Understanding the Limitations of Therapies

Medicine, for all its advances, runs up against walls. Not everything works for everybody, and nothing works perfectly for anyone. The concept of “therapeutic limitations” means every treatment has a ceiling—and no single answer fits all.

Why Do Treatments Have Limits?

●      Human biology is varied: The same drug that’s a miracle for one may do nothing, or even harm, another.

●      Pain is multipronged: It’s biological, yes, but also metabolic, psychological, social, and environmental.

●      Evidence is group-based, not person-based: Group data doesn’t predict individual responses.

When Science Meets Real Life

Even with the best systematic reviews, we see:

●      Some people get 90% pain relief.

●      Others get worse.

●      Same treatment, different stories.

That’s why it’s crucial to set expectations. If you try Duloxetine, anti-inflammatories, or exercise—and see minimal change—that’s not a personal failure. It’s baked into how treatments work and has nothing to do with personal failure.

Pain Neuroscience Education & Other Interventions

Let’s take pain neuroscience education. Randomized studies show that, on average, attitudes toward pain improve by 15-20%, but actual pain ratings may barely budge. Similarly, psychological therapies help some, but barely touch others. It’s important to understand which aspects of the pain pie you are treating with various therapies or approaches.

It’s All About the Mix

No one treatment is the magic bullet. More often, improvement is the sum of small gains from different approaches—20% here, 10% there:

●      Medications: Small to moderate effect sizes, can come with high side effects

●      Exercise: Good odds, but not dramatic and improvements happen over time

●      Psychological support: Especially valuable for those with high anxiety, depression or prone to catastrophizing and amplifying pain further

●      Interventions/devices: Sometimes transformative, sometimes neutral, you need the right one in the right person

You stack up those percentages, whittle down pain in different ways, and hopefully—over time—carve out meaningful improvement.

Evidence-Based Medicine Isn’t Just About Science

Classic evidence-based medicine asks us to blend three things:

●      Best scientific evidence

●      The clinician’s expertise

●      The patient’s preferences and goals

It’s a conversation that is unique to every person and ought to be tailored to the individual —not a prescription pad.

Setting Expectations is Key

Understanding these built-in limitations helps:

●      Adjust expectations, so you’re less frustrated as you trial various things

●      Reduce self-blame when a treatment “fails”

●      Advocate for yourself to explore and personalize your options

It all comes back to acceptance that medicine works in shades of gray, and success in chronic pain is nearly always gradual and incremental—not all or nothing.

In the end, recognizing and respecting the limits of each therapy helps you become a more empowered, resilient, and realistic participant in your own care.

For more insight and practical advice, tune in to episode 9 of It’s Not in Your Head Podcast.