Sunday, October 14, 2012

Digesting the Moose Jaw adventure: Part I

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. 


Alice Sanvito said...

That was a very gutsy question to ask in that environment. And it was probably smart of you not to say any more. Perhaps, just perhaps, someone will be surprised enough and curious enough to think about the answer.

Diane Jacobs said...

Thank you Alice.
The older I get, the less I seem to be worried about how remarks made by me might be perceived. It's rather freeing.

Mark Hollis said...

Thanks for the blog Diane!

Interesting that a discussion of 'triggerpoints' as a primary cause or a secondary effect would be sidestepped as the answer (either way) is a foundational premise to potentially significantly different clinical applications.

JQ said...

Believer or non-believer? The question you posed to Pam Squire is really unanswerable. Yet, the true believers in "Myofascial Trigger Points" will defend their position with an intensity that could be directly related to the principal source of their income.

This discussion raises an interesting philosophical question that was discussed by Samuel Taylor Gee in 1908.

"The primary and fundamental philosophic sects are two, the Dogmatic and the Sceptic. Dogmatists affirm that we can and do know; sceptics neither affirm or deny. Observe, sceptics do not deny, else they would be dogmatists; a strict sceptic cannot even affirm that he neither affirms nor denies … But practically sceptics are deniers; and systematic scepticism is full of dogmatism … In short, there are no absolute dogmatists or sceptics, and the truest way of putting the matter is to say that dogmatists tend towards affirmation, and sceptics towards doubt.

Methodism is ... another species of Dogmatism. Methodists are those dogmatists who strive to make the data of pathology and therapeutics as few as possible in number, and as universal as possible in extent. The dogmatist builds his system upon the greatest possible number of particulars; the Methodist erects his inverted pyramid upon a single proposition. The reason of Methodism lies in the weakness of the human mind, impatient of slow progress towards a goal which recedes as we go on, and wishing to find a royal road by which the end may be attained without passing though the necessary intermediate stages."

Gee SJ. Medical Lectures and Clinical Aphorisms. London: Oxford Medical Publications, 1908: 214-242.

Diane Jacobs said...

JQ -> "the true believers in "Myofascial Trigger Points" will defend their position with an intensity that could be directly related to the principal source of their income."

I concur.