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  • CT Pain is an emergent system

    With the latest discussion about Dry Needling on this thread Placeholder II - The Revival and at Mike Reinold’s blog is just another of a long list of treatments that need reconsidering when dealing with pain. Jason has eloquently stated in his thread Enough is Enough with these treatments, which is a must read and re-read for any therapist working with a patient in pain.


    At this time with our current understanding of neuroscience I would hope all would agree that pain is in the brain. If pain is in the brain and the brain is an emergent system, then pain seems to also be an emergent system.


    I recently stated in this thread on how I was “bitten”.
    When Adriaan Louw shared what David Butler would say about chronic pain patients needing to understand pain was in the brain. This contextual shift had to happen in the "marrow of their bones" to help them the most. I realized I first needed to understand this to the depth of the "marrow of my bones" before I could help a patient.
    Last night while reading The Social Animal by David Broooks, I had a moment where my understanding seemed to get a little deeper into my bones. While the concepts of emergence, emergent system, fractal, culture and meme (search the words and you will find 100s of threads) are not new to anyone that reads here at SomaSimple, the way David Brooks wrote seemed to speak clearly about Pain being an emergent system even though he was not writing specifically about it.


    I wanted to share excerpts from the book and how they speak to a deeper understanding of pain as an emergent system.
    Last edited by zimney3pt; 14-02-2012, 05:31 PM.
    Kory Zimney, PT, DPT

    http://koryzimney.blogspot.com

    "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

    "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

  • #2
    There are emergent systems all around. The brain is an emergent system. An individual neuron in the brain does not contain an idea, say, of an apple. But out of the pattern of firing of millions of neurons, the idea of an apple emerges. Genetic transmission is an emergent system. Out of the complex interaction of many different genes and many different environments, certain traits such as aggressiveness might emerge.

    Cultures are emergent systems. There is no one person who embodies the traits of American or French or Chinese culture. There is no dictator determining the patterns of behavior that make up the culture. But out of the actions and relationships of millions of individual, certain regularities do emerge. Once those habits arise, then future individuals adopt them unconsciously.



    In 2003 Eric Turheimer of the University of Virginia published a study that showed that growing up in poverty can lead to a lower IQ. Journalists naturally asked him: what can be done to boost IQ development in poor children? “The honest answer to the question is that I don’t think there is anything in particular about the environment that is responsible for the effects of poverty,” he wrote later. “I don’t think there is any single thing in an impoverished environment that is responsible for the deleterious effects of poverty.”


    Turkheimer had spent years trying to find which parts of growing up with a poor background produced the most negative results. He could easily show the total results of poverty, but when he tried to measure the impact of specific variables, he found there was nothing there. He conducted a meta-analysis of forty-three studies that scrutinized which specific elements of a child’s background most powerfully shaped cognitive deficiencies. The studies failed to demonstrate the power of any specific variable, even though the total effect of all the variables put together was very clear.
    That doesn’t mean you do nothing to alleviate the effects of poverty. It means you don’t try to break down those effects into constituent parts. It’s the total emergent system that has its effects. As Turkheimer notes, “No complex behaviors in free-ranging humans are caused by a linear and additive set of causes. Any important outcome, like adolescent delinquent behavior, has a myriad of interrelated causes, and each of these causes has a myriad of potential effects, inducing a squared-myriad of environmental complexity even before one gets to the certainty that the environmental effects co-determine each other, or that the package interacts with the just-as-myriad effects of genes.”


    For scientist this circumstance leads to what Turkheimer calls the “Gloomy Prospect.” There is no way to pin down and clarify causes of human behavior or trace the sources of this or that behavior. It is possible to show how emergent conditions, like poverty or single parenthood, can roughly affect big groups. It is of course possible to show correlations between one thing and another, and those correlations are valuable. But, it is hard or impossible to show how A causes B. Causation is obscured in the darkness of the Gloomy Prospect.



    Fixate on whole cultures, not specific pieces of poverty. No specific intervention is going to turn around the life of a child or an adult in any consistent way. But if you can surround a person with a new culture, a different web of relationships, then they will absorb new habits of thought and behavior in ways you will never be able to measure or understand. And if you do surround that person with a new, enriching culture, then you had better keep surrounding them with it because if they slip back into a different culture, then most of the gains will fade away.



    The difficult thing about emergence is that it is very hard in emergent systems to find the “root cause” of any problem. The positive side is that if you have negative cascades producing bad outcomes, it is also possible to have positive cascades producing good ones. Once you have a positive set of cultural cues, you can get a happy avalanche as productive influences feed on and reinforce one another.
    While this example is toward poverty in this book, I think we can see how it is extremely similar to issues we have with the treatment of pain. I want to break apart some of this text and relate it to the many comments and ideas that have been shared here in many ways.
    Kory Zimney, PT, DPT

    http://koryzimney.blogspot.com

    "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

    "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

    Comment


    • #3
      Kory,

      I think the excerpts are elegant but they are about cause.

      The origin is our brass ring when it comes to pain, and the participants of the Five Questions thread hammered it out out. It is the first think Barrett attempts to solidify in his class presentation when he is teaching.

      The origin of non-pathalogical pain is mechanical deformation or chemical irritation of nervous tissue. There are a myriad of human activities and cultural suppressions that cause mechanical deformation and chemical irritation, and like poverty it would be futile for a therapist to try to change an individual's causes of pain. Unless they are highly motivated or direly threatened they will remain in the patterns that cause their pain. That doesn't mean that they have to remain painful. We can treat the origin of pain with movement and manual therapy that promotes neuroplastic adaptaion, i.e. Simple Contact, EdgeWork, DNM, K-Tape.

      I would like to find the paper or book where Patrick Wall first outlined the comsumatory nature of pain, where pain needs movement to move it from the protective phase to the resolution phase. Like pain poverty which has an origin fixed in apathy, needs money to move it to its resolution phase.

      Karen

      Comment


      • #4
        Originally posted by Karen L View Post
        I would like to find the paper or book where Patrick Wall first outlined the comsumatory nature of pain, where pain needs movement to move it from the protective phase to the resolution phase.
        Science of Suffering
        Diane
        www.dermoneuromodulation.com
        SensibleSolutionsPhysiotherapy
        HumanAntiGravitySuit blog
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        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
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        "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


        • #5
          I find this interesting Kory. I am not sure that Brooks is addressing causation. I think, if he runs parallel to most discussions on causation and chaos he is arguing or going to argue that effects are so tightly bound to many tiny fluctuations that the search for a cause is potentially futile and is certainly extremely difficult to find in a reductionist manner. To me this echoes Barrett not disagrees with him

          reasons Buchanan makes clear in “Ubiquity – The Science of History,” careful consideration of a multitude of factors in any complex system does us no good when we are attempting to understand and control it.
          but maybe that reflects my failure to understand.


          I would like to hear more although I think we may find that it is another view of the elephant (to quote P Hodges if that isn't heresy in the present company)

          regards

          ANdy
          Last edited by amacs; 05-02-2012, 12:51 PM.
          "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

          Comment


          • #6
            Kory,

            This is a great idea for a thread and I want to read through all of what's been written before I comment further.

            In the meantime do you think this old thread is connected somehow?

            I know I've written of emergent phenomena before but I can't find it.
            Barrett L. Dorko

            Comment


            • #7
              Could pain be conceived of as an attractor state into which the system collapses and remains unless enough "energy" is delivered into the system to cause peturbation sufficient to tip the system into another state? In terms of pain that could be either a better or worse state I would think. I would wonder if looking at interventions surgery is not so much a peturbation as a constraint and is successful only so far as it constraints enough of the variables to ensure a stable state. A more subtle approach is to find ways of tipping the system over so the system fins its own stable state.

              ANdy
              "Here is Edward Bear coming downstairs now, bump, bump, bump, on the back of his head behind Christopher Robin. It is, as far as he knows, the only way of coming downstairs, but sometimes he feels that there is another way, if only he could stop bumping for a moment and think of it." A.A. Milne

              Comment


              • #8
                Kory,

                This (emergence) is an excellent concept to consider in light of the chronic pain epidemic. Emergent properties such as suffering in humans requires new principles of investigations not applicable to structural deviations present in all mammals, ie can not be reduced to those objective causes. Bud Craig has offered an explanation of these differences in the medial vs. lateral pain systems. Because of an evolutionary emergence in neurological structure, we are capable of an entirely new relationship to pain. Can anyone argue with that?

                There is nothing new about this in the biological sciences. Properties of the cell can not be understood by studying molecules alone. The same of course can be said of cells to tissues, tissues to organs, organs to systems, systems to organisms, and beyond.

                This is precisely the argument Gazzaniga offers in Who is in Charge in his discussion against biological causes for immoral behavior.

                Gil

                Comment


                • #9
                  @Barrett, it is interesting you mention reading other threads. When I first read this section in Brooks' book I thought of going back and reading past threads and searched the words: emergence, emergent system, fractal, culture and meme. It came back with literally 100s of treads, so these have been discussed at great length here in many formats so the thread you linked is one of many that come to my mind that could be linked.

                  @Karen, I didn't see Brooks talking about causes so much as the confusion that comes with trying to find causation in an emergent system, there is correlation but not causation.

                  @Andy, I think your right in regards to the different view of the elephant. I'm just hoping we are getting closer to maybe seeing the whole elephant finally and not the individual parts.

                  @Gil, thanks you are pointing to where I see this going.
                  Last edited by zimney3pt; 06-02-2012, 05:50 AM.
                  Kory Zimney, PT, DPT

                  http://koryzimney.blogspot.com

                  "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

                  "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

                  Comment


                  • #10
                    Some great comments already.

                    I wanted to break down some of the statements of the long post from the book and see where it takes us. First statement:

                    There are emergent systems all around. The brain is an emergent system. An individual neuron in the brain does not contain an idea, say, of an apple. But out of the pattern of firing of millions of neurons, the idea of an apple emerges. Genetic transmission is an emergent system. Out of the complex interaction of many different genes and many different environments, certain traits such as aggressiveness might emerge.
                    First I want to see if there is any opposition to the thought that pain might be an emergent system or at least a subsystem of an emergent brain?

                    Like I stated if the brain is an emergent system, and pain is an output from the brain. Is there any problem with seeing pain as an emergent system. Maybe the output can not be an emergent system all by itself. I want to make sure this is an appropriate stance or at least based on enough solid ground to proceed accurately.

                    No single nociceptor, no single neuron of the brain not even a single portion of the brain contains pain. But out of the pattern of firing of millions of neurons, the idea of pain emerges. This is Melzack's neuromatrix at its core, is it not?
                    Last edited by zimney3pt; 06-02-2012, 05:59 AM. Reason: spelling
                    Kory Zimney, PT, DPT

                    http://koryzimney.blogspot.com

                    "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

                    "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

                    Comment


                    • #11
                      Steven Johnson wrote Emergence a while ago.

                      I know I wrote about Soma Simple as an emergent phenomenon some time in the past but haven't found that yet.
                      Barrett L. Dorko

                      Comment


                      • #12
                        Kory,

                        As I understand it, what makes something emergent is its' new found properties. As you point out these properties are not present in the component parts by themselves. Should we say that pain is a property/capacity of an emergent system? Maybe all pain is not an emergent property, but certainly some types would be. The IASP identification of the category of dysfunctional pain/pain of an unknown origin seem to fit the bill. I don't think this type of pain is present in dogs.
                        This thread is very important to the cause of identifying the limitations (incomplete) of the biomechanical model.

                        Gil

                        Comment


                        • #13
                          This reminds me of Kory's Calculus. Where's that link?
                          Barrett L. Dorko

                          Comment


                          • #14
                            Should we say that pain is a property/capacity of an emergent system?
                            Thanks Gil. As you could tell with my last post I wasn't 100% certain on saying pain itself was an emergent system (but it did hopefully made for a flashy title to prime some people into this discussion :angel. Obviously the nervous system is an emergent system so it may be a bit of a leap to say all systems under that system are emergent, I like what you have Gil.

                            Pain is a capacity/property of an emergent nervous system.

                            I like both descriptors and will stick with both for now.

                            capacity = the ability to receive or contain (the nervous system has the ability to receive nociception or central sensitization input and then contain that output for persisting pain)

                            property = Something owned (the nervous system owns pain not the joint, disc, muscle or any other tissue!!!)

                            I think where I am going with this and Gil, your dead on:
                            This thread is very important to the cause of identifying the limitations (incomplete) of the biomechanical model.
                            @Barrett, you see where I'm circling back to The algebraic analogy of Zimney(thanks for the exotic name by the way)
                            Last edited by zimney3pt; 06-02-2012, 04:45 PM. Reason: added nervous to be specific to which emergent system
                            Kory Zimney, PT, DPT

                            http://koryzimney.blogspot.com

                            "Study principles not methods, a mind that can grasp principles will create its own methods." - Gill

                            "All truths are easy to understand once they are discovered; the point is to discover them." - Galileo Galilei

                            Comment


                            • #15
                              Originally posted by zimney3pt View Post


                              No single nociceptor, no single neuron of the brain not even a single portion of the brain contains pain. But out of the pattern of firing of millions of neurons, the idea of pain emerges. This is Melzack's neuromatrix at its core, is it not?
                              I am also reminded of this, from '' When Self comes to mind. '' by Damasio.
                              A Working Hypothesis
                              It goes without saying that the construction of a conscious mind is a very
                              complex process, the result of additions and deletions of brain mechanisms over
                              millions of years of biological evolution. No single device or mechanism can
                              account for the complexity of the conscious mind. The different parts of the
                              consciousness puzzle have to be treated separately and given their due before we
                              can attempt a comprehensive account.
                              Still, it is helpful to start with a general hypothesis. The hypothesis comes in two
                              parts. The first specifies that the brain constructs consciousness by generating a
                              self process within an awake mind. The essence of the self is a focusing of the
                              mind on the material organism that it inhabits. Wakefulness and mind are
                              indispensable components of consciousness, but the self is the distinctive
                              element.
                              The second part of the hypothesis proposes that the self is built in stages. The
                              simplest stage emerges from the part of the brain that stands for the organism
                              (the protoself) and consists of a gathering of images that describe relatively
                              stable aspects of the body and generate spontaneous feelings of the living body
                              (primordial feelings). The second stage results from establishing a relationship
                              between the organism (as represented by the protoself) and any part of the brain
                              that represents an object-to-be-known. The result is the core self. The third stage
                              allows multiple objects, previously recorded as lived experience or as anticipated future, to interact with the protoself and produce an abundance of
                              core self pulses. The result is the autobiographical self. All three stages are
                              constructed in separate but coordinated brain workspaces. These are the image
                              spaces, the playground for the influence of both ongoing perception and of
                              dispositions contained in convergence-divergence regions.
                              Carol Lynn Chevrier LMT
                              " The truth is, people may see things differently. But they don't really want to. '' Don Draper.

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