This is the person you are trying to help

In walks your 2pm evaluation. Well, not really…they scoot in backwards, sitting on their four-wheeled walker complaining about how long the medical history form is and “why do you need to know all that stuff?” A long past medical history is fine, you can handle that, you can synthesize how 10 years of uncontrolled diabetes mixes with COPD, a back problem they’ve had “since they were 19” and the multiple progressive knee scopes and procedures they’ve had.

During the interaction, however, the person is “off.” They don’t interact with the ease and simplicity that you do with your staff, your friends or the prior patient. You can’t quite describe it well.

If a Tree Falls in the Forest

If a tree falls in the forest, and no one is around to hear it, does it make a sound?

Ah yes, a classic riddle indeed and one I will answer. No. It does not make a sound. Let’s explore this, and how it relates to understanding pain and sensation.

First we will define a sound. The English Oxford dictionary defines it as “Vibrations that travel through the air or another medium and can be heard when they reach a person’s or animal’s ear.”  You need both waves and an ear to complete the “hear.” So in our above riddle, there is no hear of the sound due to there being no person’s ear in the riddle, as it is in the definition.

N=1

N=1 has turned into a symbol,  a representation meaning to treat a person as an individual, as a unique complex being that has personal factors and history that make them who they are. (see the mountain stream analogy via Aaron Swanson.) When we speak about treating the person in front of us we can say “N=1.”

This is being championed by many groups. The “Pain Science crowd” certainly incorporates individualism and biopsychosocial constructs.  Cause Health is bringing awareness, and I’ll also recommend Neil Maltby’s blog: Becoming More Human.

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.

Trees are AWESOME! So is PAIN!

http://contributors.pressherald.com/wp-content/uploads/2015/01/forest.jpg

Have you ever allowed someone else’s enthusiasm get you wrapped up and passionate about an otherwise “boring” topic?

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).

Time

Enter a caption

There is no such thing as Time Management. There is only Self Management, time goes on as it will, no matter your intentions for it.

So what can happen over time? Time is one of these factors that is hard to account for, but does a lot of the treating of a patient for you. (see: It’s not ALL about you).  The biology of tissue healing occurs over a timeline and it occurs at a pace that is affected, but not determined, by us or your patient.

Repetition

Repetition is a wonderful way to work at an issue. Consistent, vigilant, methodical practice.This does not speak to magnitude. Small efforts, in time or intensity, aimed at a goal are a real meaningful attack.

This is a perspective shift for many. For clinicians and patients. People, humans, want a “fix,” an immediate “undo” if you will. I find myself explaining that rehab is a process, not an event. So I will often try to tell a story about it.

What’s going on here? 1

Rhyme as Reason

Communication is complex, rich, diverse and ever important when attempting to portray your ideas, or persuade those around you. As it turns out, certain phrasing can lend an air of credibility to your words.

In the fantastically named paper Birds of a feather flock conjointly(?): Rhyme as Reason in Aphorisms, McGlone and Tofighbakhsh (2000) illustrate the power of structure in extracting meaning and truth from phrasing.