We need to keep in mind that there is no pain signal coming in from the periphery.
Pain is not an input. It is simply (and complexly?!) a nerve being stimulated, sending an action potential up to the spinal cord and then brain, where the brain interprets those signals.
…and that’s where it get’s sticky… because what is Continue reading
In reading Spencer’s recent posts (particularly Part 2, but also Part 1) I am struck by an interesting theme. The information was there. It was just somehow interpreted wrong and dispersed wrong, or received wrong… like a game of telephone.
Spencer mentions that the IASP definition of pain “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” is clearly presented in education. Since it is there all along… how does it get lost in translation? Can we blame the Continue reading
And you’d be surprised… the answer goes further back than you might think.
So if you read Part 1, we left with a series of questions — all boiling around the conundrum of what I will call “the pain education lag.” This can be defined as the time it takes for the education to take an effect (i.e. reduction of aberrant pain). Essentially, you provide a treatment, but it’s possible for no effect to be seen immediately (and its also highly likely for this to occur in such a delayed fashion). And this is something that is significant. Other treatment effects take place immediately. Yet, with pain education Continue reading
Remember when you first began practice? Patients came to you for help. You were the solution to their pain..or were you?? Admittedly, you might have been a little scared…not entirely sure of how to deal with your first complex patient of the day. He had chronic LBP for the past 8 years…heck maybe for the past Continue reading
It was his 3rd visit in for his back pain, but it was the first time I had seen him. I ask how he’s feeling that day.
“I’m hurting, not much different since last time. I’ve had back pain for 5 years, it’s gotten worse in the last 3. I had an X-ray by a gastroenterologist done a few years ago and she saw my spine on the image. She asked if I had back pain. I said ‘yes, yes I do.’ She said she could tell, because my lower vertebrae were fused together, L4 or 5 or something. She said I’d have back pain for the rest of my life because of it. I’m about a 5-6/10 pain today.”
It was the same story he’s told to every practitioner, over and over again. I know because Continue reading
“But I have in my spine.”
“Oh I can’t, my is really bad.”
“I guess I’ll just have to live with this .”
Fill in the blank with your own patient comments, but they are all essentially the same. Some gigantic, devastating, destruction is occurring inside of their body…and there’s no hope.
I don’t know if it’s funny or just sad, but the fact that such a large amount of patients respond to such “terminal” (i.e. chronic) conditions with statements like Continue reading
After a few weeks back in the out patient physical therapy setting I am re-confronted with the pathoanatomical-ness of diagnosis.
The battle for language and context of explanation rages on: full strength, full power, full speed. Whew, just trying to hang on. Daily I must combat the destructive thoughts of a fragile body, or a decaying joint, a shredded tendon, or a tear from here to there.
Sometimes it is very true. Others not. But trying to de-fixate an individual’s thoughts off of the negativity of their structures is unaided by visual proof that they are internally “disfigured.”
Nociception is subject to all the truths and flaws of any other input system.
Patients never have this view, since their pain has been described to them in terms of body parts and structures. However, the tissue is as important in pain as the eyeball is in what we see.
This past week’s viral internet subject is a great example of all that (Black ‘n’ Blue dress). Vision is simply our brain’s decision based on the information available to it, including, but not limited to, the light waves of objects. The eye itself is simply an Continue reading
So we all know that our patients experience pain relief from many placebo based mechanisms. A little bit of joint cracking, needle tapping, and (insert modality here) can go a long way towards providing a patient some temporary relief which gets us to our main goal of restoring movement.
There has been decades of research on the aspects of placebo:
- 2 sugar pills better than 1 for reducing gastric ulcers(1)
- 1 injection better than 2 sugar pills for reducing gastric ulcers(1)
- Higher priced items are more effective than cheaper ones, but only when people know they are the higher priced meds.(1)
Just more fun facts… Continue reading
Every answer, thought, feeling, decision stems from a reference-point. A single value cannot bring meaning to an informed decision. Ex: A 60 degree winter day is warm to those in Boston, and cool to those in San Diego. An increase of strength by 5 lbs is a lot with shoulder external rotation, but not so much with a leg press…. or maybe it is a lot for the leg press in someone recovering from Guillain-Barré. Transporting in a wheel chair does not seem so good, unless you have been bed bound for the previous year. So the reference is an imperative portion Continue reading