A Holistic Paradigm for Naturopathic Pain Medicine

Shandor Weiss, ND, LAc

Pain protects us from self-injury and informs us of problems in our body. But pain that continues past its purpose becomes a serious obstacle to our quality of life, health and healing. Persistent or poorly treated pain leads to a vicious cycle in which pain itself is the main disease. That’s why one of the most important goals of good health care is the effective treatment of pain.

Unfortunately, many pain patients suffer needlessly. Often they have not received a correct diagnosis of the cause of their pain, resulting in ineffective treatments, or treatments that merely mask the pain but do not remove or cure the cause. Patients then must endure untreated or partially treated pain, complications from pain and/or pain therapy that have their own risks, unwanted side effects and ongoing costs.

Pain patients have more complex problems than most other patients. Naturopathic medicine is ideally suited to treat these complex and multi-factorial problems, because it is based on treating the cause and treating the whole person. But what is a “cause,” and what is “the whole person”? How do we define causes and causal relationships? These questions are extremely important when treating pain patients. If we don’t ask the right questions, we won’t get the right answers. We can only treat causes that we can find. And we only find those causes that we look for. We only look for what we think of. Therefore, what and how we think in the practice of medicine – our paradigm – is of the utmost importance.

Evolving Tolle Causam

Most doctors of all types think that they “treat the cause.” What is meant by this injunctive depends on the medical paradigm followed by each type of physician, and by each individual physician. Generally, the conventional medical paradigm is more limited than the naturopathic paradigm. This is especially true when it comes to determining causes. But the conventional pain medicine paradigm is rapidly becoming more holistic than the rest of conventional medicine (e.g., Boswell and Cole, 2005). While the naturopathic community may applaud the movement of conventional medicine towards a more holistic model of pain medicine, we should also be evolving our own paradigm of pain medicine. It is not enough just to think and say we are treating the cause, even if we think of more causes to treat than conventional doctors.

To obtain the best results, it is essential to have clearly defined strategies based on a truly holistic paradigm. We need strategies for treating many levels and types of cause, predispositions of cause, contributing causes, changing causes, results of causes, locations of cause, mechanisms of cause, causes that are adaptations or compensations to other causes, and obstacles to treating causes. These strategies begin with a mental map – a paradigm – that describes the terrain in more precise terms than “cause” and “treat the cause.” Our minds can only travel down roads we have named and mapped. These traditional terms and principles are good starting points, but they are inadequate for finding our way when treating chronic and complex pain patients. We need a more complete map, with the names of more highways, roads, trails and destinations.

Treatment strategies are like travel plans. They may change as we go, but the more detailed the map the more options we have. In a holistic paradigm, strategy maps are not two dimensional, as ordinary maps are; they are multi-dimensional in space and time. “Space” is the terrain or territory to discover in terms of the many types of causes. Although this terrain is at least three dimensional (3-D), it can be deconstructed and constructed in two-dimensional layers … much like the way overlays are used, or how 3-D models are made by computer programs and printers. Since our analytical minds work best by building up two-dimensional layers, strategizing begins with creating a series of two-dimensional models of the terrain. As we create these maps, we then overlay them to create a 3-D picture of the causal terrain. We start with more general categories or levels of causal factors, and find our way by traveling down logic trees or map branches, expanding them into more detail to find more specific causes.

The map is constantly changing as we move through the terrain of the patient’s healing process. This movement is “time.” The usual way in which we think of time is that it has a starting point in the past, a moving present time and a future ahead of the present. But real causal time is not limited to a linear progression in one direction. In the holistic map of causal relations, time consists of simultaneously existing interactions and feedback loops in which there is no clear distinction between past, present and future. Like in a Star Trek: Next Generation episode, time moves back and forth and all around in the mind, body and life of our patients. In holistic causal mapping, time is the connectivity between the layers that make up the spatial terrain.

Our usual way of taking chart notes is with words and sentences written in lines. This is linear. It works for many cases, but with complex pain patients it may be helpful to also use drawings. As we take a patient’s case, we can spread key factors around a page and draw connections between them as we go. Or, linear notes can be converted to a mind or concept map as we analyze the case, either while with the patient or afterwards. Simple flow charting or mind mapping computer programs can be used, but using a plain piece of paper, preferably with colored pens or pencils, also works. Graphic mapping is the best way to synchronize the way our minds work with the way things really happen to and within patients.

Graphic Mapping

We need multiple types of maps or graphs because there are too many factors to think of or to write down at one time in two dimensions. In fact, we should think of all our maps as overlays that form at least three dimensions in space, plus time as a fourth dimension. There are more dimensions that can be used to represent reality, but these four are the minimum needed.

When using these maps, we can start anywhere and go anywhere to get results. We could find the most important key to solving the case in any type of map and in any part of the map. It is like putting together a jigsaw puzzle or completing a word puzzle: Whatever pieces or letters we can fill in help to find the rest of the picture or puzzle.

To begin mapping holistic causes of pain, we need to define the terms we use. These terms are like the key or legend of the map. This is important because we think with words and names. Each of us might find and define our own terms in the maps we use. Here are some mapping concepts and definitions that I like to use:

Recent or Present Cause: This is the story you will first get from the patient, if it is known. “My back pain is from the car accident I was in,” is an example in which the accident is the cause.
Result of the Cause, Injury or Pain: Are we treating a cause, or the result of a cause? A car accident is a cause, and back pain is the result of the cause.
Contributing Factors of the Cause (or of the Result): This may or may not be important. For example, contributing factors to the cause of a car accident could include intoxication, poor vision, a stiff neck, hypoglycemia, mechanical failure, black ice on the road and so forth. Some contributing factors are important to deal with in preventing a recurrence of the cause or result. Others are important to treat to get results with the present pain problem. If the accident victim had a broken bone, a contributing factor may be osteoporosis.
Triggers of Pain and Related Symptoms: Triggers or aggravating factors are often obvious, but they may be confused with causes. It is important to know the difference.
Location or Origin of Injury or Pain: This also may seem obvious, but mistakes often are made here. We usually think that pain comes from injured tissues, and then try to treat or heal those tissues to relieve pain. In theory, healing of injuries will lead to abatement of pain. But often the patient needs more immediate relief from pain originating from another site or tissue than the original injury. Muscle spasms or tension associated with many injuries, for example, are often the cause of most of a patient’s pain … even when there is damage somewhere else. There are countless cases in which the actual location of where the pain is coming from is different than the original site of pathology. There are also many cases where the origin of pain is not diagnosed because it is not visualized on imaging studies or other tests.
Tissue Source of Pain: We need to know if the pain is coming from nerves, ligaments, tendons, organs, muscles and so forth. We cannot get good results if we are looking for or treating the cause in the wrong type of tissue. Also, keep in mind that tissue types that cause pain can be on a cellular or molecular level.
Mechanism or Pathophysiology of Pain: This is one of the most important types of causes. I always look for the mechanism in each patient’s pain. There is always a mechanism, regardless of what other levels or types of causes there are. Ask yourself, “How is the cause actually causing pain?”
Compensations or Complications of Pain: These are also called adaptations or maladaptations, and include sleep loss, depression, social withdrawal, stress and many other changes. The most common compensation is a change in posture, which leads to a vicious cycle of worsening pain problems. It is imperative to correct posture in pain patients.
Obstacles to Healing or Treating the Pain: As NDs, we know about obstacles. Pain patients often have more than others. It is imperative to find and remove all obstacles to recovery.
Past or Pre-Disposing Causes: These are the conditions or events of the patient’s life that led up to or contributed to the current problem. They may be seen as deeper levels of cause and may be important. However, some past causes may no longer be relevant. It is helpful to figure out what is or is not important about the past, especially with older patients who have a longer life history.

Figure 1 shows a diagram of types of causes. The doctor can start at the top and go clockwise in an investigation. However, it can be just as valuable to start or follow and connect the causes in a variety of ways.

Causal Levels

Each causal link in the etiology of pain can be expanded with its own flow chart, diagram or mind map. A favorite area of mine to investigate more fully is the mechanism of pain. Figure 2 is focused mainly on physical or structural mechanisms. A similar diagram could be drawn for mechanisms (or causes) on many other levels. In fact, identifying and mapping causal levels is extremely valuable. Causal levels are echelons of our existence. The triad of body/mind/spirit is a commonly used model of levels. In actuality there are many other kinds of levels of existence. Some people think of these levels as hierarchical in causal relations. For example, spirit is “higher” than mind or body. While this may be true in some ways, doctors can make serious mistakes in attaching undue importance to a trickle-down theory of causal levels. That’s because a therapy may be chosen based on treating a “higher” level in order to affect a “lower” level. But this might not work. As a general principle, the best results are obtained by treating the level of cause with a treatment that works on the same level. For example, if a patient has pain from a joint subluxation – a physical, body level – it will be much easier to treat with a physical level treatment, like manipulation. On the other hand, if the subluxation keeps recurring due to a disorder on an energetic level, then an energy medicine may get better results. It is especially important to match the level of treatment to the level of cause. Knowing the right level of a patient’s problem is often the key that opens the door to successful diagnosis and treatment.

Figure 3 shows some of the types of levels I use. Due to space restrictions I will not expand on what each level means or consists of. Suffice it to say that each level can be expanded to create another map with many different categories within it. The important items to identify in terms of levels include:

Where the problem comes from
Where it has gone
Where it has spread to
Where it can be accessed or treated most effectively, keeping in mind that causes can come from and go to different levels

Each doctor may want to create his or her own map of levels (and causes).

Using causal maps can be a powerful tool for selecting the right treatment strategies. But we must be careful not to be limited by our maps. In other words, our maps should be constantly evolving to include new information as we learn and gain more perspectives. The accompanying sidebars illustrate this point. In each condition or case, the cause(s) of pain was something unusual or new to my mind maps. If I had not been open to thinking “outside the map,” I would not have been able to find the cause and therefore help treat the pain.

These cases show how finding and treating actual and/or unusual causes leads to pain relief. Often the cause of pain is much more straightforward. When it’s not, it takes real medical detective work to find and treat the cause. But, “the cause” is often complex and dynamic. Holistic pain medicine is greatly facilitated by replacing the concept of a “cause” with an open-ended view of multiple types and levels of causation. Causal or mind maps are a useful tool for seeing the whole picture, by putting all the pieces of the puzzle together with one view. This leads to the selection of successful strategies, interventions and healing plans. Causal mapping is also an excellent educational tool for patients. Simple flow charts and diagrams can help patients understand the doctor’s assessment and treatment plan. In fact, when patients finally see the causal picture of their pain problem, they often have an immediate sense of release and relief. Finding the cause in this way is in itself a healing modality.

Causal Factors and Fibromyalgia

There are many theories as to the cause of fibromyalgia (FM). Using the terms of causal factors described in this article, I have found that FM is a complex multi-factorial pain condition. However, FM patients almost always have one basic predisposing or past cause that leads to the cascade of events that is FM. FM in turn causes many other changes that produce a plethora of signs and symptoms. No amount of treatment will cure FM unless it addresses the “underlying” cause. With FM, this underlying or root cause is very much like the roots of a tree that have to be dug up, rather than cutting off the branches or even the trunk of the tree.

This past or predisposing cause of FM is pain itself … but not just any pain. FM patients have pre-existing suppressed, untreated, uncontrolled, minimized or ignored pain. Although FM patients have hypersensitivity to pain, FM arises as a reaction to severe acute or moderate to severe chronic pain. The nervous system increases its sensitivity to such pain in an attempt to tell the person that something hurts. Eventually everything hurts. Changes in pain-regulating chemicals (e.g., substance P) and brain responses create widespread immune, hormonal and neurologic imbalances that lead to the diverse symptoms of FM.

The main types of pre-existing pain that lead to FM are:

Whiplash injuries leading to facet joint syndrome. Most doctors do not diagnose this, and tell the patient there is nothing wrong; therefore, there is no treatment for the pain. The patient suppresses pain signals from the neck, because he or she has been told there is nothing wrong. Complicating the problem is the nature of the neurologic anatomy in the cervical region: multiple ganglia and cross-signaling nerves spread pain sensations to a wide area, making it hard for a patient to identify a specific pain location. The patient adapts with increased muscle tension, decreased ROM and stiffness. There may be concomitant headaches, stress/panic attacks, back or shoulder pain, and many other symptoms.
Pain from competitive athletics like sports, dance or gymnastics, because the athlete learns how to suppress the constant and ongoing pain; old injuries that are not healed, and are still a source of (suppressed) pain. This can become a predisposing mental or personality factor if there is a new pain later in life, as from an injury: The past pain suppression training is applied to the new pain.
Victims of physical abuse, who have learned to suppress pain and who may have low self-esteem, leading to inadequate pain care for themselves and poor pain coping skills.
Conditions like arthritis, which cause gradually increasing levels of pain, with inadequate pain relief.
Chronic pain patients whose pain is minimized or inadequately treated by doctors.
Acute post-traumatic pain (from injuries, surgeries, etc.) that is inadequately treated can lead to a sudden onset of FM.

Finding and treating the source of preexisting pain and other predisposing factors in patients with FM is essential. One of the main strategies for reversing the effects or causal links of FM is to reduce pain. While most patients in pain want pain relief, with FM patients reduction of pain is a treatment strategy in and of itself. Pain should be managed aggressively in order to “convince” the body/mind that it can lower its sensitivity to pain.

Remember that porphyria can mimic FM, and patients may have both conditions. Porphyria is much more common than one would think.

Affliction

Many chronic pain patients have a problem I call “affliction.” Affliction comes in two main forms: with and without awareness. When it is with awareness, the patient usually describes it as negative parental (or sometimes sibling or spousal) conditioning from childhood. Patients have often worked on the “issues” involved for years, whether on their own and/or with psychotherapists and other healers. They hear “tapes” and “memories” of negative dialog with the afflicting person(s), which is what they work on. They generally also have problems with low self-esteem and with standing up to the person causing the affliction, and this leads to problems in career, addictions, relationships, stress, panic attacks, depression, sleep, etc.

When it is without awareness, the patient thinks that all the negative self-talk and behaviors are the “bad” parts of themselves. They blame themselves, feel guilt, remorse and despair about changing themselves. They may seek therapy in many places, but it does not help much.

What I have found is that often, the “internal” dialog is not memories from and the effects of past conditioning, nor is it one’s own negativity. Affliction is actually a form of real-time telepathy. It is a psychic dialog and energetic exchange between the person causing the affliction and the patient. There are also overlays of a more psychological nature. But the mechanism of affliction is psychic. It operates by telepathy, which the patient experiences as his or her own thoughts. It also operates in dreams and other energetic exchanges. Conventional therapy is never successful in getting rid of the dialog, because it is working on the wrong cause and level.

When I discuss affliction with patients, they almost universally acknowledge the truth of it, even if only after an initial objection. For example, after describing affliction to one patient, she said, “I knew it! I knew those thoughts were my mother’s, but I didn’t believe it. I thought I was crazy.”

The “purpose” of affliction is to maintain control and/or to punish the afflicted. Affliction is a subtle, yet powerful, form of control. Usually it is from a parent to a child. The child is conditioned since birth – or before – to be sensitive to and respond to the parent. If the child does anything to displease, go against or cause trouble for the parent, the child gets afflicted. It is a psychic form of behavioral conditioning.

The relationship of affliction to pain is simple: People who are afflicted often are chronic pain patients. Many such patients report the onset of pain symptoms as “attacks.” These attacks correspond to times of affliction. During these attacks, all kinds of body pains occur. They can be severe, a “10” on a pain scale of 1 to 10.

Affliction also creates many other causal factors in pain patients, such as:

Sleep deprivation: Patients are afraid to go to sleep because affliction can happen in the dream state. Sleep is also disturbed and non-restorative. This induces a catabolic state in which healing does not happen.
Many concomitant symptoms: These challenge the doctor and make the patient’s life miserable.
Poor compliance: Affliction causes the patient to abandon therapeutic recommendations and/or to make mistakes.
General stress: Afflicted patients have high levels of stress.
Mental health problems: Depression, anxiety, panic attacks, addictions, mood swings and more are common problems with afflicted patients.

There is not enough space here to say more about affliction. My point in describing it is to show how there can be causes that we do not consider. Patients with affliction rarely get better by treating other, more easily identifiable causes. Affliction itself can be difficult to treat, but at least with a correct diagnosis, there is a chance for recovery.

“Levels of Cause are Like …”

The concept of treating “levels” can be understood better by comparing patients to something else; i.e., “This case is like … .” As a mental exercise, each doctor may wish to choose one or more analogies, develop them and then use the correlations to improve their diagnosis and treatment of causes with patients. This can help to reorganize our neural framework, so we don’t get stuck in ruts of routine thinking or habitual practices.

Each analogy chosen should be something familiar. Car repair, gardening, specific sports and computers are examples of good analogies. I’ll use computers here to illustrate how it works. Let’s say the Internet browser (e.g., Internet Explorer) is freezing up, or slowing down so much it is almost frozen. This happened recently to me, so I am familiar with it. I’m no computer expert, but with just a beginner’s understanding, I created this model of levels of cause:

The most basic levels that could have a problem are:

the computer’s software
the computer’s hardware
the Internet connection
the web site(s) being connected to
the computer’s power supply and electrical functions

Each of these levels can be further divided into varying “levels of levels,” or categories of levels. For example, a few categories of levels of software might be described as:

the operating system
major programs like word processing, databases, etc.
Internet service provider connection programs (e-mail and ISP)
security utilities like firewalls, spam blockers and virus checkers
infections like viruses, worms, Trojans, spyware, etc.
other (there’s always an “other” category for all that we can’t think of or don’t know at the moment)

Mapping software levels can get extensive, just like mapping human functional levels. But before going any further, we would want to know if the problem is on the level of software. If it’s a hardware problem, we could waste many hours trying to track down a software cause. If you have ever been in that situation with your own computer (and who hasn’t?), you can appreciate how important it is to focus on the right level. No amount of software diagnosis or repairs will fix a hardware problem. And no amount of hardware solutions will fix an electrical problem. Sometimes it’s just a matter of checking the modem connection to see if a wire or plug came loose. Sometimes we don’t know what the problem is, but if we know the level, we can fix it. Many complex computer problems have been solved simply by unplugging the power supply, removing the battery (if there is one) and waiting a few minutes before plugging in and starting up again. That fixes a cause on the electrical level.

It is exactly the same when working with patients. We should be careful not to indulge in using therapies we like – therapies that work on specific levels – even when access to the case’s level of cause is through a different kind of therapy. For example, homeopathy works well on the energetic level. If the primary cause is on an energetic level, then homeopathy can be a wonderful tool. An energetic treatment can even work if the cause is on another level and that level can be influenced from the energetic level. For example, gross traumatic bleeding is mainly on a structural level. Micro-vascular bleeding is also structural, but it has more of a biochemical or molecular structural level aspect to it. Homeopathy can reduce microbleeding, because the mechanisms that come into play can be influenced by subtle energies. But homeopathy will not stop bleeding from a large wound, because the level of cause is beyond its reach or capacity. On that level, a more physical treatment, like sutures, is needed. This may seem obvious … and it is, because I chose an obvious example. But what about a situation that is not so obvious?

Let’s say someone has a nutritional deficiency. It could be a macronutrient, a vitamin, mineral, antioxidants, and so forth. What the patient really needs is food or supplements that contain the missing substance(s). A homeopathic dose of the deficient nutrient will absolutely not work in such cases! That’s because the cause – and the cure – is on an entirely different level. If you tend to doubt this point, if your mind is starting to think of exceptions in which homeopathy can fix gross nutritional deficiencies, try this: Make your favorite meals for breakfast, lunch and dinner. Then make homeopathic remedies of each one. You could even make a very low potency. Then take a dose of each homeopathic meal for a day. If you are right and the energetic level treatment works, you should not get hungry or tired. In addition, you should be able to continue this way of eating indefinitely, without suffering any ill effects to your health.

Treating patients on the wrong level is like asking them to use homeopathic remedies for meals instead of food. We all know that won’t work, yet we make similar mistakes regularly. Using analogies can help us see our mistakes and correct them. For example, we know that cars need fuel in order to run. If a car won’t start because the tank is empty, no amount of fine tuning or mechanical or electrical repairs will work. On the other hand, if the tank is full but the fuel pump does not work, putting high-performance additives in the gas also will not work. We understand these things about the analogies in our everyday lives, but when it comes to treating patients we often make irrational mistakes. That happens whenever we fail to see the level of cause that needs to be treated. It also happens if we are attached to treating on the same level all the time, regardless of whether or not that is the level that needs treatment. By using analogies we can examine our practice and see if our treatment strategy is optimal.

Two Case Studies: EMF as an Unusual Cause

EMF Case 1: A patient had one eye that was always inflamed, swollen and painful. Numerous doctors could not find a cause, so the eye was treated with steroids. Using electrodermal testing, I found that the cause was irritation from electric charges generated by metal dental materials (called the “battery effect”). Replacement of a metal crown with a non-metallic crown resulted in a complete remission of symptoms.

Many patients suffer from chronic neck pain, jaw pain, headaches and even more distant pains from electromagnetic fields. More information about this topic is on my Web site, www.aruraclinic.com.

EMF Case 2: A woman had irregular episodes of severe back pain and other symptoms for many years. She had been to see numerous holistic doctors, including NDs. She had not been able to find the cause of these pains, nor to find a way to relieve or prevent them. She described the pains this way:

“It started a couple nights ago with a tsunami dream. Then the next day I started to get very irritable and didn’t want to be touched. That night I woke up about 2-2:30 a.m., wide awake and unable to go back to sleep. [I] was starting to hurt all over. I fell back to sleep about 6 a.m. and slept until 9 or so. Pain escalated all day yesterday, especially migrating over my back from top to bottom as well as extreme muscle tightness and difficulty breathing due to it. Even though I hadn’t slept much the night before, I was unable to rest yesterday due to the pain.”

This patient suffered from hypersensitivity to ultra low frequency (ULF) and extremely low frequency (ELF) wavelengths generated by earthquakes. Some people are extremely sensitive to such waves. They cause stress reactions that can be experienced as headaches, systemic pain, pain in specific areas, migrating pains and pains associated with bizarre sets of symptoms.

These “Earthquake Waves” are different from the standard fast and slow shock waves that earthquakes generate. They are actually a type of radio frequency. The theory of how they are generated goes something like this: Tectonic plates generate tremendous pressure along fault lines. This pressure causes the release of electrons from quartz in the continental plates. The electrons rise to the surface and create ions in the atmosphere, which rise and react with the ionosphere. This reaction generates the ULF and ELF, which then bounce off the stratosphere and are spread around the globe. ULF and ELF therefore spread around the world, rather than locally as with other earthquake waves.

Does this sound like science fiction, or an episode from a TV show? Or something a weird ND made up? It’s not. Although recently “discovered,” ULF and ELF from earthquakes is a real, natural phenomena. Scientists think it may explain why or how animals can sense an impending quake or tsunami. Earthquake waves build up for weeks before a major quake, peak at the time of the quake, and then gradually decline for weeks afterwards. A company is now contracting with the government to place hundreds of ULF/ELF sensors around California in an effort to learn how to predict earthquakes (Young, 2005; Earthquake Forecasting Web site, n.d.; EDG web site, n.d.).

Pain from Earthquake Waves is the kind of cause that no one would find unless they already had it in their mind to think of and look for. I would not have known of it, except that once a patient told me, “The migraines come whenever there is a major earthquake, anywhere in the world. I get them a day or two before the quake. Without fail, I’ll see on the news that a major quake hit somewhere, but by then I am in a lot of pain.” This patient discovered the connection by herself. She was willing to tell me about it, but didn’t tell her other doctors for fear that they would think she was insane. I almost discarded her story, but I stayed open to it and eventually found other patients whose pain was caused by ULF and ELF from quakes. Then I learned the science behind the phenomena.

Shandor Weiss, ND started the Arura Clinic in Ashland in 1989. Licensed by the state of Oregon as an ND and acupuncturist, he also has specialty training in homeopathy, environmental and body-mind medicine. Dr. Weiss received his undergraduate degree in ecology and environmental studies from Hampshire College in Amherst, Mass., then moved to Berkeley, Calif, to study natural and holistic healing. He completed his education in Portland, graduating in 1988 from NCNM and the Oregon College of Oriental Medicine. Dr. Weiss served as a research consultant to the National Institute of Health’s Office of Alternative Medicine; has written many lay and professional articles on health; and enjoys reaching the public through lectures, teaching, radio and television. As an ND, Dr. Weiss integrates environmental medicine and an ecological model of evaluating patients as an integral part of his practice.

References

Boswell M and Cole BE (eds): Weiner’s Pain Management: A Practical Guide for Clinicians (7^th ed). Sonora, 2005, American Academy of Pain Management.

Young K: Space station earthquake experiment on shaky ground, New Scientist Apr 18, 2005.

Earthquake Forecasting Web site: www.freewebz.com/eq-forecasting/128.html#Sensitives

EDG Web site: http://home.netcom.com/~edgrsprj/124.html

“Levels of Cause are Like …”

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