Forum Moderators' Current Consensus on Pain

[Diane]

I wonder if someone could clarify the term "little correlation". This would seem to imply there is some correlation but not much. Would someone mind providing a few examples of when there might be more and/or less of a correlation between pain and tissue, length, form or symmetry?

I think I can provide an example - if you were to be hit by a truck, chances are high that the external forces involved would leave you with pain correlated (at least a little) with changes in tissue length, form and symmetry.
The point being that it takes a lot to distort connective tissue/mesoderm, and next to no manual force at all to distort/excite/elicit behavior from the nervous system.

[HeadStrongPT]

Question

9. There is little correlation between tissue length, form or symmetry and the prevalence of pain. Manually applied forces will almost never directly result in clinically relevant and lasting change in tissue length, form or symmetry. The effects of manual therapy are more plausibly regarded as the result of reflexive neurophysiological responses.


I've got a lot of deconstructing here to do regarding these steps. I think you all have done some great work here to be sure but want to get some clarifications. I wonder if someone could clarify the term "little correlation". This would seem to imply there is some correlation but not much. Would someone mind providing a few examples of when there might be more and/or less of a correlation between pain and tissue, length, form or symmetry?

I have a similar question for the following statement. I do agree in principle with this statement. I think periarticular tissue is extremely difficult to influence under manual therapy and believe there must be some alternative explanation for the clinical changes we see. However, could someone identify the specific rational for saying it is "more plausibly" one mechanism vs the other more conventional mechanisms?

I will certainly be spending time investigating the references following the ten steps. It should be very interesting reading. However, if someone want's to provide a Cliff's notes response here I would really like to hear your insights. Thanks!

[Kim LeMoon]

#9 Revision looks great!!! I like the change in title as well.

Kudos to the mods!

[bernard]

Here is the wiki version of the thread.
http://www.somasimple.com/forums/showthread.php?t=4979

[Luke Rickards]

The title has also been updated.

[Luke Rickards]

After much discussion, #9 has been now been updated.

[nari]

True. In a similar but not a painful way, so is a fever.

Nari

[Luke Rickards]

I don't think that it needs to be spelt out that these corrective movements are not necessarily painfree.

And not just movements. Inflammation is both corrective and painful.

[nari]

To my simple mind, #7 points out that the effect of manual and movement therapies can be positive or negative in nature. Or maybe neutral, according to many anecdotal reports from patients.

#8 then follows on, saying the only positively effective affect (sic) lies with inherent corrective movements. Reading #7 within the context of what follows to me makes sense.

I don't think that it needs to be spelt out that these corrective movements are not necessarily painfree.

Nari

[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.

[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]

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.

[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]

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.

[bernard]

It is now the #22