Split brains and causation

There’s gotta be a reason. You can’t have an event pass by you without knowing why, right? Right.

“Well, you know, the weather made it hurt. It’s all that rain…”

“My back is hurting today, I was at a family BBQ and I stood for an hour yesterday, so…”

“The knee feels much better, I think it was the tape you put on there.”

Post Hoc Ergo Proctor Hoc. After that, therefor because of that.

Making a reason for things is not conscious, often. We always see cause and effect as a truth. If we’re wrong, it’s confabulation, not a lie. It’s “only human.” See a quote below from some of the Split Brain research:

What is that, wet?

One of the most real, shared experiences that we have as humans is non-existent in the true sense of cause-and-effect reality. The sense of wetness.

There is no “wet receptor” or nerve fiber type devoted to the sensation of wetness. No indeed. Insects have “humidity receptors” but we lack the ability to feel the water that so defines our planet. The human sensation of wetness is the complex, near magical (if you don’t mind me saying so) confluence of pressure change, light touch change, motion direction, speed and pattern, temperature change, and visual input.

Pain Education

*via KnowPain

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).

Bio-chemico-physio-behavioro-environmento being

image credit

“Why didn’t the brain go to the party? Because he had no body to go with!” – My 6.8 yr old.

There is only one thing. There is no disconnect. It is all connected, as in, related. Interacting, melding, smushing, giving and taking and trading.

There only reason you think that Chemistry is separate from Biology is because we, as humans, divided up the information in to chunks. There is no actual divide. You cannot have biology without chemistry. You cannot have either without physics, and physics is nothing without matter (chemical, particle or biological). Thusly, there is no divide, it simply depends on where you point your lens. What do you choose to “pull out” as important?

On the subjective nature of pain

Image Credit: “Inverted qualia of colour strawberry” by made by Was a bee. – Original strawberry’s image is from Image:Fragaria_Fruit_Close-up.jpg uploaded by User:FoeNyx,and original man’s image is from Image:Munemitsu Mutsu 2.jpg uploaded by User:Ueda.H,and I User:Was a bee combined it in one image.. Licensed under CC BY-SA 2.5 via Commons – https://commons.wikimedia.org/wiki/File:Inverted_qualia_of_colour_strawberry.jpg#/media/File:Inverted_qualia_of_colour_strawberry.jpg

Some things in life are definite. Some are definitely not. And some are somewhere in between.

Same goes in healthcare and medicine. When you see a hyperactive deep tendon reflex or produce an upper motor neuron sign via Babinski or Hoffmann’s, its pretty obvious. Usually, there isn’t much debate about its existence. There may be some back and forth about the degree to which it exists or to its implications; but, again, most parties will agree “that just happened.”

Same goes for an infected wound. One look, maybe one smell, most people can agree about the degree of bacterial colonization (i.e. infection or no). We can take this further with abnormal heart sounds, clubbing of the digits (indicative of lung/heart disease), or yellowing of the sclera indicating jaundice. The list can go on, but it doesn’t need to. There are a host of objective signs that indicate the presence of disease or pathology. We can even go further with laboratory diagnostics and imaging studies to attempt to confirm or rule out suspicions about the presence of a disease processes.

We have quite a body of information and resources at our disposal when trying to figure out what is wrong with the patient sitting before us. Even more than that, we have gained enough knowledge to decipher and utilize people’s reported symptoms, their subjective report, to aid in this process. As fraught with bias and inaccuracy as an individual’s own perception of their situation could be, we still have found ways to weed through the minutiae and find bits of key detail that aid in the diagnostic process. It could be how long their symptoms have been present, or what activities exacerbate their symptoms. You might ask, “Do you have any popping or clicking? Or feelings of instability?” Or if the patient reports numbness or tingling in a certain area. All of these details paint a little more of the broad picture of the patient’s condition. And one of the most helpful details when painting that picture

Just an Action Potential…

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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

Pain, Re-framed.

I had chronic low back pain.

Had.

The first incident was years prior in college: randomly getting up from a nap on the couch (college!) and my back grabbed me and put me on the floor. 9/10 P! Never happened before, so I just lay there for a bit and crawled around until I could relax enough to stand.

Fast forward: after college I would try to

Lost in Translation

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

The Crossroads of Philosophy and Physiology (Part 2): Where We Missed the Mark on Pain Education.

 

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

The Crossroads of Philosophy and Physiology (Part 1): The Pain Education Revelation

 

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