Thursday, May 30, 2013

Still reeling around post-Moseley

Just not yet. I'm still reeling around a little bit, post-Moseley. ]

Moseley blogpost 1
Moseley blogpost 2

I think I've got a few more bits to say about all this Moseley business. 

Carol Lynn Chevrier, with Lorimer Moseley.
Lorimer Moseley with Carol Lynn Chevrier.
First of all, Carol Lynn Chevrier, massage therapist in Montreal and a friend, did some nice conceptual post-Moseley digesting of her own, on Facebook. Here is a link to her post. [I don't know if everyone will be able to read it.] 

Holy hell, as Carol herself often says. 
That's her tag. 
Her neurotag. 

It's a great post. Here is an excerpt:

"Moseley is ALL about the brain. ALL about science. In one of the most reasonable, logical, science based 15 minutes I've ever had the pleasure to experience, he deconstructed that antibiotics for back pain study. For me, it was a very clear reminder of why I paid 300 bucks to attend that seminar. This man is a scientist, first and foremost, hilarious anecdotes notwithstanding. I doubt the people at Oxford really gave a shit about his charisma. This man knows his stuff, holy hell does he ever. Let's not forget that at the heart of his research, there is the Neuromatrix. He always comes back to it. He's beefed it up. Designed studies around it. He knows enough about it to know that changing a human being's pain experience sure in hell ain't *just* about method. '' About what you do with your hands. He's beyond that and soldiering on to convince clinicians-psychologists-nurses-PT's-OT's among others, that pain is always, one hundred percent of the time, a production of the brain. How you as a clinician will work out and figure out a way to import that to your field is up to you. Science, good science will eventually determine what we should keep and what should phase out. This will take time. Such is the scientific endeavor. Pain neuroscience should make your job harder, not easier. '' Moseley told us says Mick Thacker once said to him. No shit."


Here is an additional neurotagged thought from me:

Just yesterday I saw this from Nortin Hadler in Scientific American: The Scientific Basis for Choosing to Be a Patient: Forearmed Is Forewarned. Brilliant. 

Here's an excerpt. 
"Today health is a commodity, disease is a product line and physicians are a sales force in the employ of a predatory enterprise... Health, disease, and “the doctor” are constructions peculiar to a particular culture at a particular time. Each is supported by pronouncements, theories, claims, and recriminations. The difference today is the availability of a body of scientific information that can question, even discard, whatever in the din has been shown to be fatuous...  Health is not the absence of symptoms; all of us will suffer symptoms repeatedly, symptoms which give us pause without compromising our belief that we are basically well. Episodes of backache, headache, heartache, heartburn, “colds”, “flu” and much more are predicaments of life for which most are a match most of the time. Despite such predicaments, we remain in “good health.”... “Health” is a reflection of the degree to which we feel complete in our bodies tempered by the degree to which we perceive that sense to be threatened.... An effective doctor-patient interaction commences with the intertwining of 3 strands of interpretation in order to arrive at mutual understanding:
  • the context that engendered the consultation,
  • the nature of the complaint, and
  • the limitations of causal inferences.
The interpretations are always laden with presupposition and prejudice by both parties. Until very recently, there was little about this interaction that was equitable. Earlier generations of patients were largely in awe of the rituals, ignorant of the details of the clinical process, and desirous of pronouncements. That is no longer the rule.”

My thought is, PT is well positioned to alleviate the planet of biomedical harm, done onto people by otherwise well-meaning people who have been trained to carve up human flesh for a living, and think they can carve it to get rid of pain. 
If PT learns these lessons well, that is. 
The ones that Moseley and all his colleagues are trying very hard to deliver out into the world in a timely manner. Well-developed and rigorously scientific. Pretty much scientifically bullet-proof, even. Go Moseley. 

And a couple screenshots of my handy-dandy powerpoint art. 

Modulators of pain

Moseley: use of terms, "pain receptors, pain fibers, pain pathways" = ERRONEOUS
From "Teaching People About Pain"

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