Chapter 6: The Scientific Evidence
Whenever you hear or read advice from a “health expert,” ask yourself two questions before you begin following their recommendations. (This applies to me, too!)
Are they making a profit from the advice they are providing or the product they are selling? If so, there is a potential for a conflict of interest. (Dozens of these products are currently marketed for PPD conditions.)
Do they have scientific evidence (published in peer reviewed journals with high standards) that supports their claims?
If you read my last chapter, you know that I am very careful not to have any financial conflict of interest. I donate all earnings linked to PPD to the PPD Association which is approved as a 501(c)(3) non-profit by the IRS. The Board of Directors also works without financial compensation and, individually, they donate generously to the PPDA.
As for scientific research, books have been written about how to evaluate and interpret evidence. Even experts can be tripped up. But publication in well-known journals including The New England Journal of Medicine, the Annals of Internal Medicine, the Journals of the American Medical Association, the Lancet and the British Medical Journal means that experienced reviewers have screened the research for quality and for the importance of its conclusions. Also, if more than one study reports similar results, that improves confidence in the conclusions.
For decades, the PPD community could only report individual case histories as evidence supporting our practice. The cases made a great deal of logical sense and, collectively, there were thousands of them. In addition, those patients had failed to improve with their usual medical care and had great relief with the PPD approach. But this was not enough to shift medical practice toward significant change.
“Many studies showed links between chronic pain and Adverse Childhood Experiences.”
Gradually, however, evidence began to accumulate. Studies showed that psychological factors could alter the perception of pain and were better predictors of the outcome of chronic pain than diagnostic tests of organs and structures. Other research showed there were changes in nerve pathways in the brain in people with PPD conditions. This work reassures many patients that their condition originates in their brain, is not imaginary and is definitely not “in their heads.” Many studies showed links between chronic pain and Adverse Childhood Experiences (ACEs). ACEs are likely to be an important contributor to the altered brain nerve pathways in PPD though studies to confirm that would be challenging to design and implement. But all this evidence was published in a large number of diverse medical journals, so few clinicians are aware of the quality and quantity of evidence supporting a PPD approach.
Finally, there is no substitute for the gold standard of clinical research, the randomized controlled trial. In the case of PPD, evidence would only be accepted as conclusive if Pain Relief Psychotherapy (PRP) was tested against control groups consisting of traditional forms of treatment and found to be much more effective. In 2023, several such studies are available including from the group led by Allan Abbass MD in Halifax, a trial in fibromyalgia patients in Michigan (Lumley M, Schubiner H, 2017), a trial in older male veterans in Los Angeles (Yarns BC, 2020), the Boulder (Colorado) Back Pain study (Ashar Y, 2021), and a trial at Harvard (Donnino, 2021). This research showed dramatically better outcomes for several closely related versions of Pain Relief Psychotherapy than were achieved in the control groups. The controls included Cognitive Behavioral Therapy, Mindfulness and even injections into the spine. The Boulder study also showed changes in the anatomy of the brain after just eight sessions of PRP.
You can find these studies and over two hundred more in the annotated bibliography elsewhere on this website. This research has been convincing enough to attract major financial support for further studies which are currently underway.
