This series will be a longish look over several blog posts at all the ways I can think of that the nervous system of another will "feel" our own.
Of course, manual therapy won't work (for pain) without...
1. some sort of explanation beforehand - hopefully pain ed. that is congruent with reality and doesn't contain any tissue based nocebo.. (1)
2. movement therapy afterward, and suggestions re: avoiding behaviours that people unwittingly do that contribute to a pain presentation unique to them. (E.g., always standing on one leg, always sleeping on the same side, always sitting with the same elbow leaning on the same arm of the couch, always turning the head the same way to watch TV...)Let me be clear - manual therapy is optional. The aspects of treatment before and after manual "treatment" will work by themselves, a lot of the time. But manual therapy sandwiched in there can be optimal, in my opinion.
Whether it is optimal will depend entirely on how we explain what it's "for" - we need to improve the language around manual therapy!
As Adriaan points out,
"First, let’s discuss the assumption that pain comes from tissues. The Cartesian model that correlates tissue issues (nociception) to pain is over 350 years old, and it’s still doctrine in medicine and various therapies. The model is false. You can have tissue injury and no pain. You can have pain and no tissue injury. For too long, practitioners and patients have sought answers to their pain by exploring the various tissues, including joints, muscles, ligaments and more. Pain is leading reason that people seek care, and when they do seek help for pain, they are presented a tissue-based model to explain their pain. Think about it: A patient comes to you seeking help for pain, and you teach the patient anatomy! No wonder pain rates in the US have doubled in the last 15 years alone. Never before have we performed as much surgery or prescribed as much medicine for pain in the history of mankind, and pain rates are ever increasing. A large portion of the blame should be leveled at these outdated models. It’s time practitioners wake up and realize people in pain are interested in…pain!
This leads us directly to the second issue."There is also an assumption that patients are not smart enough to learn the latest neuroscience of pain. Shame on us for thinking that. Research has shown patients are in fact able to understand the biological processes of pain. Therapeutic neuroscience education (TNE) takes complex neurobiological and neurophysiological processes and explains pain to patients via metaphors, examples and pictures. We have been teaching people about pain for years, in various countries, to different age groups, in different languages, to various ethnicities, etc. The end result? They all get it. The best part is they experience less pain and disability; move and function better despite no hands-on interventions; catastrophize less; are less afraid and are able and willing to move further into pain during exercise and functional tasks. Healthcare education has simply become a display of knowledge. “Let me tell you how much I know about….” The language we use is completely foreign to patients. Even more worrisome, the current medical vocabulary contains various terms and languages that actually increase fear and anxiety. Ever been guilty of using terms like torn, ripped, instability, bleeding, rupture and so forth?"
1. Every Chronic Pain Patient Has a Brain - Adriaan Louw
Newer posts in this series:
Part 2: NEUROTAGS! YOU'RE IT!
Part 3: ABOUT "LEARNING"
Part 4: SKIN STRETCHING AND MOVEMENT ILLUSIONS
Part 5: TACTILE DIRECTION DISCRIMINATION IN THE DORSOLATERAL PREFRONTAL CORTEX
Part 6: MORE ABOUT DORSOLATERAL PREFRONTAL CORTEX
Part 7: TREATMENT CONTEXT, NON-SPECIFIC EFFECTS
Part 8: SOME FINAL THOUGHTS ON NON-SPECIFIC EFFECTS
1 comment:
I love that Diane explains that manual therapy is often optional. Reminds me of much of what John Sarno has written, or the words of Robin McKenzie, "Do not do to the patient what the patient can do for themself."
And, yes, pain education is very much a potent "treatment modality."
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