Tuesday, January 28, 2020

Peripheral sensory neurons and vascular epithelium

Two papers have come to my attention recently:

1. Chiara MorelliLaura CastaldiSam J. BrownLina L. StreichAlexander WebsdaleFrancisco J. TabernerBlanka CerretiAlessandro BarenghiKevinM. BlumJulie SawitzkeTessa FrankLaura SteffensBalint DoleschallJoana SerraoStefan G. LechnerRobert PrevedelPaul A. Heppenstall, 2020, Identification of a novel population of peripheral sensory neuron that regulates blood pressure
McCarron JG, Lee MD, Wilson C., 2017,  The Endothelium Solves Problems That Endothelial Cells Do Not Know Exist. Trends Pharmacol Sci. 2017;38(4):322–338.

I have not read and digested either of these papers yet, but I'm sure they will make a nice duet when I finally do: no tissue can survive or function without a lot of sensory neurons providing it with trophic factors, and likewise, no neuron can survive without neurotrophic factors it takes up from tissue cells. 

Saturday, January 11, 2020

Another unfortunate trivialization

In a long thread on Facebook that involved deconstruction of "myofascial pain" appeared a reference to "non-neural practitioners."

I replied as follows:

I would respectfully ask, how would one define "non-neural practitioners"? 
Re: "myofascial pain": true insofar it appears in the literature all the time (along with "muscle pain"); AND does NOTHING to de-confuse pain from pain science or help practitioners understand distinct differences between nervous system sensitivity and ordinary tissue insensitivity or enlighten us about how there are 45 miles/72 kilometers of potentially sensitizable neural tissue running throughout the entire otherwise insensate human body.
It's really annoying that the deeper you go into (biomedical) research the more things like this have been conflated.
Defending "myofascial pain" as a construct for thinking is really about throwing a big thick wet blanket of ignorance over all sparks of curiosity or ability to start differentiating the (what...300?) different kinds of tissues there are, 150 actual neuron types, let alone figure out how any physical mammal/primate/human all works as a self-organizing and self-sustaining entity that is not monolithic, or being able to see humans, being, as verbs, not nouns, or our work as being interaction with the most complex self-organizing structure in the known universe, not mere pushing around on stretchy ambulatory anatomy corpses.
Being uncertain and embracing uncertainty is one thing, but not standing up to the spread of wilful or even unwitting ignorance is a total other thing.
"Myofascial pain" is yet another one of those "unfortunate trivializations" that Patrick Wall talked about. Maybe it arose because of the perceived need to save as much space as possible in science papers restricted to 5 pages. But it sure made a fucking mess of everything.

Blogpost (2014): What Patrick Wall said about the relationship of nociception to pain.
The paper: https://psycnet.apa.org/record/1987-24240-001
The citation: Wall, P. D., & McMahon, S. B. (1986). The relationship of perceived pain to afferent nerve impulses. Trends in Neurosciences, 9(6), 254–255. https://doi.org/10.1016/0166-2236(86)90070-6

Wednesday, January 08, 2020

Manual therapy needs a new conceptual home

This is a facebook post I made on a thread that had to do with (so-called) craniosacral therapy. I've saved it because I don't want to have to rewrite it elsewhere/some other time.
 "I took a look at the post by ..... on the process of producing verifiable science and would propose some rabbit holes one must avoid/navigate in order to not waste one's time and effort when studying something as fraught as manual therapy. It's important to realize and embrace science as being a tool to DISprove, not prove. 
1. This involves confronting all one's own biases and wishful thinkings and inherited beliefs and burning them all to the ground. Yes, it hurts. But not for long, and not if you are doggedly determined to get to something that can stand on its own merit and be considered rational. 
2. It helps if you've fallen in love with and been carried away by pain science. This takes you into the nervous system right away, and away from mesodermally derived tissue. (Anywhere. Including any that may be found inside the head.) Also it will take you away from standard orthopaedic biomedical thinking, which place mesodermally-derived tissues first and foremost and have overshadowed manual therapy thinking for more than a century. 
3. And you have to deal with the idea that you are treating alive awake conscious humans, not some cadaver in a lab with its skin pre-removed. Or skulls that come apart so you can see what bones exist. Or maybe brain slices that show ventricles.Right away you realize that your own nervous system is interacting with another person and their own nervous system, not operating on some buried structure. It's a humbling but IMO way more accurate way to frame manual therapy. This realization helps one realize that there is way more to manual therapy than any of the existing operative models would ever suggest. And that it is not fair, really, to allow such a beautiful way of being in the world with other humans to be so denigrated because of the scientific backwater it has been assigned to due to its lack of rational rigor. Because people who study it routinely (still!) ask the wrong questions of it. Because of bias. 
4. Next step involves examining obvious confounds.The biggest one in my opinion, present and unaccounted for in manual therapy, is the fact (the bare, absolute, distressing fact) that none of the prevailing models of manual therapy have ever addressed the biggest of all elephant in the room, which is skin.Which is all we can *really* touch. It's as though it was mentally subtracted without any consideration whatsoever. Even though it has so MUCH neural content within it. Which is where I've been roaming around mentally ever since. 
5. When we take a long wide view of where manual therapy comes from we might want to consider it as (yet more humbling) human primate social grooming that we inherited for free just for being primates, and because we're human, has way too many indefensible thought constructs attached to it like barnacles on the hull of a ship, slowing it down, that (indefensibly!) most manual therapists are trying to "prove" or at least argue should be allowed to continue to exist. We can still be manual therapists without entertaining complicated erroneous ideas."