The Neuromatrix Model

[Diane]

We've had a thread lately called Crazy Deep Models which illustrates the amount of deconstruction there still is to be done in the world, right inside our own profession, right inside our own heads. (Ah, the never-ending work of those of us who have decided not only to be scientifically guided thinkers, but who simultaneously see the enormity of the job of doing deep mental de-cluttering/tidying inside and out. )

Never any shortage of new virtual socks to knit together or misshapen ones to unravel and start over.

I thought I would bring the neuromatrix diagram here for us all to ponder, and for anyone dropping by to ponder. I think a regular visit to this simple diagram that contains the entire human condition is like knowing where to find a certain well at strategic places in this mental desert we must all navigate/cross.

I've also attached the freely accessible article within which it is found.
Enjoy. Only 49 zillion more miles to go!

[Karie]

Very timely for me Diane; I'm presently trying to dig more deeply into these mechanisms, neuroplasticity, varied bodily systems involved, etc. The last two years of my practice I have been more directly interested in the connections of nutrition, endocrine, and immune function, to name a few, that I felt needed to be understood and addressed with respects to pain and inflammation processes that just seem to be out of control in these people's systems. I've had interesting discussions with physicians regarding these avenues and everyone seems to be at a loss to understand a cohesive picture of it all.

Karie

[rfairbanks]

Diane,

Thank you for the graphic. It is going on my bulletin board.

Karie,

This is an area I have pondered, but have not had a chance to research yet. What kind of information have you found regarding the effect of nutrition on your patients' pain and impairment? How helpful has it been to your patients?

Rich

[Karie]

Hello Rich,

Yes I have found a few areas helpful but am really still looking into alot of information that is being researched and available. It appears that limiting white flour and white sugars from the diet helps to decrease the inflammatory response and decrease pain. Whole grains are being promoted. Of course if celiac disease or sensitivity is involved than the type of grain becomes an issue. I have had patients that feel better switching their grain choices and limiting their white sugar. Of course we know that limiting sugar has alot of benefits, not just in the area of pain and inflammation. Montmorency tart cherries (type) seems to help with inflammatory mechanisms. I've seen various reports of studies being done here at the Midwest Universities that are supporting this effect. The juice made from these cherries don't seem to stay on the grocery shelves long here.

I've been seeing an increased number of patients that have chronic pain/inflammatory patterns after a viral infection that was either named our unknown and these people have developed sensitivities or full blown allergies to various foods and I find that intrigueing.

I think if one is interested, it's just another piece of the puzzle to look at. As a PT I always have the person ask their physician about potential benefits to dietary changes since it's not really in our scope of practice to advise on nutrition technically. I sometimes give them literature to aid in the discussion with the physician if I think it would be helpful.

Still researching though....there is alot to dig through when you start looking at it...some good stuff....some way out there stuff LOL.

Karie

[ian s]

http://www.amazon.com/Myth-Pain-Phil.../dp/0262082837

I was wondering if anyone has heard of this --sounds similar to Lorimers interpretation/translation ?
ian

[ian s]

http://mentalhelp.net/poc/view_doc.p...ype=book&cn=77

here is a review if anyone is interested .........

ian

[nari]

I like the basic premises mentioned - especially psychgenic pain does not exist. Sounds like Lorimer.

From what I read on forums and in other books, there is still the big divide between physical and nonphysical. Advancing technology in one way helps, but in other ways hinders: there's nothing on the MRI, etc.


Nari

[Nick]

Awesome summary. Thanks Diane.

I thought it was very interesting to see "involuntary" action patterns on the diagram - part of the action neuromatrix activated to bring about the desired goal.

Nick

[nari]

When I read this paper, about 5 years ago, I did not really 'get' it (and its great diagram of the n/matrix) until I did Barrett's class.

Probably this is why so many PTs have not taken much notice of Melzack's work; it does not fit into their concept of body function.

I do recall quite a few people in the class just sitting and doing nothing much. They didn't look bored, rather they were contemplating and watching others.
For some, I am sure they were thinking: That's funny...what am I going to do now?

Nari

[Mary C]

I propose that some forms of chronic pain may

occur as a result of the cumulative destructive effect of cortisol on muscle, bone, and neural tissue. Furthermore, loss of fibers in the hippocampus due to aging reduces a natural brake on cortisol release, which is normally exerted by the hippocampus.15 As a result, cortisol is released in larger amounts, producing a greater loss of hippocampal fibers and a cascading deleterious effect.

When patients have an "eventful past", wouldn't that exacerbate the effects of cortisol? When I look at my PPP patients, and that's most of my case load, the majority would seem to fit the above. It's a shame, but the hardest workers seem to be the worst off in the long run.

Which branch of medecine, or type of practitioner, should we refer to for ideas on evaluating the contribution made by cortisol? Can any of this damage be reversed?

While I'm on the subject, I'd like to rant a bit about malnutrition. So many of my patients are on welfare or tiny pensions. Our food bank cannot supply any fresh fruit and vegetables. That has to contribute but how much influence does it have on conditions like inflammatory OA?

And what do we do about it? Aside from teaching patients about stress, relaxation, etc--i.e. managing the present. Some days I want to throw up my hands in dismay and quit. Other days I bug my dept head about the need for a pain team.

I don't want to move to a bigger city where these are available. I want them here in our small town.

[EricM]

Mary, you would have enjoyed listening to a cbc podcast on the social determinants of health. You might still be able to download the episode on iTunes, unfortunately it's no longer accessible through cbc except by buying the cd copy.

Lacking resources, all you can do sometimes is point people in the right direction. Books like this one contain great information and practical advice for patients with chronic illness.

[Mary C]

Would you believe??? I'm a master trainer for CDSMP.

[EricM]

That's cool Mary! How does one become a master trainer? I had no idea such designations exist.

[Mary C]

In New Brunswick, the provincial government decided to fund the training for 40 MT's. so they contracted with Stanford U. SU sent 2 trainers here to train us. It took 4 1/2 days. Since the course is copyright, SU controls the training. And our gov't had to pay for a license that would cover the master trainers and the trainers that we hope to recruit and train. These recruits should be people who have taken the CDSMP course. Volunteers. And us MT's will train these volunteers to lead more courses.

Does that help?

[Mary C]

I just noticed you are in BC. There are several MT's in BC.

[EricM]

I get it now. The university of Victoria runs a couple of programs here run by peer leaders, of course there would have to be expert trainers at some point!
These programs seem to run quite well. Are you aware of whether any outcomes have been collected for them? While you lament the lack of a pain team, we lack community support and follow-up for our tertiary pain team and these programs might be part of our solution.

[Diane]

May I ask, what is CDSMP?

[EricM]

Chronic Disease Self Management Program - unless I'm seriously mistaken.

[Mary C]

Right on. The original program was ASMP--Arthritis Self Management program--developed by Kate Lorig at Stanford over 30 years ago. She's a dynamo and still very active in the self management field! Kate and her team have expanded the original program to include any chronic condition. The program is not condition specific. It is specific to SELF management. Isn't that what we all need?

Contact Stanford University for info. try www.patienteducation.stanford.edu

[Karen L]

Hi,

Here is a link to the U Vic program. I think this would be a useful resource for any therapist with a chronic patient. This looks like a free government offering.

Karen

[EricJames]

Thanks for uploading the picture, it helped me understand more about it & thanks for the information people.