PainScience.com (Paul Ingraham)

Almost full moon with clouds.

So that’s the first moon I’ve seen in Vancouver in a month — appropriately shown with clouds. It has been a particularly grey and rainy month here, even by Vancouver standards. OR HAS IT?

”Moon, clouds, Sundial app, and getting corrected by ChatGPT”
paulingraham.com/moon-clouds-...

I knew a guy who had two very intense chronic pains … but literally never mentioned one of them for months while desperately trying to troubleshoot the other! Why?

www.painscience.com/blog/worst-p...

Extensive improvements to this piece in the last 24h, BTW. That's how I roll! Always editing, revising, fine-tuning.

What are the worst kinds of chronic pain? Ranking is seductive and misleading, but here’s a list of the worst pain conditions anyway!

What are the worst possible kinds of pain? The “greatest hits” of pain are problematic … but here’s my list of the candidates anyway! A bit clickbaity of me? Only as a side benefit. 😏 This topic was of genuine interest to me, and overdue.

www.painscience.com/blog/worst-p...

It is represented, but not with that name — because that is not a widely used label, and it is not a specific “diagnosis.” Sensitization (central & peripheral) is a MECHANISM, not a disease unto itself, and there are many ways it can occur.

www.painscience.com/sensitization

“Worst pain” rankings: seductive but misleading But here’s a list of the worst pain conditions anyway!

What are the worst possible kinds of pain? The “greatest hits” of pain are problematic … but here’s my list of the candidates anyway. A bit clickbaity of me? Only as a side effect. 😏 This topic was of genuine interest to me, and overdue.

www.painscience.com/blog/worst-p...

The image shows the wordmark “Ozempic” in its familiar red-to-orange gradient logo at the top, a large blue “VS” in the center, and a comic-book style explosion graphic at the bottom containing the word “ARTHRITIS” in bold yellow letters with a black outline against a red halftone background.

Ozempic works for arthritis. And probably other pain.

Am I dreaming? Too good to be true? Nope. This is the real deal, actual good news we can have some confidence in.

Free summary, lots of nerdy details for members only:

www.painscience.com/blog/ozempic...

The Trigger Points Index Every article on PainScience.com about trigger points.

For instance, there's a whole bunch under the umbrella of "fascial stretching" which is 98% nonsense:

PainScience.com/fascia

Or: trigger point therapy, which is more cromulent, but still often delivered much to aggressively and overconfidently:

PainScience.com/all_trps_articles

I have written a book about it 🙂 and many articles. But "myofascia" kind of meaningless, barely more specific than "focusing" on "tissue" or "body." Myo is muscle, fascia is connective tissue wrappings, so basically "sausage and casing."

Very much depends on the specific method.

It’s a wide-angle-lens perspective on the idea of “manual therapy” after more 25 years of experience and hard study.

I’ve already made a number of improvements in response to some good feedback, as I do. But I’ve ignored a lot more childish insults and outrage. 🙄

Manual Therapy: What is it, and does it work? The science of hands-on treatments like massage and spinal manipulation to “fix” tissue.

My new article about the strange category of “manual therapy” is awkwardly balanced between:

☹️ a bleak and cynical review of an industry with serious problems

❤️ a lov️e letter to methods that I am still faithful to despite those problems

www.painscience.com/manual_therapy

What is “manual therapy”? And does it work? Announcing a new article reviewing manual therapy.

There are ~1800 hundred usages of the words "manual therapy" on PainScience.com. So I thought I should finally write an article about it.

www.painscience.com/blog/what-is...

Just updated my list. Did a little homework, learned that public libraries are mostly not great for this … but university libraries are quite good, though you do have to be able to actually get to one.

I know that once upon a time I tried that and it was a dead end; I just couldn't get access to most of what I needed. But … that really was ages ago, and I definitely should check that option again. Thanks for the reminder!

Enough Is Enuf by Gabe Henry review – the battle to reform English spelling Philadelphia’s Speling Reform Asoshiashun wasn’t the only group to demand a simpler way of putting things in print

Got akes and pains? “Ake” instead of “ache” was one of many early attempts to tidy up English spelling.

Just learned from author Gabe Henry, talking about his new book Enough is Enuf on the podcast You’re Wrong About (Nov 11).

www.theguardian.com/books/2025/a...

linktr.ee/ywapod

Screenshot of ironically expensive paywall for a scientific article titled “The growing inaccessibility of science.”

This screenshot went wild on social media a while back. That is some *chef's kiss* irony! Nature took down the paywall on this (ancient) article—no doubt because of the flood of traffic!

Just a bit more about this, and tips on how to get full text papers:
www.painscience.com/blog/inacces...

I phrased that poorly. What I meant was not that the moon is continuously very close throughout the entire month, but rather that it remains relatively close for several days before and after being full at perigee ("supermoon")…and it will do that yet again next month, for the third month in a row.

Moon comparison image by Şenol Şanlı: www.instagram.com/snlsanli/

As showcased recently by APOD:

www.star.ucl.ac.uk/~apod/apod/a...

APOD unavailable at its NASA.gov since the shutdown…but you can still get it from mirror sites, still posting. All the mirror URLs:

apod.nasa.gov/apod/lib/abo...

A close-up daytime photograph of the half moon against a bright blue sky, showing sharp detail in the lunar surface including craters and the rugged terminator line separating light and shadow.

Two full Moons are shown. They are different sizes because the Micro Moon image on the left was captured when the Moon was near its furthest from the Earth, while the Super Moon on the right was captured when the Moon was near its closest to the Earth. Please see the APOD explanation for more detailed information.

Today’s moon! Still closer than usual for another month. A recent Astro Photo of the Day shows how much bigger it seems—even halved! This is why I’ve been taking lots of moon photos.

And the new camera, of course: Lumix FZ80D, ISO 80, 2400mm, ƒ5.9, 1/250s. Tripod…but it freakishly doesn’t need it.

I’ve been intending to write about this topic for about 20 years now. I think I’ve been procrastinating as I tried to figure out what how to say what I wanted to say! 😜

The post is a 4-minute read. TL;DR:

Isn't it good to relieve suffering? Yes! Are they really different? They are, but they have a very close working relationship. Why does this matter? Conflating them is bad for care!

A Venn diagram showing two overlapping circles labeled “pain” on the left and “suffering” on the right, with the overlapping area labeled “pain-related suffering.” The caption reads “Pain & Suffering: Related but Distinct,” illustrating that pain and suffering often overlap but can also occur independently.

Pain and suffering: are they different things? Is treating one as good as treating the other? I took a ride on this short train of thought recently. In this new post, I take that train to several more stops, addressing key points raised by commenters:

www.painscience.com/blog/pain-an...

Testing the effect of benzos + my 10th painniversary Testing very, very, very carefully

What’s the worst health mistake you ever made? The worst thing you’ve ever done to your own body?

🙋🏻‍♂️ Benzo addiction and rapid withdrawal!

open.substack.com/pub/tryevery...

… after injuring their sciatic nerves, far away in the hip! …

And the mapping showed a shift in activity over a month from the motor cortex to the hypothalamus, which sheds some light on how pain becomes chronic.

This is my 1st take, with no commentary on cromulence.

So microglia are the immune cells of the central nervous system, and they shape-change depending on their activity.

When provoked by injury, infection, or stress, they get amoeboid, thickened, and mobile.

This study mapped where these changes happened in the BRAINS of rats …

Screenshot of scientific paper abstract.

Another useless and impractical 😜 but fascinating basic pain science study…

Peripheral nerve injury affects the immune cells of the brain, with activity moving around as the pain goes chronic.

www.jpain.org/article/S152...

If you keep getting stung, do you get used to it? This is called “habituation” in the world of pain science.

Or does it just keep getting worse? “Sensitization.”

“It depends,” but on what? Short post about a new study:

www.painscience.com/blog/brave-s...

I also used a 10 sec shutter delay to give it plenty of time to stop jiggling after the last touch. I took 100s of moon photos in the last month before realizing this — but now that I’ve seen it, I can't un-see it. 😜 At 60×, that thing is DANCING for several seconds before settling down.

A sharply detailed close-up photograph of the first quarter Moon, showing its sunlit right half against a completely black sky. Numerous craters and mountain ridges are visible along the terminator, especially near the lunar north and south poles, with subtle shading revealing surface texture and depth.

My best moon shot yet! 😄 🌓 This learning curve is nuts. My new camera can get close to this quality handheld & full auto, which is amazing, but falls short of what I really want. So this is on a tripod + full manual, my first time controlling all the exposure variables! A thrill to see this result.

(And yet think about how many things are “prescribed” for pain that are essentially just … pleasant!)