Forum Moderators' Current Consensus on Pain

[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?

[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

[Luke Rickards]

"directly" is locked in.

[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.

[Diane]

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

[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.

[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.

[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.

[dswayze]

Is "clinical pain" a term you just invented?

Clinically relevant.

[Kim LeMoon]

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

1st sentence, I'm in agreement with. But can we look at the second sentence a little closer? 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. Also, I'm also curious about how some extreme forces used in manual therapies might actually cause tissue damage, subsequent to which, in the repair process, a lasting change might occur.

[Jon Newman]

Hi Todd,

Thanks for putting this together, its useful. I wonder if new readers of soma would benefit from getting directed to this type of thread for orientation on some of the fundamental concepts that have passed "peer review."

You're very welcome.

There is a copy of it in the "Information for our guests" forum that is a read only copy.

Feel free to chime in on any of the 10 points. This is a modifiable document. I expect that a particularly compelling argument with evidence will be needed to change it but it will change.

[Diane]

There is a big empty wall where trigger point charts used to be.

:clap1:

[Kim LeMoon]

I've already sent an email containing the above 10 steps (along with the link to this thread) to my chronic pelvic pain client. I offered to explain each step in detail, telling her that I agree with this statement 100%. I bolded the last line for her: "there is no substantial evidence that posture, muscular weakness or weight are risk factors for neuromusculoskeletal pain." I've been telling her this for so long, in so many ways. Maybe she'll believe it now.

Kudos to the moderators for this seminal work. I'm making it into a framable document to hang in my office. There is a big empty wall where trigger point charts used to be.

Edit: on making the document, I changed the first line slightly.

1. Pain is the sum of complex experiences, not a single sensation produced by a single stimulus.

[toddhargrove]

Thanks for putting this together, its useful. I wonder if new readers of soma would benefit from getting directed to this type of thread for orientation on some of the fundamental concepts that have passed "peer review."

[Kim LeMoon]

Even a better question still, is why wait until "pain" arises when you can prevent, correct and maintain better dysfunction (dyskinesis)?

This has got to be the funniest parapraxis I've ever heard in the context of therapy. Still giggling over here.