Forum Moderators' Current Consensus on Pain

[dswayze]

Is "clinical pain" a term you just invented?

Clinically relevant.

[Diane]

Kim,

Taken as it is written, this would imply that even gentle forces, such as those employed in DNM, will almost never result in lasting change.

In DNM there is no attempt to change tissue in any way, period. A lateral stretch is applied to skin, not to try to affect tissue in any way, but rather to stimulate lateral stretch mechanoreceptors (eg. Ruffinis), and help the nervous system do something with the info (as per Gandevia) to down regulate its own pain production. The other thing with DNM is a (temporary) lengthening force (very small) applied to oblique skin ligaments and their neural contents, in order to induce vascular change within the container - less through force, more by introducing tissue differential, which can be very small and still be effective.

So, stretch skin, feed nerves (stimulate them to feed themselves), let go of skin. Skin goes back to its normal length. Softening of body bits below happens reflexively.

[EricM]

Diane and Kim,
I understand Kim's issue with the statement. Might it read better written as;

Force is not necessary to produce a therapeutic change. Manually applied forces will almost never directly result in clinically relevant and lasting change in tissue length, form or symmetry.

[Kim LeMoon]

Oh yes, Diane, I know that. I'm not arguing that force is necessary, but the language is a little vague. Maybe 'pain-inducing forces' would clarify. Also, in no way am I advocating such therapies, just trying to anticipate some criticisms and looking for precise language to say exactly what the mods meant by this one.

[Diane]

Looks good to me Eric.
(This is the process. Looks like we're still editing... )

[Kim LeMoon]

Looks good to me Eric.
(This is the process. Looks like we're still editing... )

That looks good to me as well. Thanks Eric.

[Luke Rickards]

"directly" is locked in.

[Kim LeMoon]

Back on topic, I'd like to discuss #7, in particular the two middle items that deal with transmission. I get it now, but it took a couple of reads. The first few times, I thought you were alluding to therapies that have a greater potential to transmit nociceptive signals like Rolfing or Pilates.

7. Manual and movement therapies may affect peripheral and central neural processes at various stages:
- transduction of nociception at peripheral sensory receptors
- transmission of nociception in the peripheral nervous system
- transmission of nociception in the central nervous system
- processing and modulation in the brain

[Kim LeMoon]

Hey mods,

I see that the conversation about ART was moved to a more appropriate thread, but along with it went Luke's post about changing #9 to include the word 'directly'. Could you move that back here?

[bernard]

It is now the #22

[Luke Rickards]

Kim,

Manual therapies that might have an direct effect on peripheral transmission would include neurodynamic treatments. This sort of approach is useful when the origin of neural firing is in the axon itself, for example, in the case AIGS or peripheral nerve compression.

[Kim LeMoon]

Luke,

The 'affect' part is what I'm stuck on. It doesn't indicate whether the therapy improves the condition or has potential to exacerbate it. Could go either way. Maybe a clarifier, such as 'beneficially affect' would work??

I know I'm being picky, but if I didn't understand this point right away, others might not either.

[Luke Rickards]

It doesn't indicate whether the therapy improves the condition or has potential to exacerbate it.

Manual handling and movement therapies can certainly do both. Obviously, the former is desired.

[Barrett Dorko]

Interesting.

My son, the Army Captain, says the "surge" has been "effective," at which point his wife wants to smack him in the head. Fending off the blows, Alex goes on to say, "How are you going to put two brigades into a single city and not have an effect? I didn't say it was a good effect."

At this point we have to somehow consider what we mean by "good" or "positive." For me, a reduction in pain takes a back seat to an appropriate alteration in autonomic support. It's been my experience that pain relief follows that, and perhaps not immediately by any means. As Jason says, "We have to water the grass when it has turned brown and should not expect it to grow green right away." Or words to that effect.

Of course, first we have to find the lawn.

[Luke Rickards]

Barrett,

This is a good point, and, I think, also ties in with your frequently made argument that correction is not necessarily painless. Butler wrote the same thing in recent review.