Bibliographic record
Abstract
Dear Editor: The neurophysiological mechanisms and comorbidities of anxiety and depression with chronic pain cited by the authors1 serve as evidence of correlation, not causality. When A (neurophysiological mechanism) and B (symptom of chronic pain) occur together, it cannot be concluded that A causes B, because it could just as well be that B causes A, or a third factor causes both. Regarding the comorbidity of chronic pain with anxiety or depression, it could be that these forms of psychological distress result from chronic pain due to physical impairment, that the pain is a symptomatic expression of anxiety or depression, or that underlying psychosocial issues are causing both. A mentor of mine used to say, “You can’t have a bad thought without a bad molecule, and you don’t know which comes first,” and this paper proves that adage. When a symptom or condition is diagnosed as psychosomatic, this should not be done solely by exclusion, that is, lack of objective medical evidence. There should be positive substantiation through identification of psychological factors that provide an understanding of what is going on in the life of the patient. The ability to at least ballpark such situations should be in the therapeutic armamentarium of every physician, while psychiatrists should be able to provide biopsychosocial formulations as a core skill. By doing so, we help our patients by empowering them to deal with real life problems, as opposed to placing them in a position of passivity as recipients of a medical solution. Problems occur when psychosomatic diagnoses are communicated poorly, such as “There’s nothing really wrong with you” or “It’s all in your head,” and when patients are not ready to assume psychological ownership of personal problems. Either of these can result in demonization of physicians who make such diagnoses, in the former case justifiably, not so the latter. Case in point: the diagnosis of tension headaches seems to have disappeared from the medical lexicon, because everyone has migraines. Despite their potential severity, tension headaches are not seen as medical enough, place an onus on patients to deal with whatever source of tension is causing the headaches, and places physicians who make this diagnosis at risk of demonization for allegedly blaming patients and minimizing their suffering. By contrast, the diagnosis of migraine is perceived as more validating and more supportive, leading to a proliferation of migraine diagnoses and treatments. Just as the failure to make a medical diagnosis can have serious consequences in patients with chronic pain and other medically unexplained symptoms, so, too, can the neglect of a psychosomatic diagnosis, in terms of extensive and fruitless investigations and consultations, iatrogenic complications of questionable treatments, and reinforcement of illness–disabled role issues at the expense of dealing with real problems. The mind is more than the sum of the neurochemical parts of the brain, and the failure to recognize this places us at risk of falling into a mindless brand of psychiatry.2
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.003 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.001 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.003 | 0.001 |
| Research integrity | 0.009 | 0.016 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".