Peri-pain Education

Allow me to make the case to discuss modern* pain science views with all who will listen, importantly, people who are NOT in pain.

There seems to be support for pre-operative pain education as an effective intervention. Studies have shown improved surgical experience and reduced health care utilization (1), improved short term pain reporting, quicker return to activities and utilization of nonpharmalogical pain management strategies (2). Long term pain outcomes are not significantly effected (that I could find), but it certainly helps the patient in meaningful way (3).

So you and I discuss pain. We enjoy the topic, the complexity, the challenges. We talk about the nervous system, how the brain takes in input and produces reactions, or output. We talk context, modifying factors, sensitization (peripheral and central) and the neutromatrix and centrally driven gaiting. Analogies about metaphors. Totally awesome.

It is much easier to have this cerebral, theoretical and philosophical discussion when it does not directly affect you. The volunteers that shadow in the clinic, my friends at social events, etc, they find it fascinating and interesting. But for those who are actively experiencing an “unpleasant sensory and emotion experience associated with actual or potential tissue damage (4)” the conversation goes much differently.

Consider this correlate, for an example: Two individuals are discussing the complexities of divorce; the societal impact, how it affects families, the emotional considerations and financial complications. Imagine how this conversation goes, as they work out the finer points. Now; how does this conversation change when one of them is going through a divorce, personally? Do the concepts get discussed in the same light, with the same depth, under the same understanding and good faith?

Clearly you can see that the emotion, personal conflict and circumstance would change the tone, the tact, the outcome of the interaction.

When we discuss pain we must remember that pain is an active participant in the conversation. It’s there while we are talking about it. While biopsychosocial factors are discussed, pain is sitting in your patient’s ankle saying “damage… damage… damage.” And yes, for some of our more complex patients the message can become magnified, skewed, catastrophized, embedded. It makes for a whole other conversation, a more difficult one in many cases.

Many people know about large muscle groups, the major bones in the body, etc. If we can spread the current knowledge of pain to even this superficial level (ex: that pain and tissue damage are not a 1:1 ratio) then imagine the downstream affects on that person’s life. What if they knew that nerves can become sensitive after an injury? What if they first thought of an “alarm system” when they thought of pain…?

Based on my experience sharing pain topics, and some emerging research, I feel it is worth-while to bring up pain (perception, context and pain processing) to those who may listen. If they get it to the level of “deltoid” or “femur” it will be a win for the future.

So let me make the case again: discuss modern* pain science views with all who will listen, importantly, people who are NOT in pain. 

Matt D

*Melzack: 1999. abstract.

“The gate control theory’s most important contribution to understanding pain was its emphasis on central neural mechanisms. The theory forced the medical and biological sciences to accept the brain as an active system that filters, selects and modulates inputs. The dorsal horns, too, were not merely passive transmission stations but sites at which dynamic activities (inhibition, excitation and modulation) occurred. The great challenge ahead of us is to understand brain function. I have therefore proposed that the brain possesses a neural network–the body-self neuromatrix–which integrates multiple inputs to produce the output pattern that evokes pain. The body-self neuromatrix comprises a widely distributed neural network that includes parallel somatosensory, limbic and thalamocortical components that subserve the sensory-discriminative. affective-motivational and evaluative-cognitive dimensions of pain experience.”

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