Painiacs, like myself, can feel at times like the process of getting practitioners to reduce reliance on reductionist approaches and adopt (even slightly) a more biopsychosocial approach when dealing with patients, is a massive uphill battle. The fact that you are reading this blog suggests that you are probably most of the way there – but how do we engage those practitioners who are most in need of the “paradigm shift” required for society to be able to approach pain with a better understanding of the evidence about pain?
Social media has become an incredibly powerful medium for information to be spread far and wide. So whilst things might appear to us to be slow, you can imagine how much harder and slower it would be without the internet. We are able to get our hands on far more content than ever before, share ideas, discuss approaches, debate opinions – put together these can help us to view different parameters of our practice in the light of an informed mind.
One of the problems with the internet is, our searching tends to confirm our own biases for the vast majority of the time. Which if you are hoping to expand the depth of your knowledge on a particular topic can be very helpful – forums can help with different resources, and others opinions can help guide your discoveries. But what happens if your initial inkilings about a subject lead you down a dangerous and ill informed path?
I am fascinated (and at the same time furiously frustrated) with Anti-vaxxers. What makes a person so convinced that Big Pharma are out to get us despite every bit of evidence telling us that vaccines are overwhelmingly safe? That the risk of exposing their child to a dangerous and preventable disease is a better option than vaccination? I ask this very genuinely – I have no doubt that they are looking out for their child’s health. My curiosity is surrounding how the situation comes about in the first place – because we know that once people strongly hold these views, getting them to change their mind is nearly impossible. In fact, using techniques such as delivering information that demonstrates the lack of a link between vaccines and autism, or about the dangers of vaccine preventable diseases, can actually make people dig their heals in even more! ( See the article here) (A subsequent study found that highlighting factual information about the dangers of diseases such as measles, particularly with the use of pictures and descriptions of children infected with the disease, had slightly better success).
In some ways it is understandable – there have been times in the past where government bodies have got it wrong in making recommendations for the public, and plenty of examples of where commercial interests play a big role in influencing public policy and recommendations even in the face of significant evidence that flies in the face of such recommendations – (see this fantastic podcast by Dr Norman Swan on the ABC Health Report reviewing both commercial and pharmaceutical influences in the calcium and vitamin D public recommendations). Perhaps hearing about these situations, the potential anti-vaxxer starts to see conspiracies everywhere and feels the need to seek “the hidden truth”. Dr Patrick Stokes, a senior lecturer in Philosophy at Deakin University eloquently laid out how this can be taken one step further:
“Antivax belief may play on the basic human fears of hesitant parents but the specific contents of those beliefs don’t come out of nowhere. Much of it emerges from what sociologists have called the “cultic milieu” – a cultural space that trades in “forbidden” or “suppressed” knowledge. This milieu is held together by a common rejection of orthodoxy for the sake of rejecting orthodoxy. Believe whatever you want – so long as it’s not what the “mainstream” believes.
This sort of epistemic contrarianism might make you feel superior to the “sheeple”, the unawake masses too gullible, thick or corrupted to see what’s really going on. It might also introduce you to a network of like-minded people who can act as a buffer from criticism. But it’s also a betrayal of the social basis of knowledge – our radical epistemic interdependency” ( You can find whole article here)
So, I guess that goes some way to explain how educated (yes, sometimes even very educated), middle class people in affluent suburbs (as that is the most accurate demographic picture of the “conscientious objector”) come around to thinking that not vaccinating their children is the correct choice. There is probably an element of the entitlement culture creeping into the issue too – “Why should I do something to help out everybody else?”. Throw in the odd distressing Chinese whispered story about the kid whose autism kicked in right after the MMR needle and I can begin to see how it comes about. It doesn’t make the situation any better though! (For those of you who don’t know, Australia has just introduced a ‘No Jab, No Play’ legislation change which is likely to vastly drop the number of conscientious objectors via financial disincentives. You can read more about this topic on this blog.
So what is the link to pain science? It’s the digging in of the heels situation – knowing that once people have settled on an opinion that suits their understanding, fits with their biases and pays their bills, getting them to change their mind about their approach can be difficult. Pushing too hard in the “wrong” direction can have the opposite effect to what we are hoping to achieve. When formulating a message, it probably needs to be carefully worded so that it doesn’t throw the baby out with the bath water – you can keep your trigger points, dry needling, manipulation, ouchy tool massage, strict order based therapy protocols, pilates……. whatever single modality floats your boat and pays the bills – you probably just need to frame that intervention accurately to the patient and use it as part of bigger picture approach that places a great deal of emphasis on working towards self efficacy.