Chart comparing effect sizes of exercise vs single-session interventions (condensed CBT etc). Big effect sizes for exercise, not so much for SSI.

If you want to improve your mood, go for a walk—it can truly work.

And maybe pass on “single-session interventions” (discussed in my last post)—because that probably won't work well. It’s an informative comparison.

PainScience.com/blog/exercise-actually-moves-the-mental-health-needle.html

Comic by Loren Fishman: humoresquecartoons.com

These methods might be helpful, but — surprise surprise — the trials just aren’t persuasive for any self-respecting skeptic.

NEW POST with all the details. 6-min read, audio version for members:

www.painscience.com/blog/single-...

So, can single sessions get it done? A new systematic review and meta-analysis by Ziadni et al. now attempts to make some evidence lemons into lemonade.

The results are framed as good news for SSI, but I think the data is a reality check if you read the numbers instead of the narrative.

Comic of a standard psychiatry scene with the psychiatrist talking to the patient: “These psychotherapy sessions will help us uncover the root of your problem, but I warn you... We’re going to be delving deep... deep... DEEP into your savings account.”

I’ll say this much for the idea of single-session therapy: one and done is sure cheaper and more accessible than many sessions of more traditional talk therapy!

But neither is a good value if the job doesn’t actually get “done.”

That is the enticing goal of Empowered Relief, “a two-hour intervention that provides individuals with essential pain relief skills.” It’s a branded, PAIN-FOCUSSED version of the generic concept of a “single-session intervention,” (SSI) an “emerging and dynamic” approach to mental health.

What if just ONE CLASS could do roughly the same job as a full eight-session course of cognitive behavioral therapy (CBT) for #chronicpain? A single dose of the medicine?

A short thread and then much more detail in a new blog post…

The illusion of agency and "intelligence" is so powerful that it easily obscures the obvious for most users: it’s just cleverly regurgitated content from the Internet. That has value, just like Google search results have value, but…it’s the Internet. Don’t believe everything you read, people! STILL!

Ack. So… the preprint-to-chatbot-to-peer-reviewed-citation pipeline … just as bad as AI skeptics would have predicted! If not worse. 😬

I asked three major chatbots about "bixonimania" and they all correctly told me it’s bogus. One told me exactly why. The others were like, "Uh, that's not a thing. Where did you hear that?"

But what you get from LLMs is to what you put in, what they "know" about you. YMMV.

👉🏻 Please never risk implying that people could be suffering less with their pain if only they were somehow … wiser. Smarter. If only they could just get their shit a bit more together.

I discuss all these points in detail in a full blog post:

www.painscience.com/blog/sufferi...

👉🏻 There is strong harmonization between “suffering is optional” and toxic positivity.

👉🏻 Many common types of pain are just too much like torture to transcend. Pain and suffering are inevitable.

The “this is fine” meme: a cartoon dog seated and drinking a beverage from a mug while surrounded by flames and smoke.

“Pain is inevitable. Suffering is optional.” 😮 O rly?

That famous quote from Haruki Murakami contains both genuine wisdom and great potential for abuse in the context of #chronicpain. It’s not a useless idea, of course, but it is highly problematic for pain patients — and it does infect pain care.

An updated red flag for a rare type of back pain Pain + weakness in both legs is the new best warning symptom cauda equina syndrome

Here's my blog post about this from a couple months ago. Mostly NOT about anal grip strength, although it is actually a legit part of the topic.

www.painscience.com/blog/updated...

Testing anal grip strength isn’t helpful! At least, not for diagnosing cauda equina syndrome—insult to the “horsetail” of nerves below the spinal cord, sometimes dangerous.

Science: “We found no relationship between digital rectal examination findings and the diagnosis of CES.”

So what is?

Inverted U-shaped relationship between sleep duration and phenotypic age in US adults: a population-based study - Scientific Reports Scientific Reports - Inverted U-shaped relationship between sleep duration and phenotypic age in US adults: a population-based study

The study: www.nature.com/articles/s41...

But here we go with CORRELATIONS again, sigh. Every time you hear “link” or “association,” always ask: rather than causing each other, maybe both caused by something else?

For instance: maybe many people sleep AND age poorly for shared reasons! (Also, self-reported sleep is super sloppy data.)

Screen shot of highlighted abstract for paper titled "Inverted U-shaped relationship between sleep duration and phenotypic age in US adults: a population-based study."

Exercising while sleeping less than 7 hours per night might do more harm than good: a study linked that pattern to biological signs of premature aging!

And vice versa: slowed biological aging with more sleep.

😮 LOL, I’d never work out again if I stuck to days when I had more than 7 hours sleep!

“Amaze amaze amaze!” ~ Rocky from Project Hail Mary

As the Artemis II crew came close to passing behind the Moon and experiencing a planned loss of signal, they captured this image of a crescent Earth setting on the Moon’s limb. The edge of the visible surface of the Moon is called the “lunar limb.” Seen from afar, it almost looks like a circular arc – except when backlit, as in other images captured by the Artemis II crew. In this photo, the dark portion of Earth is experiencing nighttime, while Australia and Oceania are in the daylight. In the foreground, the Ohm crater is visible, with terraced edges and a flat floor interrupted by central peaks. Peaks such as these form in complex craters when the lunar surface is liquified on impact, and the liquefied surface splashes upward during the crater’s formation.

A perspective you don’t see every day. We've gotten photos like this from some probes over the years, but it’s been decades since the last time a human snapped a picture like this — and we have better cameras now!

Credit: NASA, Artemis II mission.

images.nasa.gov/details/art0...

Zapped! Do TENS and friends work for pain? Transcutaneous electrical nerve stimulation (TENS) for pain is mostly pseudoscience with virtually no evidence of benefit.

I am often told by physios that no one in their profession still uses TENS anymore—it’s a joke! It’s ancient history, they tell me.

But the very next time I hear a physio story from a patient … there’s the TENS again! 🤦🏻‍♂️

www.painscience.com/tens

It has taken medical science 200 years to advance humans to the point where people are so healthy and living so long that they can afford to contract vaccine-preventable diseases to own the libs.

Can you kickstart healing with a little more damage? Can healing be forced? The laws of tissue adaptation & therapies like prolotherapy & Graston Technique.

Or maybe that just makes it a terrific engine for placebo! 😜

I have a detailed article on this topic that has gotten some substantive updates recently.

www.painscience.com/provocation_...

👉🏻 No pain, no gain.
👉🏻 What doesn’t kill you makes you stronger.
👉🏻 What hurts the most, helps the most.
👉🏻 You have to break some eggs to make an omelette.

Maybe it’s right, or half right. Maybe it’s a cliché for good reason. Or …

Many treatment strategies for #chronicpain and #injury are based on the idea of TOUGHENING UP tissues. These are the "provocation therapies." They claim to cure with small doses of damage. It’s an emotionally compelling treatment idea that's pervasive in our culture, and expressed in maaaany ways:

Stretching and mortality, correlation and causation A study linked flexibility to longevity, with the usual barely controlled confounders

There is still no evidence that stretching will make you live longer, despite what you may have heard, even if you heard it from a trusted source.

NEW POST, in which I go through a classic example of muddling correlation and causation. 2-min read.

www.painscience.com/blog/stretch...

All myths are evergreen now, because expertise and evidence backfire for many people who now see it as inherently virtuous to defy consensus and authority. They disagree ON PRINCIPLE, regardless of the facts, precisely BECAUSE they come from credible and knowledgeable sources.

Not that I expected the plot to pause for an interview and physical exam, but fascinating that physio was depicted as being synonymous with MASSAGE. Sore body? Rub it! Duh.

Great movie overall.

www.imdb.com/title/tt2971...

Daisy Ridley plays a physical therapist … someone begs her for shoulder help … she reluctantly goes to work, and … #massage.

Hurts-so-good massage, of course. “It’s horrible, don’t stop.”

Interesting …

A movie poster for <em>We Bury the Dead</em> starring Daisy Ridley: a lone figure stands on a post-apocalyptic road holding an axe, facing an advancing zombie against a blood-red smoky sky, with wrecked cars and bodies scattered around; tagline reads "Volunteers needed."

We Bury The Dead is an arty, poignant…zombie film? With physio!

Many horror fans hate it for being “boring,” but it’s exactly what I want out of that genre: genuine, emotionally mature human drama in a crazy context.

And then there was the #physiotherapy scene. 🙂