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).

THE role for Physical Therapists

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There is a clash between knowing that biomechanics and structure are not 100% responsible (ie. a 1-to-1 relationship) for pain, and the fact that (from an Example I got from Mike Eisenhart) some one with a poorly moving C5-C6, (as best we can tell the difference and as valid as our hands may be) has a risk factor for future neck pains and problems.

No. Not causative, but a risk factor.

The Thousand Word Image

1895, Roentgen develops X-ray. X meaning “unknown”

There is no more credible a thing than an image. Seeing is believing. I’ll have to see it to believe it. A picture is worth a thousand words. Vision trumps other senses (McGurk Effect).

How are the words you choose to use, in the healing context of your presence, going to combat the fact that it has been visually shown that things are “messed up in there” ?

It is not our fault, us humans. Wilhelm Conrad Roentgen developed this lovely technology. About a month later, humans were using it clinically.  It is amazing. And I mean X-ray, CT-scans, MRI, fMRI, UltraSound… it’s all incredible. It was developed so we used it. We used it on people in pain, people with broken limbs, people with ailments of this nature or another, and that is the vantage point from which our opinions were based. We saw people with pain have strange looking images. We therefore conclude, that the changes we saw were the cause of the pain, and here we are today.

Post Hoc, Ergo Proctor Hoc. After this, therefore because of this. It is all in the development of the tool. We pointed our delicate and precise imaging tools at the sick, and we found sickness.

The Claims Equation

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I’ve finally figured it out, I’ve boiled it down to the simplest of terms: I dislike unsupported claims. From this simple seed, stems so many urges to engage in discussion, debate, conversation and reflection.

I could not figure out why listening to biomedical model explanations bothered me so much. I could not figure out why those using nocebic analogies drove me crazy. I did not know the reason that I loathed unsubstantiated predictions of the future (“You will need a knee replacement.” “You will have pain forever” etc). It comes down to the claim.

Maybe you could say I just enjoy truth, but truth is a complex part of this whole thing (personal truths, facts, outcomes, etc). To explain this best, allow me to use some math:

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

V O M I T

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.”

Hey, Where is that Pain From?

Have you ever asked someone where they are from?  Sure, you have.  Have you noticed a breadth of answers in terms of history time-line?

For example: Some might say

• “Oh, I’m from Hillcrest Neighborhood” (immediate History)
• “I’m from Virginia” (current History)
• “I grew up in Boston” (Childhood / Distant History)
• “My family-line is from Poland” (Distant History)
• etc… and on.

How far back do we normally go?  Perhaps it depends on who is asking the question, and what the context of the conversation is about.  

Heel-touch vs Heel-strike in runners. There is a difference

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Much of the running world is concerned with foot strike and what loads and what forces are distributed through the foot and leg.  It has been shown that many of the elite runners seem to make heel-contact (a big no-no for the minimalists/naturalists).  But this may not be the case.

Causality vs Correlation

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This is a superbly fun topic!

Causality – the notion of cause and effect. The first thing causes the other and the other is caused by the first.

Correlation – Two items occurring together or seen together.

Correlation is easy.  You do a ‘rain-dance’ on Tuesday and it rains.  This is a correlation.  The world gets this wrong all the time.  Some people see causality.  The world easily offers you correlations between things.  It is much harder to find causality.

Comparing two cities you notice one has more crime.  You want to find out why.  You observe that the city that has more crime also has more police.  You decide that more police equals more crime.  You think you have found the cause.

It can get even messier.  Let’s say that data was collected over the next year in that city and it was shown that both crime fell and the amount of police fell.  That could lend credibility to those that think and know that police numbers cause crime numbers.  They would tote that statistic around all day.  Proof, I tell you, proof!  This fascinating position is aided by confirmation bias and cognitive dissonance. (see my post on all that here) 

Let me fix that for you!

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People don’t come in (caveat: yes, I suppose some do!)  complaining about their asymmetry on their own.  They come in complaining about a pain during some activity or another.  (Check my post on Knee OA and pain.)