Today, I feel like I've safely returned from visiting another planet. This planet was much closer, but in many ways, much stranger than the one I visited last weekend.
Last weekend I was in England, pouring information, as much as I could possibly pour, into eager sponge-like minds and hands; the psychosocial setting was very familiar, even if the geography and surrounding culture was novel.
It took a very long time to go there and to return - my biological clocks still haven't fully synched back up (e.g., my bowels still think it's just fine to wake me up at 2 or 3 AM to do their thing - all is "normal", but just way too early in the morning, by about 5 or 6 hours. Ah, that critter brain..).
This weekend I was in Moose Jaw, attending and participating in a Neuropathic Pain Conference, a continuing education event hosted by people from U. Sask, organized by the continuing education branch of the School of Physiotherapy there. This time the surrounding geography and culture were completely familiar, and the traveling practically inconsequential; the psychosocial setting was so unfamiliar as to feel almost foreign.
There is so much to unpack here that I'll have to do it over several posts, I think.
Most of the presenters were MDs and PTs - one pharmacist I think. The pharmacy session was concurrent with my own so I missed it. Susan Tupper, who is newsletter editor at the moment for the Canadian Pain Science Division, presented several times.
Pam Squire, a pain management specialist in BC, presented several times.
I guess it SEEMED so strange because it seems like forever since I left behind the whole janky biomedical model where knowledge is painstakingly built from case studies and diagnoses with nouns attached. In that world, cognitively, it's as though unless there is a noun officially attached, the "it-ness" of something..
a) doesn't exist
b) therefore may not be considered
c) certainly can't be felt as moving if it doesn't exist
d) is not allowed to just be a verb, passing through
So.. I found myself thrust back into a world concerning itself with proposed "things" called trigger points. I heard about "myofascial" (a tissue "thing".. used as a descriptive adjective).. pain.
The older I get, the more elusive becomes any sense that could possibly be made by using a noun as an adjective to describe a fleeting and un-pin-downable verb such as "pain". But I digress.
My insular cortex had to sit there and listen about injection of various substances ("things") into these "trigger points" (supposed "things") that are (in my own humble opinion) just mythical concepts, attractive to minds that need nouns to pounce on, because of the overwhelming operator mentality at work within a daily mentation). There was a presentation about epidural injecting for neuropathic back pain.
Maybe my insular cortex objected because of a news story I read lately about side effects of spinal injections including fungal meningitis from a bad batch of epidural injection material. I refrained from raising what would likely have been an unwelcome side topic, though. Very adult of me. Or was it?
I asked Dr Squire, in front of the possibly surprised (and much more august than I) assemblage, would she please define what she meant by myofascial pain? She shot straight back - "Are you a believer?" I replied.. "I'm pretty agnostic about it. I just want to know how you define it."
I had dialed way back on what I would have preferred to say, that I was a complete atheist.. I felt enough out on a limb that I didn't want to create too big a kerfuffle.
She started talking about some evidence that existed about some sort of tissue change at neuromuscular junctions.. but when I asked if those changes were primary or if they were secondary to a pain presentation she didn't answer, chose to move on, made it clear she wanted to get back on her own track by taking a question from someone else on a different topic. Maybe she never has thought about it. Maybe she has no idea.
Which was fine. I did not want to derail her in any way - I wanted a thought process, that's all. And I couldn't help myself - it was such a great opportunity. It did involve swimming against the tide, going against the grain, knowing my "place".. and then choosing to not stay inside it. (Which felt a bit liberating, to be honest.)
Part II will be about how nerves were discussed.