painful paradoxes, dilemmas & premises for the understanding of pain
TRANSCRIPT
Pain DOES NOT BEGIN WITH THE STIMULATION OF RECEPTORS AND IS NOT THE END PRODUCT OF A LINEAR SENSORY SYSTEM!
@SigMik
Meaks The notorius Warm-up gig for
What the hell is that?
Oh, just my mind.
Can I ask you a question?
It depends. Knowledge is case specific.
Can I ask you a question?
It depends. Knowledge is case specific.
Why does my back hurt?
N=1
PARADOXES
An unacceptable conclusion
Derived by apperently acceptable reasoning from apperantly acceptable premises
KNOWLEDGE PARADOXES
Specific cause = specific solution?
The problem is not that nothing works, The problem is that anything can work
KNOWLEDGE PARADOXES
The more i learn, the more i fix?
Can everything be fixed?
KNOWLEDGE PARADOXES
It doesn’t Even have to be true, But it can still potentially
be of great value
WHY? How?!
PARADOXES leads to dilemmas
A case for simplicity, but which simplicity should we listen to?
Simple solutions are everywhere!
Where facts are few, experts are many
The pLot Is it possible to find sense in chaos?
Depends on certain premises
The pLot Firstly:
YOU ARE NOT THE CENTER Of THE UNIVERSE
The pLot Secondly:
you have to be willing to live with uncertainty
Accept informed probabilities,
Not definite certainties
Conceptual hygiene
As little contradiction as possible
”Knowledge is case specific”
”True” knowledge is true In all landscapes of ”reality”
We need certain models of reasoning
Models are tools for thinking E.G. THE SAB & BPS model
What is a Model?
”George E. P. Box
What is a GOOD Model?
”George E. P. Box
Explains existing phenomeNon and provides reliable predictability
Models are tools for thinking E.G. THE SAB & BPS model
Explains existing phenomeNon and
provides reliable predictability
What is a Model?
”good”
Essentially,
all models are wrong but some are useful
”George E. P. Box
Therapeutic models – wrong, but useful?
Normative model
Causal model
Descriptive model
How the fuck
Why the fuck
What the fuck
Different situations rests on different premises
How the fuck
Different situations rests on different premises
Prescriptive
Based on an assumption On how the world works
We basically do the same,
but from wildly (?) Different premises
Normative model
Why the fuck
Different situations rests on different premises
history +
Culture = Identity
Causal model
Why the fuck
Different situations rests on different premises
How to become a man The etero vs the kaluli
Henrich J, Heine SJ, Norenzayan A. The weirdest people in the world? Behav Brain Sci. 2010;33(2-3):61–83; discussion 83–135.
Causal model
Why the fuck
Different situations rests on different premises
THE SOMATIC DYSFUNCTION
BLOCKING OF QI
HYPOMOBILITY
SUBLUXATION
TRIGGERPOINT
BREATHING PATTERN
BPS-model
neurobollocks
Causal model
DESCRIPTIVE model
WHAT THE FUCK
Different situations rests on different premises
FIRST OF ALL:
”Before we say something is OUT of this world,
first make sure that it is not IN this world”
Michael shermer
WHAT THE FUCK
Different situations rests on different premises
secondly: biological plausibility?
Thirdly:
Maybe Interesting, But So what?
DESCRIPTIVE model
cultural
consistency Conceptual hygiene
prescriptive Basic science
Normative model
Causal model
Descriptive model
cultural
consistency Conceptual hygiene
prescriptive Basic science
Normative model
Causal model
Descriptive model
THE SOMATIC DYSFUNCTION
BLOCKING OF QI
HYPOMOBILITY
SUBLUXATION
TRIGGERPOINT
BREATHING PATTERN
BPS-modellen
BRAINSBRAINS
Why the fuck
Understanding of X, y, Z Crosses all domains!
How the fuck What the fuck
Normative model
Causal model
Descriptive model
Why the fuck
Understanding of X, y, Z Crosses all domains!
How the fuck What the fuck
In which domain does the Pain discussion take place?
Normative model
Causal model
Descriptive model
Why the fuck
How the fuck What the fuck
How much (about reality) do we need to know??
Normative model
Causal model
Descriptive model
We believe what we do And we do what we do
Because of our culture!
What is pain?
Fundamental consequences
Are we machines or ecosystems?
True or false?
Our fMRI study concludes that participants performing memory tasks showed activity in the parts of the brain associated with high sounds, claustrophobia, colors and farting
CLOCKS vs CLOUDS
Bricks are relevant for a building
But doesn’t say anything about the meaning
BILDE -REDS503 @FLICKR
From THE bio-psycho-Social model
To The Socio-Psycho-Biological model?
Biography “becomes” biology
“Gains” (salutogenesis) Trust
Belonging and
nourishment
Respect
Care
Honour and pride
A life sustaining physiology of meaning,
belonging and hope
“Drains” (pathogenesis) Threat and betrayal
Isolation and neglect
Humiliation and
integrity violation
Leaving behind
Guilt and shame
A pathophysiology of disempowerment and
disadvantage
Linn Getz #CauseHealth
tendencies
The brain paradigm
Is the brain becoming the new spine?
”you have pain because something is messed up in your spine”
”You have pain because something is messed up in your brain”
Limitations of language
Do we ALL describe love, hate, fear & Joy
The same way?
The SAB-model is useful, but TOO simplistic
so what next?
Limitations of language
New definition of pain?
Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
Pain is damage
Limitations of language
New definition of pain?
Pain is a distressing experience
associated with actual or potential tissue damage with sensory, emotional,
cognitive and social components
Williams–2016–Upda0ngthedefini0onofpain
Limitations of language
…all DEFINITIONS and models of understanding are wrong, but...
Different models of understanding
are useful for different purposes
(and different realities)
Limitations of language
Humanistic (clinical) definition
Pain is whatever the person says it is
Limitations of language
Humanistic (clinical) definition
Pain is whatever the person says it is pain is whatever
the experiencing person says it is, existing whenever and wherever
the person say it does
Margo McCaffery
Problematic that A person could point at a rock and say ”That is pain”?
TID TID
MA
KE
SD
”THE MODERN BRAIN”
STRESSREGULATION PROGRAMS
ACTION PROGRAMS
PAIN PERCEPTION Cognitive, sensory and
affective dimensions
Voluntary and involuntary action patterns. Social communication
and management
Cortisol, noradrenalin, endorphin levels and
immune system activity
BODY-SELF NEUROMATRIX
INPUTS TO THE BODY-SELF NEUROMATRIX FROM:
OUTPUT TO BRAIN AREAS THAT PRODUCE:
Melzack, Katz; Cogn Sci 2013, 4:1–15 @SigMik
The neuromatrix
”SENSORY SIGNALLING SYSTEM”
”THE PRIMITIVE BRAIN”
Is not specific for pain!
TID TID
MA
KE
SD
STRESSREGULATION PROGRAMS
PAIN PERCEPTION Cognitive, sensory and
affective dimensions
Voluntary and involuntary action patterns. Social communication
and management
Cortisol, noradrenalin, endorphin levels and
immune system activity
INPUTS TO THE BODY-SELF NEUROMATRIX FROM:
OUTPUT TO BRAIN AREAS THAT PRODUCE:
Melzack, Katz; Cogn Sci 2013, 4:1–15 @SigMik
What Goes on here?
COGNITIVE-RELATED BRAIN AREAS Memories of past experience, attention, meaning and anxiety
ACTION PROGRAMS EMOTION-RELATED BRAIN AREAS Limbic system and associated homeostatic/stress mechanism
SENSORY SIGNALLING SYSTEMS Cutaneous, visceral and musculoskeletal inputs
What Goes on here?
Humans are ecosystems
“Brains are necessary, But not sufficient
For the perception of pain”
”the structure of the neuromatrix is predominantly determined by genetic factors, although its eventual synaptic architecture is
influenced by sensory inputs.”
Activity in the water stream is like synaptic activity
The swirls in the river Is like “blobs” in the brain
A brain without synaptic activity
Is like a river without water
What pain is not
Pain is not a structural injury
Pain is not brain activity
Pain is not a chemical
So what? Why does it matter?
If you really understand pain:
Then you’ll always believe people in pain
Then you’ll understand when pain becomes suffering
Then you’ll understand why communication matters
Then you’ll understand why so many treatments fail
Then your management will change
Evidence-based physiotherapy:
A crisis in movement
Touch people who need touching, this is therapy. Don’t touch people
who don’t need touching, this is battery.
Talk with people who need talking
with, this is therapy. Judge when this becomes
meaningless.
Educate your patient by all means, but also let them educate you.
The Notorious R. Kerry
Was that it?
I guess