Sunday, October 30, 2016

Dream drama

Bizarre dream this morning, made me wake up at about 5:30 am. Like all dreams, absurd in retrospect.
Still, one of those dreams that is stark, memorable. The kind that twist you a bit, emotionally. Clearly a message from one part of my brain to some other part.

The dream

I'm a teacher in a classroom in an institution. The reason I know this is because it's a home room with those university type desks and a front wall covered in green board, and outside a long hallway with other doors to other classrooms. Apparently I've taught in there forever. (Absurd.)

I arrive to class to see that two other people are in there teaching. Not only have they taken over and are teaching my class, they are teaching them biomechanics. They are not teachers that I know well, but I'm willing to let them complete the exercise.

They have a human skeleton, or rather a vertebral model, about twice human size, a real one I guess, lying on its side curled up on a table. One of them has a percussive implement of some sort. She is thumping each of the vertebrae in turn. Each thump results in a unique movement of the parts of the column.

This is supposed to mean something profound, I guess, because she looks around at each student as if to say, Truth. Case closed.
They all seem quite dazzled by this demo.

I ask, where does this biomechanical demo and tool come from? And she looks at her teaching partner, then says, Scandinavia. (Which might be absurd, but I'm not sure.)

Oh, I say.

She is a large woman, broad shoulders, about 40-ish. Looks like a lifter. Cropped blond hair. Glasses with dark frames.
Anyway, she leaves out a back door, and I turn my attention to the other one, whose looks I can't recall clearly.

I ask, from a pain standpoint, what does this biomechanical movement model have to do with treatment?
He can't answer.
He stares at me for a moment, dumbfounded, as though I'm the incomprehensible one, not him; then, still mute, with an irritated look on his face he strides out the front door and SLAMS it shut behind him.

I and everyone else still in the room startle. Such a passive aggressive thing to do. I hope that lesson is not lost on anyone.

I have my classroom back, and all the people that are supposed to be in it. I try to gauge how mesmerized they have been by the demo, start a conversation with them by asking questions about what relevance they think this has for a real patient with pain. One thing I want to drag out of them is, do they think this movement (which was presented as the only true movement) is true for every individual? Alive? With nervous systems? all sorts of tissue layers burying their vertebral column?
I don't remember how this part goes. It goes on for quite a while.

At the end of the dream, I'm taking the skeleton home in my car with it still dripping a little after having given it a careful shower. (Absurd.)

Tuesday, October 25, 2016

New rumblings in defining and philosophizing pain

Very low rumblings, like thunder far away, but who knows? They could turn into something, right?

1. This just in: Updating the definition of pain. (Full text, at least for a little while..) 

Current def:
>>> An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Proposed def:
>>> Pain is a distressing experience associated with actual or potential tissue damage with sensory, emotional, cognitive, and social components.

Yes, I think I like the proposed def more.

It seems the world has moved past the general systems theory upon which the BPS model was constructed, into something much more integrated, less objectified, more phenomenological, (more post modern?), so therefore a better model is required.

Gee, and here I thought BPS was soooooooo much better than the odious biomedical/biomechanical/postural-structural models that so many are still working with, when it comes to pain experiences.

How interesting that these two rumblings both arrive in my facebook feed on the same morning and amplify each other.


1. Williams, Amanda C. de C.; Craig, Kenneth D.; Updating the definition of painPain:
November 2016 - Volume 157 - Issue 11 - p 2420–2423

2. Dave Nicholls; Is the Biopsychosocial Model all it’s cracked up to be? Critical Physiotherapy Network 25th Oct 2016