Would anyone on this thread, hypothetically, be interested in funding, supporting or working with a speculative organisation doing what it could to reduce the amount of severe physical pain felt by people across the world?
What if it focused on government and healthcare systems as a target, using evidence and lobbying? For example, encouraging the government to fund or subsidise particularly good projects in terms of reducing physical pain and learning about it?
What if it focused on scientific research and working with funding bodies as a target?
What if it focused on stimulating and monitoring projects in developing countries?
What if it focused on doing a ‘state of play’ publication each year or so, showing the major sources of physical pain in terms of severity and number affected, and what is being done that could be promising or emulated?
Chronic pain is very hard to treat, especially with any kind of efficiency. Even in talking about acute pain, I think what you’re going to end up with is a publication that focuses on lots of negative events in the world, and this might have unplanned adverse effects on people’s perception of the world—making people have a more negative outlook, which could make their own mental health worse. It would seem more productive to focus on the aspects of the world that are changeable—where people’s physical or mental state can be improved, rather than where it’s worst. I also think that most people wouldn’t want to read a pain report, but might want to read about where people’s experiences can be improved.
I’ve heard proposals of this nature before, and my reaction to this kind of proposal tends to be mildly to moderately worried about the consequences if such a project could come to pass, and to recommend against funding it. For people running the project, I would recommend thinking of alternative projects, or performing a risk assessment before going forward.
Perhaps to make it more concrete—what would be the problem in principle with speculative funding or other support for an academic working on practical solutions of chronic pain like Lorimer Moseley
Thanks for the feedback Ryan. I’d appreciate answers if you could make the time:
Who did you hear these proposals from please?
What gives you the confidence to say that severe pain is not a changeable phenomenon?
Why do you think that recognising that others are in pain and understanding how many and how badly with a view to doing something about it will be a net loss for mental health?
I don’t think there are any active proposals at the moment.
Pain is most definitely changeable, it’s just very costly to do so. Lots of different medical, lifestyle and psychological therapies are tried. I think the best current solution for chronic pain is to have an interdisciplinary pain clinic that has physiotherapists, psychologists, doctors with an interest in pain medicine, some kind of medical or allied health folk with an interest in addiction medicine. And then you want to diagnose the type of pain, and give the minimum amount of opiods possible yet the maximum amount of pain relief. I’ve visited a bunch of these kinds of clinics as a medical student. All of this stuff is extremely costly, and still doesn’t work very well, given the cost. It’s not effective altruism. And this has been an active area of research for a long time. Hundreds of doctors in any country would class themselves as pain-specialists. There are pain-specialised-teams that visit patients in any major hospital. All of this is good, but it’s far from a priority. What’s interesting is that pain teams and pain specialists have emerged to a significant degree from the specialty of anaesthesia, who are really the original people who could reduce pain. If you want to look at where pain-reduction is cost-effective, it’s getting the first anaesthetists. Having surgeries done with anaesthesia compared to without is terribly important, and it would seem critical to make sure that in areas of the developing world, basic operations can be safely performed, and local and general anaesthesia are available when required. Chronic pain could be of personal or selfish interest, but from a point of view of effectiveness, it’s a disaster.
I think the problem is that a lot of pain is caused by being aware of the pain, and likewise a lot of mental ill-health is caused by ruminating about pain and suffering, so I think that if someone was going to work in this kind of area, it’d be very important for them to be a person who has very robust mental health themselves. The part that seems globally worrying is if people try to run awareness campaigns about the amount of pain, or writing pain reports, which could make worse-off more people who already have bad ruminations about these kinds of things.
There’s good evidence to be found that interdisciplinary clinics are effective for chronic pain, though it’s easy to see their cost-effectiveness, and likewise it’s easy to discern that a lot of research has been committed to pain research (including much of the specialty of anaesthetics). The ideas about worries about people ruminating about pain is more complicated, but is a notion that has evolved from discussions with thoughtful EAs.
Would anyone on this thread, hypothetically, be interested in funding, supporting or working with a speculative organisation doing what it could to reduce the amount of severe physical pain felt by people across the world?
What if it focused on government and healthcare systems as a target, using evidence and lobbying? For example, encouraging the government to fund or subsidise particularly good projects in terms of reducing physical pain and learning about it?
What if it focused on scientific research and working with funding bodies as a target?
What if it focused on stimulating and monitoring projects in developing countries?
What if it focused on doing a ‘state of play’ publication each year or so, showing the major sources of physical pain in terms of severity and number affected, and what is being done that could be promising or emulated?
What if it did all of the above?
Interested to hear your reactions :)
Chronic pain is very hard to treat, especially with any kind of efficiency. Even in talking about acute pain, I think what you’re going to end up with is a publication that focuses on lots of negative events in the world, and this might have unplanned adverse effects on people’s perception of the world—making people have a more negative outlook, which could make their own mental health worse. It would seem more productive to focus on the aspects of the world that are changeable—where people’s physical or mental state can be improved, rather than where it’s worst. I also think that most people wouldn’t want to read a pain report, but might want to read about where people’s experiences can be improved.
I’ve heard proposals of this nature before, and my reaction to this kind of proposal tends to be mildly to moderately worried about the consequences if such a project could come to pass, and to recommend against funding it. For people running the project, I would recommend thinking of alternative projects, or performing a risk assessment before going forward.
Perhaps to make it more concrete—what would be the problem in principle with speculative funding or other support for an academic working on practical solutions of chronic pain like Lorimer Moseley
Thanks for the feedback Ryan. I’d appreciate answers if you could make the time:
Who did you hear these proposals from please?
What gives you the confidence to say that severe pain is not a changeable phenomenon?
Why do you think that recognising that others are in pain and understanding how many and how badly with a view to doing something about it will be a net loss for mental health?
Thanks!
I don’t think there are any active proposals at the moment.
Pain is most definitely changeable, it’s just very costly to do so. Lots of different medical, lifestyle and psychological therapies are tried. I think the best current solution for chronic pain is to have an interdisciplinary pain clinic that has physiotherapists, psychologists, doctors with an interest in pain medicine, some kind of medical or allied health folk with an interest in addiction medicine. And then you want to diagnose the type of pain, and give the minimum amount of opiods possible yet the maximum amount of pain relief. I’ve visited a bunch of these kinds of clinics as a medical student. All of this stuff is extremely costly, and still doesn’t work very well, given the cost. It’s not effective altruism. And this has been an active area of research for a long time. Hundreds of doctors in any country would class themselves as pain-specialists. There are pain-specialised-teams that visit patients in any major hospital. All of this is good, but it’s far from a priority. What’s interesting is that pain teams and pain specialists have emerged to a significant degree from the specialty of anaesthesia, who are really the original people who could reduce pain. If you want to look at where pain-reduction is cost-effective, it’s getting the first anaesthetists. Having surgeries done with anaesthesia compared to without is terribly important, and it would seem critical to make sure that in areas of the developing world, basic operations can be safely performed, and local and general anaesthesia are available when required. Chronic pain could be of personal or selfish interest, but from a point of view of effectiveness, it’s a disaster.
I think the problem is that a lot of pain is caused by being aware of the pain, and likewise a lot of mental ill-health is caused by ruminating about pain and suffering, so I think that if someone was going to work in this kind of area, it’d be very important for them to be a person who has very robust mental health themselves. The part that seems globally worrying is if people try to run awareness campaigns about the amount of pain, or writing pain reports, which could make worse-off more people who already have bad ruminations about these kinds of things.
Thanks for expanding, and telling me the source of your opinion, even if not giving much in the way of evidence.
There’s good evidence to be found that interdisciplinary clinics are effective for chronic pain, though it’s easy to see their cost-effectiveness, and likewise it’s easy to discern that a lot of research has been committed to pain research (including much of the specialty of anaesthetics). The ideas about worries about people ruminating about pain is more complicated, but is a notion that has evolved from discussions with thoughtful EAs.