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  • #31
    You are also a man with a memory an elephant would envy.
    Thanks Diane. It's search function enhanced to be sure. I remembered reading the article, not Rempel or the title of the article per se.
    "I did a small amount of web-based research, and what I found is disturbing"--Bob Morris

    Comment


    • #32
      The Stories We Tell Ourselves

      Last month's Skeptic magazine had a review called A Mind of Its Own: How Your Brain Distorts and Decieves called The Matrix of the Brain.

      The reviewer states: "Although we like to think of ourselves as rational beings, our brains covertly strive to create for us a view of the world that and of ourselves that is self-serving but not necessarily consistent with reality. Beliefs and opinions are formed quickly and become part of how we define ourselves, so the brain selectively perceives and recalls evidence that supports cherished beliefs while disregarding or forgetting evidence that contradicts our beliefs." The author, Cordelia Fine, calls this "motivated skepticism."

      The reviewer continues: : It would seem that going through life deluded by our own brains would not be a good thing, but that is not necessarily the case. Some people have markedly more balanced self perceptions than normal people - they know clearly what their limitations are and how little control they actually have over their lives." ...

      "Life is pleasant inside the virtual reality of our minds. So what if we think we are more intelligent or virtuous than others and believe we are more in control than we really are? Such minor self-deceptions are, for the most part, harmless, and they may help us get through the day. But we are not necessarily prisoners of our minds. When the deceptions become harmful to ourselves and others, there is a way out. Science gives us a way to unplug ourselves from the Matrix of out brains."
      Nick Matheson, PT
      Strengthen Your Health

      Comment


      • #33
        I appreciate all the thoughtful contributions to this thread and hope to make it a regular reference for others hoping to understand more about the patient in front of them. In fact, I think it emphasizes how much more important understanding is than skill. Perhaps not knowing how these two mechanisms exist and interact is common but it may easily lead to haphazard care.

        Aside from the moving target this edge between peripheral and central gives us, the absence of a linear relationship between the size, intensity, severity or drama of the peripheral mechanism and the intensity of the brain's output of pain is something that needs further illumination and discussion. In my experience, therapists have great difficulty believing that could be true.
        Barrett L. Dorko

        Comment


        • #34
          Why do you suppose we're taught: "don't chase pain, treat dysfunction"?

          I've heard that at more than one course, the rationale for which seems to go something along these lines: if you "treat" pain, you'll just keep chasing it and never "solve" the problem.

          Why would this be so?

          I would guess that if polled, the majority of patients would agree that they would rather have their pain diminished/resovled more so that have me "fix" a dysfunction that I "found."
          Nate Mosher, PT, DPT, SCS, CSCS
          Board-Certified Clinical Specialist in Sports Physical Therapy

          Comment


          • #35
            Nate,

            Paris began to articulate his "treat the dysfunction, not the pain" meme while I was working for him in Atlanta in 1976. What we had at the time was a perfect storm of ignorance, intimidation and charisma. Our colleagues never objected that I can recall and Ola Grimsby, whom I was teaching with at the time, went right along. So did I.

            I recall thinking years later while in my own tiny practice that this attitude would be really hard to maintain if one were faced personally with patients every day. That's where I ended up but, to my knowledge, Paris and Grimsby did not. My patients made it clear that it wasn't enough, and I listened to them.

            These days I speak to therapists working in virtually identical situations across town from each other. One will claim that pain is a major problem in their patients and the other that it is minor. A little careful questioning always reveals the same thing - the latter practitioner just doesn't ask about it.
            Barrett L. Dorko

            Comment


            • #36
              If we use Moseley's approach, are we not treating dysfunction?

              When we use Diane's approach, are we not treating dysfunction?
              Guess learning is a lifestyle, not a passtime.
              Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

              Comment


              • #37
                Usually pain is the dysfunction.
                The Paris Proclamation was a mesodermal meme.
                Diane
                www.dermoneuromodulation.com
                SensibleSolutionsPhysiotherapy
                HumanAntiGravitySuit blog
                Neurotonics PT Teamblog
                Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                Canadian Physiotherapy Association Pain Science Division Facebook page
                @PainPhysiosCan
                WCPT PhysiotherapyPainNetwork on Facebook
                @WCPTPTPN
                Neuroscience and Pain Science for Manual PTs Facebook page

                @dfjpt
                SomaSimple on Facebook
                @somasimple

                "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                Comment


                • #38
                  Marci,

                  Perhaps the question should be: What is a relevant dysfunction and how did you determine that it was present?

                  Early in my career I was armed primarily with notions about function and pain that proved untrue. Among other things (stiff spinal joints could be reliably assessed and blamed for painful movement, for instance), I had made A Big Mistake (as explained in the link) and didn't initially know where to turn to correct that. Breig's work righted me initially and then a plethora of others chimed in.

                  I am treating dysfunction, just not the stuff I thought I once was.
                  Barrett L. Dorko

                  Comment


                  • #39
                    As Barrett and Diane stated, it is a very stubborn meme, that likely persists because it rang juicily "right" for the insurance companies, for the mechanically oriented PTs (and there were lots), and for the PTs who just did (and DO) not know what to do with the idea/concept of pain.

                    Especially when a clear tissue related pathological link was absent.
                    We don't see things as they are, we see things as WE are - Anais Nin

                    I suppose it's easier to believe something than it is to understand it.
                    Cmdr. Chris Hadfield on rise of poor / pseudo science

                    Pain is a conscious correlate of the implicit perception of threat to body tissue - Lorimer Moseley

                    We don't need a body to feel a body. Ronald Melzack

                    Comment


                    • #40
                      I think it was taken from the D.O.'s Mitchell used to say: Pain is a Liar....

                      Comment


                      • #41
                        I think it was taken from the D.O.'s Mitchell used to say: Pain is a Liar....
                        All those memes... I remember them well. The ones who taught them had no access to pain science.
                        I wonder what the excuse is nowdays? It's not like pain science hasn't been updated by now...
                        Diane
                        www.dermoneuromodulation.com
                        SensibleSolutionsPhysiotherapy
                        HumanAntiGravitySuit blog
                        Neurotonics PT Teamblog
                        Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                        Canadian Physiotherapy Association Pain Science Division Facebook page
                        @PainPhysiosCan
                        WCPT PhysiotherapyPainNetwork on Facebook
                        @WCPTPTPN
                        Neuroscience and Pain Science for Manual PTs Facebook page

                        @dfjpt
                        SomaSimple on Facebook
                        @somasimple

                        "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                        “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                        “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                        "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                        "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                        Comment


                        • #42
                          Barrett said
                          Perhaps the question should be: What is a relevant dysfunction and how did you determine that it was present?
                          Painful, stiff, fusiform IP's = severe hand dysfunction.
                          If I treat the pain first, the rest improves without further treatment.
                          Swelling decreases over several treatments, as well as stiffness.

                          I want to say that the pain was the "relevant" dysfunction.
                          The actual relevant dysfunction (RD) could be inflammation, but IMO the decrease in pain is too fast for this.
                          Or the RD could be stiffness. Both UQ's lack ROM and the neck is caught in between.
                          Since the intervention consisted of gently stretching the skin of the arms, I don't see how this could directly affect the IP's.

                          I gotta get this right. I'm presenting a workshop end Sept.

                          Last winter I saw one report on fMRI's of patients with arthritis. Their pain was being processed in the emotional centers (as opposed to the somatosensory cortex.) So I now wonder if the RD is the manner in which the patient processes the pain.

                          Just because it works... Not enough any more. :embarasse

                          I'd like to see the fMRI's taken with only the patient's head in the machine and a PT working on the skin. Might answer a few questions. Or is there another way to analyse brain activity?
                          Guess learning is a lifestyle, not a passtime.
                          Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

                          Comment


                          • #43
                            Hi Mary,
                            Here is a link to a bunch of threads on autonomics in skin nerves/skin. You might find some ideas in there helpful.
                            Diane
                            www.dermoneuromodulation.com
                            SensibleSolutionsPhysiotherapy
                            HumanAntiGravitySuit blog
                            Neurotonics PT Teamblog
                            Canadian Physiotherapy Pain Science Division (Archived newsletters, paincasts)
                            Canadian Physiotherapy Association Pain Science Division Facebook page
                            @PainPhysiosCan
                            WCPT PhysiotherapyPainNetwork on Facebook
                            @WCPTPTPN
                            Neuroscience and Pain Science for Manual PTs Facebook page

                            @dfjpt
                            SomaSimple on Facebook
                            @somasimple

                            "Rene Descartes was very very smart, but as it turned out, he was wrong." ~Lorimer Moseley

                            “Comment is free, but the facts are sacred.” ~Charles Prestwich Scott, nephew of founder and editor (1872-1929) of The Guardian , in a 1921 Centenary editorial

                            “If you make people think they're thinking, they'll love you, but if you really make them think, they'll hate you." ~Don Marquis

                            "In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists" ~Roland Barth

                            "Doubt is not a pleasant mental state, but certainty is a ridiculous one."~Voltaire

                            Comment


                            • #44
                              'd like to see the fMRI's taken with only the patient's head in the machine and a PT working on the skin. Might answer a few questions. Or is there another way to analyse brain activity?
                              I'd be interested in a study like this as well. Perhaps someday, fMRIs could be used like BP, cholesterol/triglyceride levels and other lab values in determining risk of heart disease to provide a baseline to show risk of developing mal-adaptive (I'm starting to like that term more than "chronic" or even "persistent") pain. Perhaps baseline cold pressor testing or even visualization/imagination of standardized painful experiences could be performed under brain fMRI for individuals who have been determined at risk based on genetic/family history information and/or presence of significant psychosocial variables. This information could be used to provide more timely and appropriate pain interventions for such individuals in order to prevent the mal-adaptive pain experience.
                              John Ware, PT
                              Fellow of the American Academy of Orthopedic Manual Physical Therapists
                              "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                              “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                              be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                              Comment


                              • #45
                                John, I think the mal-adaptive pain can be detected in the very early stages by any observer. IMO we need this type of research to get those observers to pay attention to this type of pain instead of saying-"oh, it will go away with these (pills, whatever.)"

                                I think we physios should be the front line people most likely to catch this type of pain. ER nurses and md's are another group.

                                I would also like to see one of those nice, clear cut "decision trees" for dealing with it.

                                Guess we have a ways to go.
                                Guess learning is a lifestyle, not a passtime.
                                Those people who think they know everything are a great annoyance to those of us who do. ~ Isaac Asimov

                                Comment

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