painful paradoxes, dilemmas & premises for the understanding of pain

Pain DOES NOT BEGIN WITH THE STIMULATION OF RECEPTORS AND IS NOT THE END PRODUCT OF A LINEAR SENSORY SYSTEM!

@SigMik

Meaks The notorius Warm-up gig for

What the hell is that?

Oh, just my mind.

Can I ask you a question?

It depends. Knowledge is case specific.

Can I ask you a question?

It depends. Knowledge is case specific.

Why does my back hurt?

N=1

PARADOXES

An unacceptable conclusion

Derived by apperently acceptable reasoning from apperantly acceptable premises

KNOWLEDGE PARADOXES

Specific cause = specific solution?

The problem is not that nothing works, The problem is that anything can work

KNOWLEDGE PARADOXES

The more i learn, the more i fix?

Can everything be fixed?

KNOWLEDGE PARADOXES

It doesn’t Even have to be true, But it can still potentially

be of great value

WHY? How?!

PARADOXES leads to dilemmas

A case for simplicity, but which simplicity should we listen to?

Simple solutions are everywhere!

Where facts are few, experts are many

The pLot Is it possible to find sense in chaos?

Depends on certain premises

The pLot Firstly:

YOU ARE NOT THE CENTER Of THE UNIVERSE

The pLot Secondly:

you have to be willing to live with uncertainty

Accept informed probabilities,

Not definite certainties

Conceptual hygiene

As little contradiction as possible

”Knowledge is case specific”

”True” knowledge is true In all landscapes of ”reality”

We need certain models of reasoning

Models are tools for thinking E.G. THE SAB & BPS model

What is a Model?

”George E. P. Box

What is a GOOD Model?

”George E. P. Box

Explains existing phenomeNon and provides reliable predictability

Models are tools for thinking E.G. THE SAB & BPS model

Explains existing phenomeNon and

provides reliable predictability

What is a Model?

”good”

Essentially,

all models are wrong but some are useful

”George E. P. Box

Therapeutic models – wrong, but useful?

Normative model

Causal model

Descriptive model

How the fuck

Why the fuck

What the fuck

Different situations rests on different premises

How the fuck


Prescriptive

Based on an assumption On how the world works

We basically do the same,

but from wildly (?) Different premises

Normative model

Why the fuck


history +

Culture = Identity

Causal model

Why the fuck


How to become a man The etero vs the kaluli

Henrich J, Heine SJ, Norenzayan A. The weirdest people in the world? Behav Brain Sci. 2010;33(2-3):61–83; discussion 83–135.

Causal model

Why the fuck


THE SOMATIC DYSFUNCTION

BLOCKING OF QI

HYPOMOBILITY

SUBLUXATION

TRIGGERPOINT

BREATHING PATTERN

BPS-model

neurobollocks

Causal model

DESCRIPTIVE model

WHAT THE FUCK


FIRST OF ALL:

”Before we say something is OUT of this world,

first make sure that it is not IN this world”

Michael shermer

WHAT THE FUCK


secondly: biological plausibility?

Thirdly:

Maybe Interesting, But So what?

DESCRIPTIVE model

cultural

consistency Conceptual hygiene

prescriptive Basic science

Normative model

Causal model

Descriptive model

cultural

consistency Conceptual hygiene

prescriptive Basic science

Normative model

Causal model

Descriptive model

THE SOMATIC DYSFUNCTION

BLOCKING OF QI

HYPOMOBILITY

SUBLUXATION

TRIGGERPOINT

BREATHING PATTERN

BPS-modellen

BRAINSBRAINS

Why the fuck

Understanding of X, y, Z Crosses all domains!

How the fuck What the fuck

Normative model

Causal model

Descriptive model

Why the fuck

Understanding of X, y, Z Crosses all domains!


In which domain does the Pain discussion take place?

Normative model

Causal model

Descriptive model

Why the fuck


How much (about reality) do we need to know??

Normative model

Causal model

Descriptive model

We believe what we do And we do what we do

Because of our culture!

What is pain?

Fundamental consequences

Are we machines or ecosystems?

True or false?

Our fMRI study concludes that participants performing memory tasks showed activity in the parts of the brain associated with high sounds, claustrophobia, colors and farting

CLOCKS vs CLOUDS

Bricks are relevant for a building

But doesn’t say anything about the meaning

BILDE -REDS503 @FLICKR

From THE bio-psycho-Social model

To The Socio-Psycho-Biological model?

Biography “becomes” biology

“Gains” (salutogenesis) Trust

Belonging and

nourishment

Respect

Care

Honour and pride

A life sustaining physiology of meaning,

belonging and hope

“Drains” (pathogenesis) Threat and betrayal

Isolation and neglect

Humiliation and

integrity violation

Leaving behind

Guilt and shame

A pathophysiology of disempowerment and

disadvantage

Linn Getz #CauseHealth

tendencies

The brain paradigm

Is the brain becoming the new spine?

”you have pain because something is messed up in your spine”

”You have pain because something is messed up in your brain”

Limitations of language

Do we ALL describe love, hate, fear & Joy

The same way?

The SAB-model is useful, but TOO simplistic

so what next?


New definition of pain?

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage

Pain is damage


New definition of pain?

Pain is a distressing experience

associated with actual or potential tissue damage with sensory, emotional,

cognitive and social components

Williams–2016–Upda0ngthedefini0onofpain


…all DEFINITIONS and models of understanding are wrong, but...

Different models of understanding

are useful for different purposes

(and different realities)


Humanistic (clinical) definition

Pain is whatever the person says it is


Humanistic (clinical) definition

Pain is whatever the person says it is pain is whatever

the experiencing person says it is, existing whenever and wherever

the person say it does

Margo McCaffery

Problematic that A person could point at a rock and say ”That is pain”?

TID TID

MA

KE

SD

”THE MODERN BRAIN”

STRESSREGULATION PROGRAMS

ACTION PROGRAMS

PAIN PERCEPTION Cognitive, sensory and

affective dimensions

Voluntary and involuntary action patterns. Social communication

and management

Cortisol, noradrenalin, endorphin levels and

immune system activity

BODY-SELF NEUROMATRIX

INPUTS TO THE BODY-SELF NEUROMATRIX FROM:

OUTPUT TO BRAIN AREAS THAT PRODUCE:

Melzack, Katz; Cogn Sci 2013, 4:1–15 @SigMik

The neuromatrix

”SENSORY SIGNALLING SYSTEM”

”THE PRIMITIVE BRAIN”

Is not specific for pain!

TID TID

MA

KE

SD

STRESSREGULATION PROGRAMS

PAIN PERCEPTION Cognitive, sensory and

affective dimensions

Voluntary and involuntary action patterns. Social communication

and management

Cortisol, noradrenalin, endorphin levels and

immune system activity

INPUTS TO THE BODY-SELF NEUROMATRIX FROM:

OUTPUT TO BRAIN AREAS THAT PRODUCE:

Melzack, Katz; Cogn Sci 2013, 4:1–15 @SigMik

What Goes on here?

COGNITIVE-RELATED BRAIN AREAS Memories of past experience, attention, meaning and anxiety

ACTION PROGRAMS EMOTION-RELATED BRAIN AREAS Limbic system and associated homeostatic/stress mechanism

SENSORY SIGNALLING SYSTEMS Cutaneous, visceral and musculoskeletal inputs

What Goes on here?

Humans are ecosystems

“Brains are necessary, But not sufficient

For the perception of pain”

”the structure of the neuromatrix is predominantly determined by genetic factors, although its eventual synaptic architecture is

influenced by sensory inputs.”

Activity in the water stream is like synaptic activity

The swirls in the river Is like “blobs” in the brain

A brain without synaptic activity

Is like a river without water

What pain is not

Pain is not a structural injury

Pain is not brain activity

Pain is not a chemical

So what? Why does it matter?

If you really understand pain:

Then you’ll always believe people in pain

Then you’ll understand when pain becomes suffering

Then you’ll understand why communication matters

Then you’ll understand why so many treatments fail

Then your management will change

Evidence-based physiotherapy:

A crisis in movement

Touch people who need touching, this is therapy. Don’t touch people

who don’t need touching, this is battery.

Talk with people who need talking

with, this is therapy. Judge when this becomes

meaningless.

Educate your patient by all means, but also let them educate you.

The Notorious R. Kerry

Was that it?

I guess

painful paradoxes, dilemmas & premises for the understanding of pain

Health & Medicine