Tuesday, October 30, 2007

Neil Pearson's Pain Webcasts

On October 15th, CPPSG (Canadian Physiotherapy Pain Sciences Group) co-chair Neil Pearson did a free three-hour presentation on pain to a group of about 60 women who had gathered to listen. About half of the audience was there to participate in a study that Neil is conducting, to determine the effects of education alone on persistent pain.

He has agreed to allow me to post links to the entire talk, in three sections.

This information is freely available here to anyone who would like to learn more about pain, whether it is pain they have, pain they are treating in patients, or pain in a family member/friend.

I've also put these links in the menu to the right.

Neil Pearson's Webcast Part 1 (45 minutes)

Neil Pearson's Webcast Part 2 (42 minutes)

Neil Pearson's Webcast Part 3 (60 minutes)

It is a really good series. Educate yourself - it's the best way to grow hope.

Friday, October 19, 2007

Neurotopian's "Pain for Dummies" series

Neurotopian is a German PT I met online long ago, named Matthias. He is and was brilliant - I am so glad he is writing his blog in English for those of us who don't speak, write, or communicate in any way in German.

Recently I came to realize that people actually do read this blog, that it comes up when they search for certain words, like "pain", etc.. If that's the case, I really want to give Matthias and his Neurotopian blog some press.

Check out his latest post, Pain for Dummies VI. Read through his older posts in the series as well. This is a guy who never stops thinking. Thumbs up Matthias. :)

Tuesday, October 09, 2007

Thoughts on zombie states

Deric Bownds always has interesting bits blogged at his site, Mindblog (see link to the right). Today, he offered up this: Some Rambling on Selves and Purposes.

I won't recreate the links in his post. Just go to his post and click on them yourself. Especially, read the quote from the Blakeslees' book.

Ginger Campbell recently interviewed Christof Koch (neuroscientist) (see her show notes page for podcast #22) who has many insights into what he calls "zombie" behavior. Zombie behaviors are those which have grown so automatic that no one really has to really be "home" for them to be enacted. Much ordinary social exchange could go into this category - conventional behavior, smiling, etc. I think much PT practice can easily become zombie-like as well. This is a little-recognized and glossed-over possibility. If I am in pain, and am taking my body in to see if I can get some help for it, I don't want a zombie PT treating me. I want someone who will come alive to the pain output my nervous system is broadcasting throughout my body, and I want that individual to care about it and for it. I want her or him, to demonstrate this care, by handling me gently.

I will need this consideration from them, for no matter how together I may seem on the outside, inside I will feel thoroughly discombobulated. My nervous system will be completely sensitized to any hint of any lack of attentive care, especially while being touched - my nervous system will be reading theirs like mad. It will be like I have no boundaries, and I will rely on my caretaker to have ones that are adequate, both with respect to my physicality AND inside themselves, a simple ability to attend, to stay focused, to not permit interruption from outside the treatment room during this process, and to set up the treatment crucible with an optimum length of time in which our two nervous systems can be connected through manual contact.

I will most definitely need to be reassured in the midst of my decompensation, wittingly or unwittingly, and will need a helper who is NOT enacting behaviours from some disconnected state of awareness or attention. I want nothing less from a care giver of mine than I offer to others as their chosen Human Primate Social Groomer.

The only way to not become a zombie, insofar as I can gather, is to practice attending to things (with whatever illusion we can scrape together as an "I" construct), simple, physiological things like breath, like one's own movement/motor output, finding something fresh and new in it every single day, until the day comes when finally we no longer need to think about constructing any more "days" - our personal arrow of time will have hit its mark.

Monday, October 01, 2007

Sorting out manual therapy

As far as I know, no one has really taken this on in any sort of serious way. So what the heck, I'll give it a bit of a go.

First there are a few self-explanatory truths to base this project on, that are beyond dispute in my opinion:
1. Energy concepts do not belong in manual therapy.
2. The nervous system is the part keeping a human organism "alive", and it is the part responsible for the phenomenon of felt and experienced pain. Nothing about the pain experience will change until this system is ready to change it, or to let it change.
3. Neuro-modulation in the broadest sense means, supplying a novel input in order to facilitate a new output.

If we are faithful to these three basic concepts, and use Occam's razor, ever so carefully, ever so precisely, we will end up with the following idea: All manual therapy involves touching the body somehow, so therefore all of it is neuromodulatory. The receptors that are affected are mostly mechanoreceptors and exteroceptors, all afferents. We could call ALL manual therapy, "Extero-Mechanorecepto-neuromodulation."

Some forms of manual therapy, or mechanorecepto-neuromodulation, focus on the surface more, while other forms focus on what lies below the surface. For example, acupuncture and needling in general supposedly treat something underneath the skin, but given the depth of cutis/subcutis, and the ubiquity of cutaneous neural twigs, it is more likely that needling stimulates mostly exteroceptors, maybe a few mechanoreceptors. Which is fine. Let's move on.

Manipulative therapy purports to treat joints, including those mechanoreceptors known as proprioceptors. To get to those, it is necessary to get past mechanoreceptors in skin and other tissue; however, manipulative therapy ignores more superficial mechanoreception as if it were not even there.

Soft tissue sorts of therapies, of which there are too many to call out by name, stimulate mechanoreceptors in skin mostly, and in layers just deep to it. So we could classify all these as neuromodulation of the exteroceptor/mechanoreceptor classes of afferents.

So, we could end up with a very small flow chart that depicts all of the manual therapies, with "Manually Applied Neuromodulation" at the top. There would be two branches off this item. One would read, "Extero-mechano-proprio- neuromodulation" (for manipulation of joints) and the other would read "Extero-mechano-neuromodulation" - exactly the same but for proprio (everything else).

Now, the razor can be pulled away for a time, until it is shown that Extero and Mechano only are more than enough effective to permit the dissolution and gradual fading entirely away of that whole first branch of the tree, which basically includes only joint manipulation.

I contend that any "proprio" stimulation necessary can be done without the audible pop noise. Studies support this. I contend also that joint manipulation by whatever name, as a manual therapy, has been kept on life support for a hundred years, and it is time to pull the plug on it. If it can stay alive under its own steam, fine, but no extreme efforts should be made to maintain its existence as a set of "special" knowledge to be handed along in a cult-like manner.