A cognitive intervention for wrist pain

The assumption is that stress can cause pain (by whatever mechanism). So yes, in the cases where RSI and perhaps other chronic pain is caused by stress, mindfulness meditation should alleviate the pain. I made a note to look into the research. If I get to it, I will post my findings here.

As for anecdotal evidence: I just searched for "chronic pain meditation" and got plenty of results. Also, I'm stressed now and sometimes some pain comes wafting through my wrists and forarms. I apply mindfulness (which I learned in 2016, long after the wrist pain subsided) when I want to fall asleep and at those times my wrists feel great.

As to Sarno, the only thing I confidently take from him is that stress can cause pain (sorry for repeating this often). Probably there's more – Sarno has cured many people – but we'd have to dig through and separate the true stuff from the wacky fluff.

Edit 2019-03-19: I now dimly remember searching my mind for suppressed rage whenever wrist pain increased.

Thanks for writing this! It's good to see more sceptical approach. Do you have any more recommendations for reading on the subject?

Not really, sorry. Wacky old Sarno did the job for me, so I didn't look further. Then I took what rational argument I could find and put it in the above article. However, for the people who think that the human body is easily broken, I'll repeat one recommendation from above: Through the Valley by Col. William Reeder.

EDIT: Another recommendation: When I have sports-related issues, I treat them with recommendations from Becoming a Supple Leopard by Kelly Starrett. And when this doesn't fix it, I call one of the PTs at what used to be MobilityWOD. Apparently they've changed their branding to ‘The Ready State’.

I've had RSI for five years now. I read Sarno, tried the Curable app, and tried on the hypothesis that my pain was psychosomatic. For my case, the benefit I've got from a more psychosomatic approach is to try to form fewer negative associations with the pain. I used to view the pain as an indication that my body was broken and that I was ruined. Now I still have the pain, but I have much less of that secondary psychological reaction to the pain, and that's greatly improved my life.

I've heard a similar story from a friend with chronic fatigue. Good for you!

[…] In my estimation, this article and other arguments that RSI is psychosomatic move too quickly from (true) evidence that chronic pain is a weird and mysterious to the claim that it must be psychosomatic.

I'm not saying that all RSI is psychosomatic. Sorry for not being clear. I just know that my case was psychosomatic, so I assume that it's psychosomatic for a certain unknown percentage of wrist pain sufferers.

My reasoning is this: I had severe wrist pain. And the physical remedies I tried didn't work. I read a book that gave me a few ideas and "thought remedies" and the pain went away. And it's been staying away for years, no matter how much I type. (As I mentioned in the article, I get occasional slight, which pains I attribute to stress and which go away quickly.) As the psychological change led to a physical change, I conclude that I've had psychosomatic pain. And since it's unlikely that only I had it this way, I conclude that there must be other sufferers of psychosomatic wrist pain.

The pain being ‘weird’ is not required for my argument. There is one paragraph mentioning ‘strange’ pain, but that's just one of my handwavy diagnostic criteria, not an antecedent.

I worry that saying that RSI is psychosomatic feels like it explains the condition, but really doesn't explain it very well. I like that in your post you make some predictions based on your hypothesis.

I'm not aware of any satisfying explanation. I just know that changing my mind somehow cured my pain, so I call it ‘psychosomatic’.

Actually I make another prediction in the comments: ‘If stress causes wrist pain and people stress out, because they think that typing is bad for them, wrist pain should be "contagious". Take an office full of workers who are doing fine. Then one starts having wrist pain for whatever reason, finds online warnings about RSI, tells their colleagues, they get worried about their work being harmful for them, and some of them also start having wrist pain.’

It would be informative to make a study of the EA and rationality communities and see if we find a contagion pattern. I thought about doing it myself, but my intuitions are stuck in the ‘RSI is psychosomatic’ camp. So I would just be seeing evidence the way I want to see it.

My impression is that the hypothesis of myofascial trigger points has better evidence and does a better job of explaining cases of RSI, and many people who argue that RSI is largely psychosomatic are not aware of the theory of myofascial trigger points.

This might be the explanation for the physical cases. I have skimmed the page on trigger points. And what you write about the foam roller and the lacrosse ball sounds like what I'm doing when I've messed up some body part with poor weightlifting form. This works well, even though I wouldn't explain the weightlifting pains with trigger points.

Another thing I'd like to warn against is trusting the ‘pleasurable feeling of pain’. Doing this, I once (or twice?) seriously messed up the muscles under my shoulder blade and later aggravated my elbow joint. All healed, though.

I should note that I'm probably biased against the hypothesis that RSI is largely psychosomatic. This is because it feels like the hypothesis trivializes my condition. Of course, I think this bias is silly, but I think I do still have it.

Trivializes it how? I wouldn't consider psychosomatic issues trivial at all. In fact, it's terrible that a mostly reasonable person like me can be kicked into a vicious circle of stress and pain by well-reputed and well-intended information from family, friends or the web. This is why I want to change the communication around wrist pain: help the people with purely physical pain, but don't make it worse for those with a penchant for psychosomatic issues.

I also wonder if this bias could explain why I haven't got benefit from a psychosomatic approach to my RSI. I do certainly seem to meet the psychological profile of people who are susceptible to psychosomatic pain I've heard described in books and media such as Sarno's.

I guess I'm the opposite. Sarno's arguments somehow made it into my brain to a degree sufficient to get rid of the pain. And being ‘magically’ cured this way has reinforced the psychosomatic hypothesis to a point where a "PSYCHOSOMATIC" neon sign pops up in my head whenever I hear about a mysterious, unexplained condition. Which in turn shuts down the mechanisms that originally caused the pain.

Of course, when I write about this, I try to shield my eyes from the neon sign and concentrate on established facts.

Just for fun (and not for argument, please), here's a little rave from the troupe that's providing the electricity for the neon sign:

Overuse injury from typing on a keyboard? Maybe. It is an awkward movement. But it appears absurd to me that using a mouse would lead to overuse injuries. Come on! We open and close our hands all day long, and flex our fingers with much greater force than is required for a click. And think of all the repetitive (handcraft) activities that people had to do in the past! Typing on mechanical typewriters, playing musical instruments, copying books by hand, grinding grain with a stone, knitting, sewing, spinning, weaving baskets and cloth, weeding, picking berries, making arrows, ropes and fishing nets, planing, sawing, cutting, hacking, thatching, carving, filing…

Heck, if typing was so bad for you, shouldn't half the secretaries of the mechanical typewriter era have fallen out of the workforce within three years?

I've written this post with my recommendations for treatment here. I have a section on the psychological component to RSI, but I don't discuss the hypothesis that RSI could be more or less entirely psychosomatic.

I saw that section and I'm happy that it's there. Thank you!

While doing pain-control directly isn't a useful long-term strategy that doesn't mean that the same is true for a mind-body approach that goes over how do deal with stress.

I think, as one grows old, one gets a better sense that the human body just breaks down sometimes, and doesn't repair itself perfectly.

And it repairs itself a lot worse when it's highly stressed.

If you have pain that you think is due to wrist inflammation, check out the literature and take action to the degree you can.

The problem with this is that checking the literature on page 1 of Google makes the problem much worse for people like me. Every article about ergonomics, RSI etc. should have a caveat: If your thoughts follow this pattern xyz, don't read the horror stories and fix your thoughts instead.

Here's another proposal (aka Richard Diagnoses Your Chronic Pain): Get yourself some legit strain from heavy physical work, then compare the sensation with your wrist pain. Is the wrist pain similar? Then it might be purely physical. If not, not.

For example, when I swing a kettlebell and pull it by extending my wrists, my forearm muscles have to generate more force than is good for forearm muscles. They get tight and pull on my elbow joint. Now when I flex my elbow, it hurts. This pain is different from my wrist pain. It's synchronous with the flexing motion. It comes predictably after swinging the kettlebell with bad form. It goes away predictably when I smash my forearms in order to clear the muscle tightness. The wrist pain in contrast comes and goes seemingly randomly. Sometimes it's the right wrist, sometimes the left, sometimes both. Sometimes it reaches up my forearms, sometimes down my hand. (I'm writing in the present tense. These days I have occasional mild pain. In 2014 it was much worse.)

Oh, and my left wrist is unhappy, because I sometimes get wrist locked during BJJ sparring. This pain is also different.

Charlie Steiner, your comment misquotes me.

If there was great productivity loss because of wrist pain, an economically oriented outlet such as the Wall Street Journal should report on it, shouldn't it? Except in sports, I find it mentioned in a few articles, okay. I made another note to look for statistics.

Here's a prediction that follows from my proposal. If stress causes wrist pain and people stress out, because they think that typing is bad for them, wrist pain should be "contagious". Take an office full of workers who are doing fine. Then one starts having wrist pain for whatever reason, finds online warnings about RSI, tells their colleagues, they get worried about their work being harmful for them, and some of them also start having wrist pain.

I asked my wife this morning if she has heard of anyone having wrist pain. She works in a company of 200 people, in a typical Japanese open plan office with the same small desks and mediocre chairs for everyone. And they're typing a lot on bulky laptop computers. She hasn't heard of anyone having wrist pain.

Why does stress make my wrists hurt rather than my toes or elbows? I don't know. Speculating and summarizing research about that would be another article. Why do people get psychosomatic chest pain and start worrying about it and that makes it worse? I don't think it is, but it could be a selection effect: if my toe randomly starts hurting a little, I don't worry about it, I don't get more stressed, I don't get more pain. It's different with the wrist.

Thanks! Maybe I can reduce my stress by referring people to the book instead of writing a series of articles. ;-)

Short answer, if you want to try a psychological approach (hopefully you will get better before you've tried all of this):

1. Read my article carefully several times. If something is unclear, you can ask questions in the comments or send me a private message.
2. Read John E. Sarno's The Mindbody Prescription.
3. Learn cognitive-behavioural (self-)therapy.

There are several options for cognitive-behavioural therapy, from cheap to expensive.

• David D. Burns' book Feeling Great. Review here. [LW · GW]
• An app such as Sanvello, Mind Ease or UpLift. (Disclosure: Mind Ease and UpLift are made by companies that are closely related to the one where I work.)
• A therapist who offers cognitive-behavioural therapy. I don't have any experience with this, but https://astralcodexten.substack.com/p/peer-review-request-depression, the author of which I trust, has a section ‘How can I get a therapist?’.

Meditation can be helpful if you want to improve awareness of body and thoughts. But it's a wide field and there are risks.

Whenever you try an intervention, pay attention to whether it makes you feel less stressed and more relaxed, and whether your wrists feel better.

One physical intervention, just in case: Do you type a lot? If yes, have you tried different keyboards? Most keyboards are fine for most people, so I don't think you need a super expensive super ergonomic one. But some keyboards give even me trouble and it's worth ruling that out. Go to an electronics shop and try the keyboards there. Does typing feel better than with your normal keyboard? If you don't have an electronics shop available, the Microsoft Sculpt Ergonomic Keyboard is a safe bet. It's around 60 USD.

Note that I'm neither a doctor nor a therapist. All the above is based on my personal experience or what I've heard.