PainScience.com (Paul Ingraham)

Belly fat and chronic pain: the waistline plot thickens Two new studies shoring up the case for visceral fat as a driver of chronic pain.

Not all fat is unhealthy. But when it is…it’s a risk factor for #chronicpain.

And it’s mostly the BELLY fat that is the issue—the visceral fat tucked around your organs like foam packing peanuts.

NEW POST! 5-min read, audio for members.

www.painscience.com/blog/belly-f...

The morning view of Manaslu, 8th highest peak in the world, from Samagaon village.

Imagine having baaad knees…

But then recovering enough to climb THIS mountain. And not JUST this mountain, but also the 7 Summits—the tallest mountain on each continent! 🤯

Amazing knee pain recovery story:
www.painscience.com/blog/is-ther...

Photo by Samdesherpa, CC BY-SA 4.0, Wikimedia Commons

Figured that was likely, knowing you. But I’m careful with that assumption. 😜

You have a hand problem that seems helped by PRP?

Or … satirizing?

This is the “what’s really going on here” with RFK Jr.

Acetaminophen was just a convenient scapegoat, part of the "chipping away," inching closer to the real target: VACCINES as the cause of autism.

On a birding tour of VanDusen Garden in Vancouver, talking about owls, I suggested that the ratio of "people spotting owls" to "owls spotting people" is probably about 1:100. 😜

Platelet-Rich Plasma (PRP): Does It Work? PRP is a simple regenerative medicine concept that’s still far from clinically proven.

“You know how this ends: despite a lot of allegedly ‘promising’ evidence over the years… platelet-rich plasma injections remain experimental, supported almost exclusively by low quality trials with mixed and generally unimpressive results.”

PainScience.com/platelet_rich_plasma

Can Journavx replace opioids? The reality seems much less awesome than the theory.

“You’ll take this non-opioid … and you’ll like it!”

I fear that many patients who need opioids will be given Journavx instead, and it will end badly for them.

NEW POST: "Can Journavx replace opioids?" 5-min read, audio for members.

PainScience.com/blog/can-journavx-replace-opioids.html

The somewhat more useful finding here is that people prefer "any recommended treatments" for back pain "even when effects were very small." Also fairly obvious, but a bit more interesting to have confirmed.

You don’t say. 😏 "Respondents preferred physical therapies with higher effectiveness, quicker symptom improvement, lower out-of-pocket expenses, reduced side effects, and shorter duration."

Yep, that'd be what people want: better, faster, cheaper, safer!

www.jospt.org/doi/10.2519/...

That active calorie burn was almost the same as the last run on the same route sans vest. Actually slightly FEWER calories this time!

So the error bars on measurement are bigger than the modest extra energy I needed—only ~15 kcal! I could have fueled that with one peanut! 🙄

But glad I tried it.

Just did a run with a 5kg (11lb) weight vest, just to see how it would feel to carry that mass again … after recently losing about that much in fat. Yep, sure does feel heavy!

And yet … not that big a deal. It felt like more of a slog, yes, but nothing dramatic.

Evidence-Based User’s Guide to Over-the-Counter Analgesics The science of the common pain-killers like acetaminophen/paracetamol and the NSAIDs: ibuprofen, aspirin, diclofenac, etc.

The salamander's review of OTC analgesics. I’ve just added a quick, urgent note to the top of the article about this insanity.

www.painscience.com/analgesics

Tylenol and Autism Earlier this year, HHS secretary RFK Jr. predicted that, "By September, we will know what has caused the autism epidemic and we'll be able to eliminate those exposures." Scientists have been researc

For serious analysis of this deeply unserious idea, see ScienceBasedMedicine.org: "Tylenol and Autism,” by Dr. Steven Novella.

sciencebasedmedicine.org/tylenol-and-...

Know of other good sources? I’d like to build up a little list.

I feel like I must be preaching that almost exclusively to the choir here on Bluesky. 😜 But it has to be said, as strongly and as often as possible, and probably for a long goddamn time.

Tylenol does not cause autism. It’s a crackpot theory, getting promoted at a level that we've never really seen for any crackpot theory in modern times. There are safety issues with Tylenol (acetaminophen, paracetamol), but at recommended dosages it’s one the safest medications that exist.

Sunset over water, rowboard in the foreground, forest on the far side of the water.

Sandstone carved into smooth "waves."

View from our room

Did a late summer trip, 1st stay at Yellow Point Lodge, a fascinating, famous camp/resort on Vancouver Island. Slogan: “Eat. Read. Sleep.” (But we did the eat, read, EXEECISE version: hiking, kayaking, swimming, tennis!

Full review and 20 pics…

paulingraham.com/yellow-point...

A vintage pop-art style cartoon of a distressed woman clutching her chest, with a red burst symbol showing pain. She wears a teal sweater, polka-dot blouse, and turquoise earrings. A thought bubble reads, “If only I hadn’t stubbed that toe ten years ago!” — satirizing the idea of distant minor injuries being blamed for chronic pain.

Pet theories about compensatory injury really do get QUITE silly. 🙄

Compensatory injuries exist, but mostly just the boringly obvious ones.

I’ve banged out a “new” article about implausibly COMPLEX compensatory injuries, which has been in the pipeline for ages:

www.painscience.com/blog/new-pai...

🙂 Yep, that too! And there's good overlap between those things. What people "know" is partly a function of what we WANT to know…and what we want to avoid learning. We all do it. In a unconscious and non-malicious way, we conveniently fail to learn things that don’t confirm our biases. Oopsie!

Statistically 'Significant' Study Results Are Rarely 'Important' A lot of research makes the evidence seem much more "significant" than it is, with chronic abuse of the concept of statistical significance.

If you want to try to wrap your head around this, you can do it here, on a page I’ve dedicted to the two big, common "statistical significance" problems in science:

www.painscience.com/statistical_...

The PRINCIPLE is downright simple. I always walk away from my mental review thinking, “Yep, actually kinda obvious! Why the hell would any researcher neglect that?! Sheesh! 🙄”

The obvious cynical answer: neglecting it makes your results look better. Sigh. 😕

Every time I look at this science glitch—not measuring the “difference in differences”—I realize it’s really quite an elegantly simple idea, even intuitive.

The ONLY thing that's tricky about it? Viewing it through a window fogged by statistics!

The "within-group significance fallacy" is a tricky but worthwhile concept if you care about how clinical science works.

But is it really so “tricky” though? 🤔 I’m contractually obliged to say it is, because, you know, statistics. 😱

The two least lousy trials of PRP for plantar fasciitis I’m working through a big update to my plantar fasciitis book chapter on “regenerative” treatments, especially…

Fine design of a PRP study…but they missed the only analysis that mattered? So odd.

Stranger still: if they HAD done it right, it likely would've made PRP look GREAT! But nope. And it is a deal-breaker. Textbook “within-group significance fallacy.”

www.painscience.com/blog/two-lea...

NEW POST (finally, after a late summer lull): 800 words of science summary + 1200 more words of nerdy details + members-only audio version with all of that.

PainScience.com/blog/two-least-lousy-trials-of-prp-for-plantar-fasciitis.html

The 2 least lousy trials of platelet-rich plasma for plantar fasciitis:

1️⃣ is a weirdo, with baffling flaws and too-good-to-be-true results I just don’t believe.

2️⃣ is more believable, but still flawed, AND there is less to believe: mediocre results even if true!

Citation still needed for PRP.

And then every couple weeks I’ll turn off the motor entirely and do a hard all-muscle ride, just to prove I still can. 😏

Mostly lately I use only a bit of motor power. Still plenty of exercise, but the ride is 10% easier, nicer, less sweaty.

And less painful.

For the biggest hills, and the hardest headwinds, I’ll bump it up to a middlin’ boost. But mostly I just want that gentle “tailwind.”

Favourite thing about the e-bike? It’s not the help with the hills — it’s the HEADWINDS. 🌬️I mostly don’t mind an honest sweaty hill climb, but I LOATHE headwinds, and erasing that resistance feels like MAGIC.

Screenshot of post from Bev Schechtman @ibdgirl76: "PSA of the Day:🚫 Patients: Refusing to take opioids after major surgery or trauma, doesn't make you a hero. 🚫 Providers: Denying opioids to a patient begging for relief doesn't make you a hero 🚫 Providers: And if you make fun of pain patients on social media as a healthcare professional? You’re not funny. You’re exposing the cruelty and bias that are killing people.Pain relief isn’t a moral test. It’s basic, humane care."

“Whoever is spared personal pain must feel himself called to help in diminishing the pain of others. We must all carry our share of the misery which lies upon the world.” ~ Albert Schweitzer