Monday, June 18, 2007

The Problem with OMPT: Part II

The following is something I wrote this morning in the MyPTSpace pain forum in an attempt (which may be in vain) to clarify what I'm wanting to show by doing a study on DNM:
I'm not sure why you think pain patients are a different group than regular patients. Do not all patients who arrive for PT treatment have pain, or at least discomfort when they move parts of their body? Is that not why they come in the first place? Seems to me that all PT outpatients have at least three things:
1. Intact functioning nervous systems, i.e., no major neuro deficit
2. Skin, usually intact and also functional
3. Pain of some kind.

They may or may not have some kind of mesodermal joint/bone/muscle problem. We just don't know. Even if they do it may or may not have anything to do with the discomfort they feel. These are correlations, and we may not assume cause if we are serious about being clinical scientists. Yes we've been "trained" to treat as if cause were to be assumed, but in fact, "education" tells us we can't get away with that if we are going to start sorting our profession out a bit more logically.

So, what do we do with all these people coming in to see us that may or may not have a mesoderm issue but who almost 100% of the time have a pain complaint? Well, why not devise a way to lower the pain factor *first*? Then, all the patients for whom the pain was causing the "impaired" function, will separate themselves out into a beautiful and identifiable "subgroup", leaving those whose pain may be lessened but who still have a *mesodermal* impairment of some sort, in another beautiful and identifiable subgroup, who then can go on to be treated in the myriad of ways that will benefit *them*. And less painfully to boot.

See, really I'm trying to make our professional lives easier, not harder. I really would like to see how well the horse could pull the cart instead of forever plodding along behind it. My study will be a test of how well horses can pull carts. I'd like to see DNM and by extension all "ectodermal" therapies, become a simple and effective sorting tool for the profession to use.

Don't worry, the profession will always need the mesodermal people too. Cows are animals but surely not all animals have to be cows.

Bear in mind I am not diagnosing and treating impairments. I am not stretching an area of skin because it is tight and then saying treatment will probably be successful because the skin there isn't tight anymore (this is essentially what the MFRers are saying about fascia for example). If I were, then arguments about the reliablilty and validity of diagnostic testing and outcome would be appropriate.

But all I'm saying is that novel, skin-based input at and surrounding the symptomatic region may modulate ongoing nociceptive processing. While this certainly requires construct and face validity (which, while not yet 100% proven, I think I am in the process of addressing satisfactorily), it does not require reliable methods of finding impairments that I'm not treating anyway.

So the only real question is what essential diagnoses is this method appropriate and effective for. And since we really have no reliable clinical methods of determining essential diagnoses for most pain conditions I say we need some basic research here, which I will do, to see if DNM is as good or better than other methods that are really no more certain, as a sorting tool to see which patients or what percentage or kind may *need* a stronger form of manual treatment and which ones most definitely do not.

In retrospect, I'm sure they'll jump all over me for having used the no-no word "all" in the first paragraph. I should have painstakingly qualified that by using the word "most" or "virtually" as in "virtually all".

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