monetization play that comes later.

In this case, there are numerous existing resources on the topic (as linked by others already) from people with actual academic research experience in the topic that could have been linked in the post.

The claim about having quit a tech job and sold his house to “work on chronic pain” is also a giveaway that some monetization motives are at play.

I’m not opposed to people earning money from their work, but everyone reading this should know that monetization motives inevitably conflict with giving you the best access to information. The more you get from existing resources, the less interested you will be in following this specific author and paying for whatever products or services they are pushing.

Chronic pain is complicated. There is no universal solution. Sometimes there's no solution at all.

Went hospital, took medication. No magic. That's the cause

I recently decided to go all in on addressing chronic pain - a condition which affects an estimated 1/5 adults in the US[1] and nearly the same proportion in my country of Australia.

This is the first of several blog posts exploring this invisible condition.

If you're passionate about this space feel free to reach out, thanks!

[1] https://www.cdc.gov/mmwr/volumes/72/wr/mm7215a1.htm [data from 2021]

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[Edit] Thanks so much everyone! Excited to get the next article out soon!

Hi Dan, I wanted to share a few links to articles on pain and circadian rhythms that I wrote during my PhD. Would love to connect if you have any questions.

[0] Circadian rhythms and pain: https://www.sciencedirect.com/science/article/abs/pii/S01497...

[1] The disruptive relationship among circadian rhythms, pain, and opioids: https://www.frontiersin.org/journals/neuroscience/articles/1...

[2] Circadian rhythm disruption exacerbates pain behavior in male mice: https://www.sciencedirect.com/science/article/abs/pii/S03064...

Would love to connect/chat. Will read over these in the meantime.

Awesome!I had two tumours in my hip and I lost around 90% of a few muscles. Pain is my friend since I started this journey, and I need to say, that learn how to deal with that should be the first treatment!

I'll read this blog with love!

Thanks

I did a 10 day insight-meditation retreat and experienced how pain is triggered by the mind first hand. This is impressive to me and id be curious what your perspective is

Hi, thanks for the thread, what are the websites you follow the most to read about this topic ?

Sometimes I wish there was a medHN

agumonkey I love this - maybe it's about time a wellness/health "HN" was started. We're living in a time of chronic health dysfunction and lack of clarity. DM (and/or anyone else) if you'd like to jam

For my recovery my reading/listening was focused on people like Dr Schubiner, Alan Gordon and some folks in Aus like Lorimer Moseley.

I'm engaging more in linking research studies in now as I experienced a lot of people (often not practitioners) making claims without links to evidence (likely to keep things simple), which made my logical brain skeptical orignally and slowed my entry to this field

Thanks for the answer, I'll ping you.

“As pain becomes chronic, it is increasingly associated with activity in the affective and motivational systems tied to avoidance and less closely tied to systems encoding nociceptive input” [1]

I’ve been on the slippery slope of chronic pain. Minor post surgery issues caused me to change my routine and avoid certain activities which only exacerbated the issues, which led to more avoidance. Eventually I couldn’t walk.

The American medical system is very focused on avoiding health issues that show up on mri, rather than quality of life health. But quality of life issues quickly become serious.

I think the middle ground of activity: not all out intense as if you are healthy, but also not avoiding movement is so challenging to find for many people but also so crucial. A lot of chronic pain for myself and I suspect for many others could be avoided with short and quick combination of therapy and daily movement. So simple but so challenging to effectively identify and allocate resources.

Not suggesting this is the total solution but it’s the pathway that I took to return to activity and I’ve seen it help a number of my friends as well.

[1] https://pmc.ncbi.nlm.nih.gov/articles/PMC8482298/

> Minor post surgery issues

My wife has had two surgeries and each time she had a minor post surgery issue. One of them was an area that was tender to touch; another was chronic pain. Neither was mentioned as a possible side effect of the surgery by the surgeon. The main takeaway even if a bit extreme here is avoid all surgeries unless absolutely necessary.

Surgery is a bigger deal than doctors make it seem, but after surgery care can make a huge difference.

I had a surgery asked for more pain meds once on day 5 or 6. Instead the surgeon had me come in to look at the wound, made a tiny incision a blob of pus came out and things felt fine the next day. That’s the kind of thing that could have easily resulted in major problems, but just the right treatment at just the right time fixed it.

> Instead the surgeon had me come in to look at the wound

I'm surprised this is not the standard for any surgery involving a significant incision. In my country it's been the standard for instance for all three of my cervical spine surgeries, including the one I just had.

At the 7-10 day mark I must go to my normal GP who performs wound review and checks for signs of infection or other anomaly.

It was standard to have a follow up. He called me in early, the same day they called. And he looked to it himself rather than having a GP do so.

Oh ok that makes sense, for a second it just sounded like it would have went I caught otherwise and I began wondering if maybe this wasn’t as much of a standard as I thought it was.

Depending on the underlying issue, delaying a surgery could easily lead to needing an even more invasive or extensive procedure, with worse complications or side effects. A blanket avoidance of all surgeries is a great way to be even more miserable.

Anecdotal case: My wife broke her arm some 10 years ago or so. She was really upset about potential recovery time, insurance copayments and such, especially since she was (at the time) a single mother. The doctor suggested setting it and letting it heal on its own, which was absolutely the wrong call. Had she gotten surgery straight away, she would have recovered by the time she actually ended up getting surgery.

I've often wondered if there wasn't a malpractice case that could have been made, but it was before we met so that's lost to time.

Any time you have surgery, especially anything to repair a bone, joint, muscle, or tendon, do the post-op physical therapy religously. Do not skip it. It will be uncomfortable at first, but stick with it. If you slack off or don't do it, you may end up with persistent pain and mobility issues.

Vasectomies are never “absolutely necessary”, but the risk of chronic pain (very small) vs the risk of unintended pregnancy, risk to the partner, or potential financial hardship, can make it a good decision. It’s never black and white in medicine.

> used me to change my routine and avoid certain activities which only exacerbated the issues, which led to more avoidance. Eventually I couldn’t walk.

Anecdotally, I had a phase where pretty much the same thing happened to me with the Achilles (+ calf/ankle) flare-ups I was having (during this part of my chronic journey). Eventually got through it by doing small walks around my home, then outside but keeping the frequency high each day (i.e. instead of 1 "long" walk, doing 3-4 short ones). I.e. Desensitisation / daily movement

Splitting up activity to bite sized chunks was critical for me as well. It prevents over straining but I think more importantly it also prevents you from being stagnant for an extended period of time.

Your method is how I treated pain and it served me well for many years (including broken ankle, countless elbow/wrist/finger injuries), as soon as I could I started movement again, and for tendon injuries even decent intensity seemed to help trigger healing.

That all changed when I tore my achilles, the pain/recovery/etc. process had me doubting everything I knew about recovery and now 14 months later I still question if it needs more rest or more activity or the whole thing is in my head. Ankle/foot injuries seem to have an entirely different approach because standing and walking are so fundamental that you might overdo it just by deciding to make eggs or something.

I learned this the hard way, got achilles/ankle tendon issues trying to rest from a joint problem instead of ramping up activity which would've made me more resilient.

You are not wrong in my opinion - at least all my doctors share the same idea.

Pain is a legitimate diagnosis, though.

Pain is a symptom. There's a strong psychological component to pain avoidance which can lead to behaviors that make it worse. Physical therapy isn't going to feel good, but it plays an important role in lots of recovery scenarios, and I think should be more often prescribed after surgeries.

I deal with fibromyalgia pain. When I first developed it, I pretty much avoided doing anything, and really that was the opposite of what I should have done. There's no "recovery" and really no avoiding it; all I ended up doing was letting my physical condition weaken to the point that even normal activities were painful, so I was hurting for two reasons.

Treating the underlying cause of the symptom, and training to avoid behaviors that exacerbate the symptom is the real key.

Make friends with pain.

I have a pretty severe back injury - double pars fracture and significant spondylolisthesis from an accident (not a car accident). For many years i was in incredible pain, but it just kept going, sometimes getting a lot worse. When this happened I would go get some imaging done to make sure there weren't degenerative changes that needed to be addressed - you should never, ever get back surgery if you don't need it, so I am cautious about it. But I noticed something, all on my own, and that is that it seemed to correlate with periods of intense stress. I still have a ton of stress, but recognizing that actually kind of made a tremendous difference.

I hesitate to add a link to this on the thread, but there is an interesting story around chronic pain actually being psychological and there are now some high quality studies coming out.

https://journals.lww.com/painrpts/Fulltext/2021/09000/Psycho...

I especially hate to link to LessWrong but this is an actually decent thread on the topic:

https://www.lesswrong.com/posts/BgBJqPv5ogsX4fLka/the-mind-b...

I didn't know about any of this and had never been exposed to any of it when I drew my conclusions and started to feel less pain. Don't get me wrong, there are still things that will set my back off, but now I probably go actual years without even thinking about it.

> I hesitate to add a link to this on the thread, but there is an interesting story around chronic pain actually being psychological and there are now some high quality studies coming out.

This is a misinterpretation of these studies which is common throughout this thread.

The research isn’t showing that chronic pain is a psychological condition. It’s suggesting that some cases of nonspecific chronic pain that specifically do not match the symptoms of typical physically-rooted pain are psychological. The participants in this study were filtered for this criteria.

For some reason, people see this idea and lose the nuance, concluding that most or all chronic pain is actually psychological.

I think if someone matches the description used by the author of the substack for this HN entry (he describes his chronic pain as random and popping up all over his body) then pursuing the psychological explanation would be a very good idea.

However, it’s getting frustrating to see all of the reductionist claims that “chronic pain is psychological”.

> However, it’s getting frustrating to see all of the reductionist claims that “chronic pain is psychological”.

It's incredibly frustrating and disheartening... For obvious reasons, I'm not going to go into too much detail, but chronic (non-visible) pain is the worst of the worst. People will either think you're "faking"[0] or it's "just psychosomatic"[1]. I actually relish being able to work for a good long day because I'm lucky enough to actually enjoy making computers do stuff.

[0] Yes, I love to miss lots of family occasions, just because.

[1] I'll just will myself better. Nevermind the MRI scans and all that.

EDIT: I should add... the cognitive biases at work are understandable because they've probably been around since proto-humanity, but that doesn't change the outcomes.

I agree. I lived with chronic pain for over a decade due to a specific medical problem that, though I could never get a precise diagnosis, was not caused by stress or my mental state. It was incredibly frustrating to deal with family and others who had read articles like this one and insisted all chronic pain was psychological in origin and needed a mind-body approach. I am happy for the author and am sure this approach works for many, but I'm not sure why they think that all chronic pain is common in cause. There are a host of chronic pain conditions that are physiological in origin and not psychological.

I did not say _all_ chronic pain. I would go back and edit that to be "some" if I still could.

"You should never, ever get back surgery" sounds like that easily could be wrong. It's annoying to have to always caveat but talking to a (good) doctor is important when making such decisions and not relying on tech forum advice necessarily. I know someone who said they went in for back surgery and walked out feeling permanently cured from the specific problem they had and the pain was completely gone. Details matter. Always consult experts when possible.

You left off the 'if you don't need it'. Even back specialists will tell you that surgery is typically the last resort because of the risks of not fixing the issue and/or making it worse. It's not like fixing an ACL.

Along those lines is this excellent website: https://www.painscience.com/

> there is an interesting story around chronic pain actually being psychological

I think this is an incorrect oversimplification.

I had a pretty bad accident a year ago and am still dealing with physical therapy and recovery from it. I have spent a lot of last year traveling the land of pain.

It's not that pain (chronic or not) is psychological. It's more that our pyschological state modulates how we experience pain.

If you hit your thumb with a hammer, the pain you feel is absolutely not psychosomatic and entirely in your head. There are real nerves in your hand sending your brain real pain signals.

But if you happen to do that on a day that you're really stressed out, it will hurt worse. And if days after the accident you are still hurting and you find your inner monologue saying things like "See, you hit your thumb because you're such a stupid clutz." then you will experience that pain with greater intensity and for longer than if you had a more positive narrative around the injury.

I’ve been dealing with chronic reflux for about 8 mos now. On PPIs and they don’t seem to do much. But once I get away from my typical routine of work/dadding then all the symptoms vanish, even to the point of being able to eat foods that are not good for reflux: spicy things, tomatoes, a bit of coffee. In my case, this is absolutely a downstream symptom of something mind-body. Already been scoped and got a diagnosis of visceral hypersensitivity, which is medical speak for “nerves in esophagus are too sensitive.”

The question of why is out of scope.

In this case, docs just don’t know why. (I think it kinda pisses them off not know, tbh). And finding out is not really in their wheelhouse.

I’ve made some life changes (new job) to see what happens here. But I also have to be prepared for the possibility that it doesn’t fix it. Been working through The Body Keeps The Score as well.

Looking forward to seeing what the author discusses here.

https://pmc.ncbi.nlm.nih.gov/articles/PMC9550520/

This exercise fixed it for me. I was diagnosed with GERD last year, I already had it for 2-3 years before that, but it got worse last year. I got ppis for a couple of months and when I finished all of them it came back worse. Fortunately I found this article, and I started doing the exercise daily morning after I woke up(and still do it). I can now eat tomatoes, food with mint, spicy food etc etc :) I have shared my experience with others and it helped them too

Edit - Changed the link, had posted something else by mistake

https://news.ycombinator.com/item?id=42528399

Since reading the above HN comments, I have lost ten pounds and (mostly) stopped drinking carbonated beverages. My GERD is vastly reduced.

¢¢

I don't see anything about carbonated beverages in those comments? I've had good results with some of the exercises mentioned there, but since then have been in a rut unable to make it stop (my only symptom of GERD is a small persistent cough, which sucks more than it sounds like). I drink a lot of sparkling water though. Do I need to give that up too?

Carbonated beverages expand once swallowed, not helpful if your LES is relaxed.

>I drink a lot of sparkling water though. Do I need to give that up too?

That helped more (for me) than the minimal weightloss, so far.

Thanks for this, will add it to the experiment queue while I work on losing the slight dad bod I have going on.

How did you implement this? I can't figure out what these instructions in the article mean: "Exercises of dry swallowing in the bridge posture lasted for 4 weeks and were performed ten times per day (Fig. 2). The exercise was performed with 10-s intervals between swallows."

Does this mean that total number of daily dry swallows in bridge position was 10 or 10 times 10 (100)?

You get in the bridge position. And then swallow, wait 10 seconds, and swallow again. So total of 10 times, I'm not sure if I could have kept up with it if I had to swallow 100 times :)

Thanks for this - it looks interesting, I'm planning on giving it a try for my low level reflux that's been bothering me for over a decade (but always had other health issues that seemed higher priorities to try to address).

That looks interesting, and can't hurt. So you do 1 set of 10 reps (swallows) a day in the morning? I'm surprised that just swallowing 10 times can provoke any sort of physiological change...

> In this case, docs just don’t know why. (I think it kinda pisses them off not know, tbh). And finding out is not really in their wheelhouse.

Chronic reflux as a symptom is almost always initially treated by PPIs because the cause among white collar workers is assumed to be chronic stress[1]. Since doctors can't "treat stress" only its symptoms, they will just tell you to try and manage stressors in your life yourself. Maybe suggest counseling but in general they are limited in what they can do. What they can do, if you are persistent in the complaint, is to just run through all the other less likely causes of it.

I was lucky omeprazole worked for me the first time. I knew exactly what was stressing me out 24/7 and the acid reflux and frequent belching combined with the "pit in my stomach" feeling was all too common and connected around my main stressor. In my case, it started 8 months after accepting a role shift from engineering into management. I was cautiously excited initially, but it just soured very quickly. I would feel physical angst parking at work every morning trying to remind myself of all the web of political infighting "what our team is hiding from this other team", "who we can discuss what with", "how that other team is actively undermining us and their other downstream partners, but how we are circumventing that" how to 4d chess maneuver yourself in the most counterproductive ways possible. It was illuminating on where a lot of those special "business requirements" come from sometimes, but it just wasn't for me. Cutting that out was a massive relief

[1]: Stress and glucocorticoids have well documented effects on the digestive system. I recommend the "Why Zebras Don't Get Ulcers" book chapter on stress and the digestive system.

Western medicine “can’t treat stress” but Eastern medicine definitely claims to be able to. But then so do various nebulous “alternative medicines”. Another comment mentioned deep meditation as being effective, and I believe there are a number of studies that have shown it to have actual effect. I’ll add another tried and true stress cure but with a twist. Exercise has consistently been shown to help reduce stress, but I find that you have to pick an activity that’s different than what you normally do, e.g. if you’re a runner, try swimming or tennis. The goal is to actually raise the stress level while exercising by doing something unfamiliar and therefore more challenging. In my experience, if the exercise is too relaxed or routine, it doesn’t allow your mind to disengage from the other stressors that are causing symptoms. Of course, all this is pure anecdata from an internet rando.

> Western medicine “can’t treat stress”

This is false. Therapy is designed to do just this and it’s readily available in different modalities that have been trialed and studied. You can book an appointment with a therapist today and start working on techniques to build stress resilience and stress handling techniques

> but Eastern medicine definitely claims to be able to. But then so do various nebulous “alternative medicines”.

Much of the allure of so-called Eastern medicines is the feeling that it’s ancient, semi-secret knowledge that is mysteriously superior to modern medicine. There are a lot of herbal medicines that kind of do something, but the effects are small and often prone to rapid tolerance build up and side effects. A large part of the efficacy is getting the patient to believe that the medicine and/or practices are a cure for their ills. Feeling like you’re tapping in to a mysterious ancient solution to stress will encourage a very strong placebo effect, which can actually reduce the stress.

Similarly, when we do randomized trials of medicines for depressive disorder it’s incredible how much the placebo group improves. When people have been told they’re receiving a treatment, it usually helps to some extent even if the treatment does nothing at all!

I don't think the allure of Eastern medicine has much to do with a feeling that it's ancient or secret. It's pretty normal here in Taiwan to go to a TCM clinic here in Taiwan for various treatments, including stress. The practitioners have degrees and certifications for it.

I can't say how much is placebo, but there isn't really anything mysterious about it.

The ancient and mysterious part is the idea that it’s based on wisdom passed down through generations and herbal concoctions, as opposed to synthetic medicines tested in RCTs. This is precisely what draws a lot of people to it, and why it falls in the category of alternative medicine.

It’s actually very interesting that many of the herbal compounds they use do have some quantifiable biological activities. So it’s not all placebo, but you’ll also discover that many of the herbs being sold don’t contain the ingredients they claim, don’t contain enough active ingredients to do anything, or might even be contaminated.

I once asked some doctor friends what things they’ll never do after seeing the consequences in their patients. One of the most surprising answers, to me, was that they avoided TCM and Avurvedic medicines. Apparently they see a lot of people come in with elevated liver enzymes or signs of kidney problems and discover that some TCM or Ayurvedic herbal remedy is causing the damage. Discontinuing the supplement can stop the damage. This happens with megadoses of other supplements too, especially some of the things peddled to gym bros. However, TCM and Ayurvedic supplements seem to catch people by surprise because they assume it’s safer.

> it started 8 months after accepting a role shift from engineering into management. I was cautiously excited initially, but it just soured very quickly.

Thanks for the edit that added this. Very similar experience as this.

It's BS that IC ladders top out at quasi-management roles, but perhaps part of the issue is believing that professional growth is as tidy as a FAANG career ladder (since most companies just copy them wholesale), and that not reaching those rungs reflects on me in any way.

It feels a bit taboo to say, but I believe not everyone can flex into management easily, even part-time. I'm alright at it, but it clearly isn't long-term sustainable.

This was years ago now and I came to complete peace and acceptance with it. I don't view it as complete BS tbh. Here is how I look at it:

First of all, there ARE more steps on top of the IC ladder. They are really really exclusive though in our industry. A large company needs thousands of managers, but only a dozen or so those positions. Half those people are really smooth talkers, and the other half are truly remarkable human beings. You can set it as a challenge to yourself to shadow and follow in that direction. It might take you another 10 or 20 years and it might never happen.

The reason I don't view it as BS is because there is a limit on the amount of value a single person can generate. At the end of the day "managers" are viewed as force multipliers. Their job is to direct and control the output of 10 people. A great manager can 2x or 3x the productivity of their team compared to just 10 aimless people with no accountability or structure. Paying that person 2x or 4x is justified. Your entire career in management, from M1 -> CEO is all about trying to convince the one above you that you are a bigger force multiplier than others in your position. That's basically your job.

As an IC, you need to be someone who has had a track record of founding and delivering multiple highly profitable products/business/features/etc. Otherwise, you did, in fact, hit a ceiling of sorts.

From FAANG prospective, for an IC there is a sweet spot between their technical seniority, output vs burnout, and their compensation expectations/asks.

> I think it kinda pisses them off not know, tbh

Oh definitely. Some doctors are physically incapable of uttering the words “I/We don’t know.” I know a few doctors, and have asked a couple of them about this. In private, they’re very frank about the limits of modern medicine. But in front of patients, they’re afraid any sign of uncertainty will lead to patients concluding that some other quackery is just as good as actual medicine. I can definitely understand their perspective, but it does sometimes make them come across as arrogant know-it-alls.

>But in front of patients, they’re afraid any sign of uncertainty will lead to patients concluding that some other quackery is just as good as actual medicine

This, but also in particularly litigious countries like the USA, they have to be extremely careful of opening up lawsuits.

A doctor saying "I don't know." followed by a bad patient outcome has a pretty high chance of being a lawsuit.

I'd be fine with that if the posturing didn't go along with unnecessary medication and the lack of suggestions to search for treatment somewhere better equipped.

Hey, I just wanted to let you know that I have the _exact_ same issue as you since 2 years. It was much worse than what you described 2 years ago. Now it's just very annoying.

The diagnosis I got from my therapist is PTSD from my chikdhood due to the strong connection between stress and body.

The only thing I found that alleviates my symptoms short term is lots of Buddhist meditation (1-2 hours per day).

I wish you all the best and thank you so much for sharing.

How'd you get started?

If you mean the Buddhist meditation: I joined a local group a few years ago. I wasn't super serious about the practice until I saw how directly it can improve my life. Even now it's hard to find this much time every day.

This is a book that helped me getting started: https://www.amazon.com/Roaring-Silence-Discovering-Mind-Dzog...

For me, the two big things that help are losing weight and reduced anxiety. When either are high the problem is noticeable when both are low it’s gone.

Foods make it worse, but it’s rarely an issue if I’m in decent shape and not stressed.

The link between the gut and brain (especially in the case of dietary intolerances) is an interesting one! Keen to see if others have come across good research in the space

Sleeping on a inclined bed can help with GERD:

-https://www.healthcentral.com/digestive-health/acid-reflux-e...

-https://www.refluxguard.com/the-acid-reflux-game-changer-sle...

I had terrible acid reflux at night when I was in my 20s. It was awful. I was getting a couple of hours of sleep per night, then waking up in terrible pain, stuffing down plain yogurt under a doctor's orders, and sitting up on a sofa for the rest of the night.

Putting my futon on a sheet of plywood with two concrete blocks under the head completely solved the problem within a few days. It takes a while to adapt to sleeping on an incline. I kept it up for about a year, then went back to a flat bed. I've never had acid reflux again.

I had the same diagnosis, and treatment was getting on serious antidepressants for their nerve dulling properties.

After getting that diagnosis. I eat everything within reason. I decided not to take medication, knowing whats up with my body is sufficient. I mainly try to do all eating 4 hrs before bed.

What i have read is that covid may be responsible for micro lesions in the esophagus...acidic foods are essentially rubbing salt in the wounds.

Just a note about VH - it is more so over sensitivity to regular digestive function. Which is why feeling super full after eating/dispepsia is common as well. Im sure you did a 24 hr acid monitoring test - i pressed the reflux button during all my trigger foods and was surprised to see ph levels as neutral.

I had this for years. Then I took vitamin K2 (about 50mcg per day I think), and after a few months it went away. No idea why, though. Anyway, happy that I can drink coffee again :)

Have you tried H2 blockers?

And as you have said, avoid anything that increases stomach acid production (such as caffeine or even tea, along with spicy food).

You might also have success with Venter[1] (Sucralfate).

[1] https://www.medicinesfaq.com/brand/venter

Yep. I track which foods affect that and try not to stack them. In addition, I take famotidine in the evening with two different antihistamines.

I suspect I have a histamine intolerance behind it all, as it tends to be comorbid with ehlers-danlos.

I have never heard of Ehlers-Danlos syndrome. Does it really cause histamine intolerance? You may try 1st generation ones.

In any case, good luck and I hope you can find something that makes it manageable at the very least.

I had this for about a year, and it really only went away when I quit my job. It wasn't even a particularly demanding job, but I guess the lifestyle + the fact that I felt I was wasting my life away might have played a role. Nothing else is really different.

Most people are familiar with the Peter Principle where it talks about people rising to their level of incompetence.

But I think there's still plenty more that makes it worth a read. For example, something along the lines of, sometimes a man will pop an antacid and lament that their illness is negatively affecting their work, when in fact the causality is exactly reversed

I have had near-debilitating non-GI physical symptoms when it was time to leave a job in the past. I might just be bad at responding to those before it gets to be a five alarm fire.

Worth mentioning is I got the same symptoms (tendinitis) a few months prior to this, but went to PT and got them resolved. Bodies/minds are fun!

All of my reflux went away last year when I started tirzepatide via my Zepbound prescription. I was having horrible heartburn daily and it’s just completely gone. I used to take tums and omeprazole literally daily, now it’s basically never.

For me intermittent fasting after 6pm and small diet changes fixed my acid reflux. PPI were not helping and making things worse. I actually took Betaine HCI supplements to fix digestive issues after PPIs.

I seem to have something very similar going on. I'm on the early end of trying to understand it. Coffee was the first indicator because it'd ruin my day to drink some. I hope the best for us.

Lots of anecdotal cures here, but I'll add Aloe Vera gel to the mix since it seems to help* both soothe/recover/prevent the return of my reflux symptoms for long periods of time.

Gel, as in, applied to your skin?

I love smoothies with aloe Vera juice and freshly grated ginger. I’ve never felt such a powerfully calming sensation from ingesting something before. Can’t tell if it’s the ritual/association or the ingredients.

FYI, The Body Keeps The Score is full of misinformation, and is alternately ignored and criticized by other psychiatrists

> The most consequential problem with BKS is its promotion of a large number of treatments, outside of EMDR, that have limited to no evidence (e.g., massage, acupuncture, yoga, community theater, and neurofeedback), according to the latest treatment guidelines by the International Society for Traumatic Stress Studies (Frank et al., 2020), while simultaneously ignoring or criticizing PE and CPT, the two treatments with the highest quality evidence (Sakaluk et al., 2019).

https://web.archive.org/web/20250120164320/https://journals....

Just a sidenote: GERD can lead to Barrett's Esophagus (precancerous changes in tissue), and erosive damage to the esophagus can accumulate over time and abruptly become life threatening. After decades of terrible GERD, my father nearly died from exactly such an undetected gastric bleed, losing 11/12 of his blood (which doctors replaced as it coursed out) before an emergency-medicine team finally found and sealed the rupture.

He almost certainly suffered minor brain damage during this episode, and later, after about a decade of taking anti-protonic medications for reflux, developed exactly the abnormally rapidly growing abdominal cancer that patients who take anti-protonics apparently develop at a higher rate than similar GERD patients who don't.

I don't mean to give medical advice. I can only describe what happened in my family (which has a heritable deformation in the esophagus, leading to severe GERD). Take it with a grain of salt (and an antacid) as what it is: an anecdote from some anonymous nonexpert on the internet.

Anyhow, good luck. I'm glad to know you're working actively on the problem, not ignoring it as my father did, and I hope you find some long-term relief and peace.

As someone who had years of undiagnosable pain and after many years (and more than one doctor trying to suggest it was all in my head) I just want to say to anyone reading who has it -

Don’t let yourself be gaslit that it’s all mental. It seems some do have that, but there are also many hard to diagnose and completely valid physical health conditions that cause terrible chronic pain. And don’t give up on trying to find out what they are. Once I did, I was able to largely manage mine, and more importantly, to stop constantly questioning my own sanity.

> Don’t let yourself be gaslit that it’s all mental.

I agree, though this is a very difficult subject. Often, the people who would benefit the most from psychosomatic interventions are often the most resistant to accepting those explanations. Meanwhile, many of the physical chronic pain sufferers I know have desperately tried various mind-body programs (without success) because they will try anything that might help.

If people match the description of the author of this post and blog, where the pains are widespread, vague, and popping up around different parts of the body without explanation then you really should explore psychosomatic explanations like this author did.

However, I’m growing weary of the trend of people who fit this description starting newsletters they want you to subscribe to (like this one), writing apps they want you to download/buy, and making comments implying that they know better than doctors about chronic pain (while putting an obligatory “not a doctor” disclaimer juxtaposed to their comments complaining that doctors don’t know what they know). I think it’s great when people share their experience, but it’s getting tiresome to see it productized and generalized as a more universal explanation.

EDIT: Another trend in this space is to productize by building an audience (please subscribe to my Substack) and then introduce the monetization plan later: A subscription app, an e-book, a partnership with some product. It’s possible this person organically decided to quit their job, sell their house, and focus on writing a no strings attached Substack blog series to share information. However, I’ve seen this play out across enough health influencers that I recommend everyone stay cautious about people who claim to hold some information that will change your life but they need you to subscribe first. Be careful.

> and making comments implying that they know better than doctors about chronic pain (while putting an obligatory “not a doctor” disclaimer juxtaposed to their comments complaining that doctors don’t know what they know).

I am not claiming to know better than doctors whom are proficient in pain science/medicine.

Rather, that most doctors are not adequately educated on this topic. If you ask the average doctor they will tell you how little it is taught in most medical education programs. Case in point, most pain sufferers will tell you how many doctors they had to bounce between before they finally got some answers/direction (if they were lucky).

FWIW I was preparing for two months this year after I left my job to sit the Australian med school entry exam. Ultimately, I decided I would be able to help more people today, with tools readily available (including a computer and substack) than spending the next decade of my life preparing for a medical career.

I would consider amending that part of my post to say something more narrow like "Not a pain doctor", but it seems more straightforward as it is now.

Technically it is an experience that is internal to the nervous system... but a doctor telling someone that it's imagined because they can't identify the root cause is criminal!! If we have to make something up about it we're literally better off calling it a demon.

Thanks for sharing this.

Very much agree it's critical to get an accurate assessment, ideally from a doctor who understands pain science to rule out a structural cause. In saying this, I recognise many practitioners are not fully across this so I'm hoping this series will help increase awareness.

This first blog is meant as a quick intro to the series - blog post #2 will break down the different categories of chronic pain (i.e. broadly including tissue, nerve damage and pain due to brain plasticity - what the series is primarily focused on).

Would you mind sharing a little detail about what the physical malady turned out to be, and why it took so long to diagnose?

Sounds like an interesting medical mystery.

Combination of two autoimmune conditions, one Ehlers Danlos.

Actually EDS is interesting because it became a fad I guess on TikTok to claim you had it like Tourette’s, further exacerbating the above issue.

It’s got a wide spectrum. My dad had it so lightly he was just considered “double jointed”. I gained a further thing from mom’s side, which seemed to interplay poorly. Spent 19-26 basically having extreme nausea and vomiting episodes every month or two, often having to go to the hospital to stop it. Had other weird symptoms and pains before that and during too.

Did every scan, met tons of specialists. Kept getting referred down the GI side, had gallbladder removed for no reason.

At one point I was convinced it was psychological. This was after a second doctor suggested it. It sent me down a dark path for a few years of trying to figure out what was wrong with me - didn’t help my mental state was terrible from all the uncertainty, and I had developed anxiety about eating since basically any meal could end up in hours of extreme pain. I was a total wreck. Then it just cleared up finally at 26.

It wasn’t until years later I got the EDS diagnosis, and then a genetic test showed the other immune condition. When looking at the two lists of symptoms it was such an intense moment in my life, finally having closure.

> At one point I was convinced it was psychological.

I ended up thinking the same thing after a prolonged period of symptoms that didnt make sense. I 100% began to think I was losing my mind and imaginging it. Turns out I had a spinal cord injury. The problem is, not knowing that for as long as I did ultimately did impact my mental health in other ways.

It was nice to find out ultimately that no, I was not just going insane.

Cheers brother, not many people know that specific nightmare. Glad you’re over it.

What were your symptoms?

It started as just pain. Mild at first, mostly in my arms and shoulders, like someone had yanked them out of their sockets. Over time, it got worse. Not constant, just... random, brutal spikes. One minute I’m fine, the next I move slightly wrong and I’m yelping like a dog, unable to lift my arms, turn my head, or function at all.

I’d go to doctors, and try to explain. "Look, I know I seem okay now, but yesterday I literally couldn’t move etc etc." Time after time they would just respond with some variant of "Patient is stressed, stress is inducing pain, patient should stress less." or "patient is overworked, should do less work, etc".

This went on for over a year. I kept having these episodes, days at a time where I was barely functional. The pain, the immobility, completely real to me, but apparently all in my mind according to my doctors. "Take painkillers/antidepressants/rest etc etc." As a result eventually, I began to wonder if maybe I had just gone insane. Maybe this was all in my head and I was just imagining being in pain.

Then things got worse. I suddenly had to pee all the time. My hands started losing dexterity. I began bumping into things, losing my balance, subtly at first, but unmistakably. It was no longer just pain, my whole body was going off the rails.

After I woke up one day, completely unable to move, I was rushed to the hospital. Same story: they told me it was stress, maybe anxiety. I snapped. I told them if they discharged me without finding out what was going on, and I was later to find out that something had in fact been wrong, I’d sue everyone I had interacted with that day. I don’t even remember exactly what I said, but I must’ve hit the right nerve, because they finally agreed to do an MRI, not to help me, but to shut me up.

The scan finished. I never saw the general staff again. Instead, the next person who walked in was one of my country’s top neurosurgeons. He asked, very calmly, if I’d please come to his office for an urgent (and free) consult, because the imaging contained some pretty serious findings that we needed to act upon immediately.

Finding out I had not in fact being going insane...I burst into tears as the news was delivered. For so long i'd just been left to think I was going mad and here I was finding out that there were in fact very real reasons for everything I was experiencing.

That's wild. I'm glad you got a conclusion.

I have some strange medical results but not nearly as serious as yours, but still I'm hoping to also find some answers and I can relate to the feeling of being dismissed by some doctors.

Not OP but similar story with someone I know. Five years of many specialists that always ended in "all the tests are negative so it must either be fibromyalgia or psychological." Doctors never helped but eventually they empirically found that abilify and rexulti in very low doses (ie: half the minimum) made it just go away. Empirically based on the reaction to various medications it was probably some type of dopamine imbalance or issue. There's other case studies of similar reactions to abilify and chronic pain but not many.

Extra fun fact, a deep research AI nowadays will actually suggest this as one of the treatments given a few paragraphs of information on the symptoms/medications tried/etc.

Dopamine can help autoimmune issues - if they haven’t seen a rheumatologist I’d recommend it.

> Don’t let yourself be gaslit that it’s all mental.

This is a big problem women have around menstrual cycle pain. "It's normal" is what many doctors say - particularly men. A woman I know was basically bed ridden for a couple days/month until she found a doctor who believed her and addressed the problem.

I make an app called Reflect [0] that’s designed to track things like chronic pain and help you get to the root cause with self guided experiments. I’ve used it for my own pain symptoms, especially joint pain. Happy to answer any questions. Wish you the best on your journey.

[0] https://apps.apple.com/us/app/reflect-track-anything/id64638...

Amazing, I'll take a look at it.

Thanks!

Another option for this is Bearable. I used it for headaches a while ago and it worked well:

https://bearable.app/

Here’s an actual peer reviewed study evaluating a pile (over 1000!) symptom tracking apps, including Bearable.

https://www.sciencedirect.com/science/article/pii/S245210942...

I've been using Bearable too. It's great and price is awesome, but data entry is so slow

Awesome study - thanks for the link!

He decided he could monetize his recovery by selling the "the cure" on a newsletter basis and using organic growth to make more money.

As he does point out he is not a doctor and his solution is not backed by extensive medical studies.

He could just write a document laying it all out, and letting people download it, easier for everyone.

(and try to get some researchers do the chekcing).

This is damn close to snakeoil.

I appreciate your skepticism.

> by selling the "the cure" on a newsletter basis and using organic growth to make more money.

I am not selling anything, the information from what is happening -> to how to recover (if it is relevant to you) is and will be freely available on this substack. It is not paywalled and I'm not intending for it to be.

Additionally where are you quoting "the cure" from? I will be sharing information for people to use to self assess if it applies to them. Recovery from chronic pain is rarely simple as your quote implies - instead it requires daily concentrated effort.

> his solution is not backed by extensive medical studies.

Please read this study from 2021: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/... https://pubmed.ncbi.nlm.nih.gov/34586357/

> He could just write a document laying it all out, and letting people download it, easier for everyone.

Readers are more than welcome to download an offline copy from their browser if they'd prefer to consume it that way.

> (and try to get some researchers do the chekcing).

This is a valid point and I'll see how I can integrate it into future pieces, even if it's just collaborating with (legitimate) researchers. Thanks.

Something to understand is until yesterday no one knew I was in this space. Me DM'ing a researcher and asking them to vet my writing would likely have at best resulted in them letting me know they're busy. That likely isn't the case anymore.

> This is damn close to snakeoil.

Happy to discuss this in more depth. I don't see which part is comparable to snakeoil.

> For the next 4 years, I continued to accumulate weird and persistent pains in different parts of my body.

Anyone who is accumulating weird pains in random, different locations should definitely pursue some of these alternative explanations. Another sign that these techniques are appropriate is if the pains come and go depending on your mood or situation (worse when working, disappear when doing something fun) or are prone to suggestion (someone talks about their back pain and then you have back pain for the following days or weeks).

However, I’m also getting tired of the people who benefit from this techniques deciding that their explanation for chronic pain covers everyone. It’s a huge trend in parts of tech Twitter right now to apply these theories to all chronic pain. A small number of people who had unexplainable pain and addressed it through meditation, therapy, and similar techniques are now pushing it as a far more universal explanation. It really needs to be applied to the appropriate situation, not used as a universal treatment for chronic pains.

This parallels similar trends with topics like PTSD, where a smaller group of people have benefited from therapy that addresses past trauma and now they’re trying to export the theory that past trauma and PTSD is the explanation for all psychological ills. Again, matching the right treatment to the condition is critical and being open-minded is important, but beware of people who are preaching that doctors are misinformed and you should subscribe to their app, blog, newsletter, or course instead.

On your first point, the moving of symptoms is not uncommon in patients with chronic pain - and yes definitely a sign something not normal is going on!

On the second, I've mentioned it elsewhere in this thread (on a different comment) that it's critical to determine if a structural cause is at play (i.e. tissue/nerve damage or something else causing inflammation). It is unfortunate however that many doctors are not familiar with modern pain science so I'm hoping spreading awareness via patients (and some practitioners) will change this.

In the next few blog posts this very thing will be discussed (i.e. exploring when it's likely something is mind related vs the body [though I will focus primarily on the former in this series] - as you're 100% correct sometimes it's the body and sometimes it's the mind, and sometimes it's both!).

r/cfs ... those are the wise sages. They've heard it all. They know what to do. They know the BS. They warn each other about it.

That they do. I've been working through chronic fatigue for six years now, and I spent two years thinking it was somatic. No amount of meditation, therapy, socializing, antidepressants, or supplements made a dent. Thankfully I found my way to r/cfs which has fantastic advice on dealing with long-term chronic illnesses. It's a little depressing, but also freeing to accept that there truly is no cure to these horrible illnesses (there should be, but there still isn't). I'm glad I ruled out somatic symptoms so I'm sure that it's not that, but I'm also glad that I now understand that a lot of chronic fatigue is 100% biological. If I ever recover I plan to go into biochemistry to help all of these people who truly cannot be cured with today's technology.

I’ve been struggling with chronic pain for almost eight months. It started when my orthodontic treatment caused the root of one of my teeth to break—it had already been weakened from a previous injury. The extraction was straightforward and only took 10 minutes, and I had an implant placed (with a temporary crown attached to my braces). Healing went smoothly, and the CT scans looked fine.

But soon after, I developed constant headaches that never went away. At first, I assumed they were related to the procedure, but everything had healed well, and multiple check-ups didn’t reveal anything. Since then, my braces have been removed, but the daily headaches persist. Occasionally, I also feel a strange “foreign object” sensation around the implant site.

A follow-up CT scan of the implant showed perfect integration with the bone. I’ve also had other tests done, including a head MRI. Medically, everything appears normal.

It’s getting really hard to manage—painkillers don’t help at all. Has anyone experienced something similar or have any idea what to try next? I’m even considering having the implant removed, despite there being no medical reason for it.

Not a physician but how long have you had symptoms for? I've had dental work that took much longer than expected to heal.

The pulp in the teeth are quite sensitive and can inflame easily, and that inflamation has nowhere to go (being bound by the hard sides of your teeth and jaw), which can lead to constant pain. I once had a routine filling that took about 3 months to stop aching and I had to take ibuprofen every day during that time to be able to focus. Per the dentist, constant aching pain = it's slowly healing, leave it alone. Sharp intense pain = pulp is dying, need root canal. Granted, this is pain the mouth and not in the head like you described.

If it's been a while and it's still bothering you, I'd definitely consider having it removed too. It would suck to remove it and still have the headaches, but at that point you can start looking at other causes.

It has been eight months and there is no tissue damage. Allergic reactions to implant materials are rare and usually stop an implant from fusing with the bone, but mine has integrated perfectly. I would consider removing it, except it is my upper central incisor... I kept waiting for braces to be removed etc but I'm running out of options now.

Painful! Definitely seems long enough to fully heal, plus you've already done the imaging (CT, MRI) which would be a best next step. Maybe you could try another specialist, though it sounds like you've already done everything correctly and in sequence. I hope you can find relief.

Thanks, it's not as bad as for some ppl but made me really rethink what's important in life and I'm 42 lol. Random event you can't control can be life changing. I have 3 more things on the list to try: - diagnostic temp nerve block around implant - bite / occlusion specialist - some blood work for those rare allergies (super unlikely but why not...)

Dental procedures can setup trigger points in the masseter and pterygoid, as well as in your neck, all of which can cause headaches until they're resolved. Massage and trigger point needling by a physical therapist can help resolve these.

I dealt with mobility issues the last 2.5 years after turf toe (healed after 1 year and then reinjured), didn't realize how crucial strengthening was after losing muscle resting, then after research found out how critical loading tendons is to having them repaired. I left my stable job a couple of months ago to dedicate myself to getting my life back. I'd let thumb RSI simmer for a long time too, even though I got to the point where I could do most things with Talon (friction made me get lazy occasionally). The hardest part is mental - the ups and downs, isolation, not knowing what to do to fix yourself, feeling like your body is betraying you and the lack of help from the medical system besides some basic scans and generic advice. I'm glad that I had a cushion so that I haven't had to stress too much taking time off.

To folks dealing with physical pain, I recommend: Built From Broken by Scott Hogan, Rehab Science by Tom Walters.

For joint issues these may help: celadrin, pro-resolving mediators, red mineral algae w/ aquamin, natural eggshell membrane, collagen peptides w/ fortigel.

I've dealt with chronic illnesses for the past 10+ years now. It's such a hard path.

I recently found out after a violent burn-out that a significant cause was chronic stress and its psychosomatic symptoms. It made me have a hard look at the topic, and I'm gradually adjusting to solve the issue.

If I get better, I'm tempted to do as OP and spend more time working on this issue for others. It seems so much more impactful than grinding the tech / startup life.

> I recently found out after a violent burn-out that a significant cause was chronic stress and its psychosomatic symptoms.

Thanks for sharing. I am walking down this path as well. In my experience I can tell I'm deeply out of alignment and it wreaks havoc on the body. My soul says to X but my mind says do Y, it's safer, maintains a stable status quo, income, and relationships, etc., even though it's slowly killing me.

It's definitely a difficult time to deal with these issues, especially when the world appears so unstable. But we eventually have to face the music one way or another. Best of luck!

Feel free to get in touch if you'd like to chat Adrig (my contact is in my profile), wishing you the best of luck.

It's crazy how much your physical health is tied to mental happiness/lack of stress. I had a friend that during his most stressful period as a 24 year old in Investment Banking had strep throat 4 times in 2 months.

Several doctor visits concluded that it was the long hours and insane amount of stress that was severely crushing his immune system.

Moral of the story is love what you do and take care of yourself: nothing is as important as your own health and happiness

I think most people underestimate how much of their immune system depends on their sleep. Sleep quality, amount (hours) of sleep, time in bed, all of it -- they matter.

In stressful periods, it's likely not stress crushing the immune system, it's the indirect relationship that stress causes bad quality sleep and low amount of sleep, that in turn crushes the immune system.

If, even if under stress, you manage to work out a system/habit that allows you to get proper sleep, you'd likely be ok.

Did your friend leave IB after this diagnosis, or did he tough it out?

To me that's the real question. I think either option is defensible, depending on what one values in life. I've known certain people who pulled 80 hour work weeks for years only to give away double-digit percentages of their salaries to charity, because that was what was important to them, and I don't think they were wrong for doing that, just making choices at a margin I would find intolerable far earlier.

> I had a friend that during his most stressful period as a 24 year old in Investment Banking had strep throat 4 times in 2 months

He may need his tonsils out. I got mine out in my 30s. It was 3 painful weeks to recover but my quality of life is a lot higher.

Very odd pipeline from rank and file tech employee to wellness and alternative medicine "influencer".

Ticks all the boxes:

- not a doctor

- not a physical therapist

- offering tips to solve your pain that somehow nobody could

- emphasizing a single "landmark" study with no other context

- results based off of personal experience

Guy is trying to become the RFK Jr of Aussie land.

Since I became 30yo, I suffered various health issues. I see people much older than me including my parents who were in much better shape, and I kept thinking what was wrong with me. I’m 37yo now and in almost the best shape of my life, and there was so much I learned - I’m sharing here in case it can help others.

First: With the exception of extreme health issues (e.g. Cancer), you likely have a good chance of resolving your health issues. Don’t be discouraged by your chronic pains and think you have to now live with the pain or health issues for the rest of your life. Tackle your health issues like any other engineering problem: understand the problem, make a plan, execute, monitor progress, and iterate over this process (e.g. revise your plans). If you do not take action, nothing will change.

Second: Stress is a killer. I’ve had to visit the emergency room twice because I thought I either had a heart attack or I was dying from high blood pressure. I was way too into my work (due to both passion and commitment), that delays with my projects gave me high mental pressure. Upon re-evaluating my life, I asked myself: which is more important, my work or my health? Once I started prioritizing my health and started pushing back on unreasonable timelines, my stress is gone and none of the chest pain, headache, and high blood pressure issues have come up again.

Last but not least: Your body is a very complex machine and you need to learn how to use it correctly. I had a very sedentary lifestyle and had many chronic pains, e.g. heels, ankles, knees, hip, elbow, wrist, etc. My body was so weak that I even injured my neck and back once just by sleeping in a not-so-great position. I found an awesome PT who specialized in holistic physical therapy and he helped address issues from my feet all the way to my neck. I am now able to resume all the activities from my younger days such as DDR & tennis. There’s too much to explain here but I have two key takeaways: one is my body was extremely tight & inflexible and PNF treatment from my PT was needed for recovery, and another is I just didn’t know my body and muscles well. I did not know how various muscles work, how to use my body & muscles effectively, and what exercises to do and their correct form. Learning and doing the exercises properly and frequently changed my life. Btw: I highly do NOT recommend all the YouTube fitness videos - you simply just cannot tell if what they’re saying is correct and whether their suggestion is even the correct remedy for your problem.

That is all. I wish everyone good luck in addressing their chronic pain!

I was just talking to a friend of mine, yesterday, about what happened to me.

In 2017, I was laid off of my job (of almost 27 years). I immediately started looking for work. Since the company I worked for, was a marquee-name company, I assumed that it wouldn't be hard.

Boy, was I in for a shock.

I almost immediately learned that no one in tech, is interested in hiring a 55-year-old, regardless of their pedigree. I could have gotten a job, but those companies made it clear that I would be treated quite badly.

So I made the decision to just throw in the towel and retire. I had the means, but I would have liked to have at least another ten years of salary. I have never had any intentions of stopping working, though. I love developing software. It's a hobby and a personal passion; not just a job.

I was really pissed off at the treatment. I suffered great butthurt.

But in the long run, it's the best thing that ever happened to me. I never realized how much stress I was under, while working. I sincerely believe that, if I had kept working, it would have killed me. I have no intentions of returning to the rodent rally; even though I'm quite good at what I do, thanks to all the learning that I've done, in the last eight years.

I now work every day (my GH Activity Graph is quite green), and do a fairly good job on my chosen projects, but I no longer feel that awful weight on my soul.

Sometimes, the only way that we learn how much pain we are in, is to stop suffering it for a while.

>> I almost immediately learned that no one in tech, is interested in hiring a 55-year-old, regardless of their pedigree.

My comment is off topic but I have to chime in: while I'm sad to hear of your bad luck, this is YOUR experience, and it is not universal.

At 54, I got my highest paying job ever in tech after being walked out of a "marquee-name" company after 24 years. This was three years ago. There is a tremendous need for senior engineers in smaller companies. The main reason is that all the A+ engineers (clearly I am not one!) have retired from decades of fat equity compensation, and those of us at the B+ level (or me who financially screwed up) are actually now a rare commodity.

So hang in there, greyhairs are still valuable to smaller companies.

Fair point.

I should say that I wasn't particularly interested in a "good-paying" job. I was set, already.

I wanted something that I found interesting.

The places that would hire me, had crappy work.

The places with the interesting work, had no interest in hiring me. Saying that it's because oldtimers are expensive, is a red herring. I would have happily taken half of what they pay people with half my expertise.

In any case, it's all good, now. I have no interest in returning to work. I'm having way too much fun, working harder than I ever did, without managers pissing all over my work.

As someone who will, eventually, hit that age, I would love to hear more about that treatment?

My own impression is that the software industry is one of the industries where experience and qualifications are completely divorced.

So from my perspective one is really always back at square 0 when looking for jobs - including the need to prove oneself and stay humble.

Well, I found that independent recruiters were the worst. They all ghosted me. A couple actually hung up on me, as soon as they learned my age. In-house recruiters and managers were much better, but the interview process generally derailed, as soon as one single tecchie got involved.

I actually had one refuse to look at my [extensive] code portfolio, because "I probably faked it." One of the luxuries that I had, which I am eternally grateful for, is that I don't have to eat shit.

If reacting badly to that kind of treatment is "not humble," then guilty as charged.

I should add that I am a high school dropout, with a GED, and no matriculated education. Despite that, I ran a "skunkworks" team, employing some very good engineers, and was kept on by a very demanding Japanese corporation, where I was given an insane level of trust.

I'm pretty used to having to prove myself. I've spent almost my entire career, looking up noses. Someone with my background won't make it far, unless I know how to work well with un-humble people, and deliver the goods. I never was given much latitude. I wasn't really allowed to fail.

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Low‐Dose Naltrexone aka LDN

not a cure and barely a treatment but it's one of the only tools in the toolbox

Modulates endorphin receptors (by blocking them for a little while)

Not only causes the body to produce more endorphins to reduce pain but is actually proven in studies to make the ion channels work better if dysfunctional

https://scholar.google.com/scholar?q=Low-Dose+Naltrexone

https://reddit.com/r/LowDoseNaltrexone

Thanks for posting. I look forward to following along.

I have had chronic pain and other annoying functional neurological symptoms for the past 4 years. It started about halfway throughout my PhD.

I was born with congenital torticollis (fibrosis of the right sternocleidomastoid muscle) and had surgery for this twice when I was young. I also had 3 other surgical procedures for different reasons as a child.

Because my pain started in my neck and shoulder, I was set on believing that my previous surgeries were the cause of my pain. But as I learned more, meditated more, did yoga more, and faced pushback (and lots of confusion) from health professionals, it became clear that my symptoms are mainly "mind-body" (I hate that dualistic term).

I'd be very interested in talking more.

For people on the spectrum here, just want to add to the thread the term Fibromyalgia

It seems to be relatively common and under diagnosed. Also somehow controversial and not fully understood

However, looking into it might shed some light on some issues of chronic pain and potential ways to address it

When I was 34, I was laying in bed one night and noticed that muscles all over my body were twitching. It didn't go away. A month later I went to a neurologist in my hometown in the midwest for a workup that culminated in a EMG-NCV study (the neurologist doing that study asked if I liked the NY Yankees.. "I do not.. and I've definitely never heard of Lou Gehrig.. so let's get on with it.."). Ultimately he congratulated me on having no signs of ALS or any other neurodegenerative disease and told me to "live your life." He hadn't seen the widespread persistent muscle twitching I was experiencing before. Six months later, I went to another neurologist, this time at Stanford. She did another workup and said the same things as the first guy, except she added, "yeah, we see this fairly often." The diagnosis was "Benign Fasciculation Syndrome" (BFS), aka "we don't know what caused everything to start twitching or how to stop it, but it won't progress and kill you."

What really struck me was that 1) the midwestern neurologist seemed to have never seen symptoms like mine, whereas the Stanford neurologist had seen them often, and 2) the Stanford neurologist linked it to poorly managed anxiety. At the time I was five years into a data scientist role at a big tech company in the bay area (now it's two year later - the symptoms improved somewhat but are still there). I definitely had burnout and mental health problems and was in denial about them ("I have all these great perks, how could my work be causing my mental health issues?").

The best thing you can say about BFS is it isn't physically painful; I am definitely not equating it with the chronic pain issues that others have described on this thread, which seem much tougher. It's another one of those things that has no known cure (diet / lifestyle / mental health improvements help somewhat), is only vaguely understood ("your nerves are oversensitive"), is linked to mental health issues, and seems overrepresented in the bay area (maybe in other tech/urban centers too, I don't know). Two years in, I don't have any answers, just wanted to share in case it's helpful to anyone.

I feel you. Used to work 16 hours a day. I quit my job and started freelancing. These days, I only commit 20 hours a week to work. Still make enough to pay my bills and live a little, but I won't be getting a boat anytime soon. But with that extra time, I go to the gym, play video games, or blast the neighborhood using my brand spanking new Eric Clapton Pewder Strat.

I have 15 years in data, and 10 years in machine-learning. Back in 2016, I couldn't find a job doing machine-learning. These days, I don't worry anymore about finding work. Things have improved.

Why this has so many upvotes? This is very much a wall of text with just waffle and very little substance.

The "mind-body" thing is a great tool for doctors who are into abuse and take pleasure in having power over their patients.

"You are still having chronic pain, because you are not working hard enough!"

"No, I will not prescribe you medication. The pain is in your head!"

Oh and abusive partners also love this crap. You have a flare up? No you don't! You are just a lazy slob who doent't want to work and is whinging like a little baby. Stop imagining your pain!

GTFO with this crap.

It has many upvotes because HN loves to think of itself as "against the establishment." The alternative medicine folks tend to think this.

In reality , nothing more than grifters. I wouldn’t be surprised if there’s a book or "masterclass" pitch at the end of this series.

I'd be curious to follow along and read more. My experience is that everyone's body is quite different and what causes chronic issues with everyone can be quite different. That's not to say his observations and solutions won't be useful to others, but it's another good anecdote to understand and things worth trying for others having similar issues.

I myself for example have had headache and migraine issues for more than 25 years. I understand deeply an incredible amount about what causes my migraines, how they feel, how I help with it, and so on. I understand migraines more than anyone else I ever know in my life because I observe, pay attention, study, and try different things so much. I understand it more than most doctors I talk to. But I also know that everyone's migraines are a little different and not everyone gets triggered by the same things (though there's a lot of overlaps) and my solutions may not help for everyone. I'd totally write something like this for migraines if I had the time (I don't :( ).

> Before moving forward - I’m not a doctor. Just a bit of a nerd with a blog. Please do not sue me or use these posts as a replacement for medical care.

unnecessary disclaimer here. when it comes to chronic pain treatment doctors are mostly useless or even harmful, proposing surgeries or drugs that will do more bad than anything else because they have no interest in learning how to customize their approach and will parrot and prescribe what they heard from medical representatives. Remember, the opoids crisis was enabled by doctors in the first place.

It's not unnecessary to tell people you aren't a doctor when people may reasonably believe you are a doctor in the absence of such a disclaimer.

I was not focusing on the 'not. a doctor' part, rather the 'seek medical care' as being bad advice when dealing with chronic pain

It was enabled by doctors but they were deceived by Purdue Pharma and Sackler family. They also deceived the (understaffed) FDA, paid off researchers to get their exact wording approved. Purdue used their wealth and influence to launch a nationwide campaign and lobbyist group advocating that mistreatment/mismanagement of patient pain will lead to litigation.

Those stupid pain face charts you see at hospitals, physician offices. Purdue marketing, nothing else.

Everybody is shitty here. This is what happens when a market has loose regulations.

> it was enabled by doctors but they were deceived by Purdue Pharma and Sackler family.

it was enabled by doctors accepting kick backs for the prescriptions (legal ones but still kick backs). And lets not forget that medical professionals are supposed to have eyes. When most of your patients get strongly addicted to the drug you are prescribing, you are supposed to ask questions not blindly follow what a company tells you.

I think he has to put that to prevent any crazy things from the law side. You have a great point on doctors there, no wonder why people lose trust in them after so many wrongs.

Heavily agree much destruction has come from overprescription. With this note I'm just seeking to cover my bases and be transparent with readers who don't know me.

Life is pain, highness. Anyone who says different is selling something.

Buddhist?

Dread Pirate Roberts

Yes, and honestly probably the deepest line in the film (though plenty others are often quoted in my family).

I think there is a lot of strength that comes from waking up and doing the “hard” thing, whatever that is. I’ve had injuries, unexplained health issues, mental health issues, high stress, etc. I have found that for me, at least, refusal to let these things break me and meeting them head-on has been a positive overall for my quality of life.

To abstract it away some, I grew up hearing a lot of family members say things like, “I can’t do X anymore because of Y.” I just refuse to allow any of those damn Ys to kill off my beloved Xs, as far as I am able, despite whatever temporary pain or difficulty it may require me to go through. Sometimes telling the Ys to shut the hell up makes them go away completely. And when it doesn’t, sometimes I just have to be okay “embracing the suck” in order to prevent the Ys from bossing me around.

Prince Humperdinck: First things first, to the death.

Westley: No. To the pain.

Have had long term chronic pain. Think possibly due to a combination of tendinitis and lack of movemen as a dev

Our bodies aren’t meant to be in one position for that long no matter the ergonomics unless you know what you’re doing.

Lots of people mock tiktok for the dancing but in observing the dances, I’ve grown an appreciation for full range of movement and trying to increase range of motion in the joints

I was able to find some exercises that helped in this to decompress but I can go into more detail if people want

What a coincidence! I’m also in Australia and have just finished a self-imposed 8 month holiday from the tech world BS you describe.

I started the holiday super jaded with the idea of working in tech forever. I spent my time on everything but tech. Recently my passion has been reignited and I’ve got more clarity around what it is about tech and my career I enjoy, and what I want from my future.

Now, I’m working on a healthcare service for chronic disease.

YES! I'm experiencing a separate-but-related problem to do with myopia, and my eyes perpetually getting longer (likely due to the long hours of computer use).

I wish I could go back to completely undistracted building, but I realize now that I was a bit addicted and that level of intensity was hurting me.

Now what occupies my waking hours is, "How can I debug this failing system?"

I highly recommend look at Susan Luschas web site. [1] She is also a former tech person who is doing deep dive into debugging health. Much chronic pain maybe dental and organ related.

1. https://debugyourhealth.com/

Prolonged stress is often a major contributor to cp. The problem is that after being stressed for a long period we no longer feel the weight until it's fully lifted which requires taking some time off and the majority of us are not in a position to do that.

If your pain stems from covid, try high doses of thiamine or alternatively TTFD. Quite a few people reported feeling great for the first time in ages after a single high dose and there seem to be some studies showing pain disappearance in fibromyalgia.

Great article, will watch your developments with great interest!

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Are you familiar with Dr. John Sarno's work and if so, how does it relate to what you'll be writing about?

Weight needs to be mentioned more. Even in Europe 50% or so are overweight or obese.

Any pixel pushers out there experience PMR? aka Polymyalgia rheumatica

related: https://x.com/mxslk/status/1940832698366619681

Thank you for sharing your story, and congrats on your endeavour.

The mind/body part for dealing with chronic pain is vital to embrace, but isn't always enough. Finding ways to "attack" pain would be a relief to millions.

The best I've been able to find is kratom, but that's not without its concerns -- drug laws are no friend to pain patients (let alone society as a whole).

Pro tip: get a shingles vaccine if you are able to -- postherpetic neuralgia is no fun.

This should be a show HN.

Another post reflecting the aging HN population.

I mean… tech jobs are already there TBH.

Hi

No idea

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tldr; Pain Reprocessing Therapy: https://pubmed.ncbi.nlm.nih.gov/34586357/

As stated at the end, the authors of the study have a lot of conflicting interests.

Thanks for sharing the link - this one goes into more depth: https://jamanetwork.com/journals/jamapsychiatry/fullarticle/...

I can't comment on the conflict of interest as I do not know the practitioners personally, but from additional/supplementary research in this space as well as the massive amount of people this work has appearerd to help recover (look at reviews/discussion for books like the 'The Way Out') - it does seem to be having a big impact.

I'm aiming to link supplementary research in follow-on articles (e.g. the relation b/w pain and injury where nociplastic pain is present, the impact of psychological factors on pain etc) to paint a comprehensive (yet digestible) picture.

You are sharing exactly the same article I already did. It has the same information, it is just a different url.

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>Pain Reprocessing Therapy

I asked chatgpt to explain this to me and it did a poor job.

Generally speaking in my friend group. Chronic pain used to be opiods; though long ago medical cannabis came along. I couldnt tell you how many people i know who arent stoners who got into the cbd thing and fully got off opiods. 1 addiction for another, but at least cannabis has far less negatives.

>If you don’t have chronic pain and you’re just here for vibes and to see some cute brains, I really appreciate you .

The problem, CBD never fixes the pain. ~8 hours later you need more.

There's no business case for solving chronic pain. Here's my take.

1. There can be cases where there's something legitimately physically wrong causing chronic pain. In detroit I had a friend who got shot with birdshot, a tiny pellet was in his spine that surgeons didnt want to go after but there's no getting away from that pain. If this is the case, you're not seeking explanation.

2. There's stress/emotional pain. "The body keeps the score" by Bessel van der Kolk. He's big on EMDR and yoga. Your achilles pain and such absolutely could be, Probably something like 'change or abandonment' one of my favourites for yoga: https://www.youtube.com/watch?v=2XhJ63OQ7Ww

Do that 23 minute video and see if it helps.

3. Mindfulness meditation. Get into the most comfortable position possible. Dont move; and far more difficult dont think. Your mind will wander. If the pain is in your achilles. The only thing you're doing is monitoring the pain. What's the exact shape of the pain? Is it 4 inches long or is it only 2 inches? Is it sharp like a knife, or is it round in shape? Do you have any taste, smell, or sound from it? You need to wait as long as you have to, maybe it only makes a sound every 2 minutes, you have to wait and your focus is only on waiting for the sound and nothing else.

4. Yoga nidra or progressive muscle relaxation. Start at your toes, you try to flex the muscles to the maximum and hold for 5 seconds, release. then do your feet, ankles, legs, every muscle has to have been flexed and held for 5 seconds. Then when you're done, you simply do nothing at all. dont even focus on anything; maybe your breath at most.

> The problem, CBD never fixes the pain. ~8 hours later you need more.

100%, medication plays a great role in providing comfort and support but it can be ineffective (and often harmful) if relied on solely for recovery from (neuroplastic) chronic pain.

> There's no business case for solving chronic pain

It seems some parties may be incentive aligned (e.g. insurers in Australia) - though I'm still navigating this space to find an approach which makes solving the root cause viable. Keen for your thoughts.

> 1.

Sorry to hear about your friend. This is often referred to as a structural diagnosis - i.e. where a knowledgable/proficient doctor has diagnosed there is legitimate tissue (nociceptive) or nerve (neuropathic) damage.

> 2.

Yep! This is what the series will be targeting, data points to a substantial percentage of chronic pain sufferers solely (or partially in comorbidities) being impacted by psychological disorder (otherwise known as neuroplastic pain / TMS / and a few other names!). There are a lot of causes and factors which have been shown in research to date, but largely it's adverse childhood experience, stress, personality traits, and more.

Will check out that vid!

> 3.

Related to this, there is an exercise called somatic tracking which has helped many people (including myself) - during it people often notice pain shifting throughout your body. This was a big turning point for me seeing how my mind behaves in real time. https://www.youtube.com/watch?v=Lw1D_UvzIDA

> 100%, medication plays a great role in providing comfort and support but it can be ineffective (and often harmful) if relied on solely for recovery from (neuroplastic) chronic pain.

Medication can help you get out of a local maxima, sometimes with pain the issue is that your nervous system is hyperactive and just constantly firing which feeds back into itself in a positive feedback loop. If you can take pain meds and/or nerve blockers it can help break that loop and let you do things like go out and walk, exercise, live a life where pain is not always on the forefront of your consciousness. That in turn can let you get into a better state and break the local maxima and then you can wean off the meds.

If however, you do not change your lifestyle/condition when on the meds things will not get better long term as your body will lose responsiveness to the meds.

I am not a doctor.

>It seems some parties may be incentive aligned (e.g. insurers in Australia) - though I'm still navigating this space to find an approach which makes solving the root cause viable. Keen for your thoughts.

Ive been sort of part of this sort of approach before. I was sysadmin, not a suit. These do tend to work out.

This is also the mechanism for how they squash and hide stuff that would cut into tylenol sales. Dont sell it, license it for periods of time is my recommendation.

Or you seem to agree much with my post. Put it together. The chronic pain fixer upper place that takes in patients and explains these things and trains them. You hire the emdr and yoga folks.

>Will check out that vid! Big fan of the body keeps the score.

It helped me for sure. I really need to try EMDR but never have. Id bet it works great. Adrienne is one of my favourites, but the science actual says slow yoga is more effective; whereas she needs to go quicker for video length.

>Related to this, there is an exercise called somatic tracking which has helped many people (including myself) - during it people often notice pain shifting throughout your body. This was a big turning point for me seeing how my mind behaves in real time. https://www.youtube.com/watch?v=Lw1D_UvzIDA

3000 year old religious ritual :)

Its very interesting to me how science when i was young called this all hoo-haa pseudoscience but is now giving it a new name and saying it works.

You know what's interesting, my post is pretty heavily downvoted. I wonder what people disagreed with.

I find CBD about as useful as a sugar pill for pain treatment.

THC amongst its most minimal side effects increases my pain, not decreases it.

I would suggest everyone try everything that is open to them, but cannabis is not a miracle cure for every ailment.

Are you talking about THC isolate? I found high THC full spectrum oils to be life changing. They don't "cure" pain, but fade it into the background noise. You can still feel it if you focus on it, but pain no longer consumes your attention. I found this to be the most debilitating problem, not being able to do anything because pain just constantly grabs your thoughts and imprisons you. Medical cannabis removes that aspect almost completely. Now, I found oil to be individual thing - I had to go through a half dozen of them before I found one that is actually working for me. It was discouraging at first, but I still had hope and once I found the one... I got my life back! I've been taking it for many years now. I don't have any side effects. I don't feel "high" etc.

> I got my life back! I've been taking it for many years now. I don't have any side effects. I don't feel "high" etc.

That's fantastic! It's pretty much the goal for all of us right? Haha, so glad to hear it. I'm still on that road a little myself, but it is what it is.

> Are you talking about THC isolate? I found high THC full spectrum oils to be life changing.

I have tried it in pretty much all its forms. Flower, oil, lozenges, wafers, vape etc. If it has THC in any form, pain goes up. But it's not just pain, it induces within me sinus tachyardia and heart palpitations, no matter the strength or presence of other cannabanoids.

However I have just had surgery again, which should relieve some pressure on my central nervous system, so it's likely ill try again at some point in the future. There has been some suggestion that my nervous system has been misinterpreting the affects of cannabis as a "threat" effectively. But i'm very early in the stages of recovery so probably not going to diddle with it for a while.

I've always found strange all the talk about using cannabis to manage pain. I've smoked alot of weed, well before all those talks promoting THC for this.

It was my experience, and common knowledge in my circles at the time that THC made pain way, way worse, at least in resin form.

Probably simply because you'll tend to isolate things and focus on them very strongly when under the influence, it makes you notice pain more. I remember toking some days after a knee surgery and regretting badly having done it. So much pain I hadn't noticed...

> Probably simply because you'll tend to isolate things and focus on them very strongly when under the influence, it makes you notice pain more.

This is a very strong contender for why it increases my pain I think, and possibly why it induces some other side effects. I'm ok with my injury and how its changed my life for the most part, but when using THC i'd laser focus in on the pain, then from the pain to the cause and from there to "how unfair it is etc."

Its hard to explain, but the work i've done to be ok with this disability is undone when I go near THC for some reason, and is when I tend to break down and lose my ability to be "stoic" about it for lack of a better word I suppose.

>I find CBD about as useful as a sugar pill for pain treatment.

Same.

>THC amongst its most minimal side effects increases my pain, not decreases it.

I had green card before canada legalized and thc was my main go. Higher potency just meant less smoking needed.

Alcohol was what increased pain for me.

>but cannabis is not a miracle cure for every ailment.

For me, I cant do cannabis at all anymore; but you'd be surprised how effective it is as a medicine for a lot of people.

> but you'd be surprised how effective it is as a medicine for a lot of people.

Nah, I mean even for me, it had some positive impacts, again, allowing me to eat for instance. So i'm not blind to its capacity to be a positive force for many conditions.

The problem is that it's really not a miracle cure without side effects for everyone which a lot of people are not willing to entertain. There are people who simply refuse to accept that cannabis is not always the best, or even a workable choice.

In my case for instance, despite the positive of an increased appetite, it increased my pain, it gave me heart palpitations, it gave me sinus tachyardia, etc. Despite this, cannabis users will argue with me and tell me I "must have been doing it wrong" or various other statements along those lines, rather than accepting that like any drug, the reaction and utility of it is down to the individual.