There are countless treatments available for pain if the Internet is any indication. Often, the description of a therapy is accompanied by explanations, endorsements and testimonials. When I read some of these things I am often impressed by the stories of relief and the passion with which they are told. I’m convinced that many who offer a treatment or testify about its effectiveness sincerely believe what they are saying.

But to me that is the problem. I’ve seen as many or more failures than successes. We certainly have no sure-fire cures. I think that we doctors and patients alike start believing in our own explanations for the things that seem to work for us. Our lived experience of pain relief or of seeing a patient respond is real, making it easy to overlook the contradictions to our beliefs. We sometimes explain away those times when our beloved therapeutic interventions don’t quite work so well.

Our tendency to fool ourselves is aided and abetted when money and power are at stake, hence the inevitable politics at every level of pain care. There is competition for recognition of different therapies/theories, competition for research funds, competition for pay and competition for status.

Given all this, it is hard to remain objective and think clearly about pain treatments. It may be impossible to be truly objective but at the very least we need to be on guard against uncritically endorsing the things we want to be true because we will profit from them. Learning to think rationally and honestly isn’t easy but is necessary if we are going to improve how we care for pain.