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  • ??? Tissue requiring healing or repair

    I just posted all this at the end of the 'more than placebo' thread. I started a new thread in the hope that it will get more replies. Once again, apologies for the beginner nature of these comments.

    Luke said:
    "There is no doubt that the brain is the key player, however, I think we need to be careful about attributing this kind of exclusivity to it. While it is true that in some, usually exceptional, circumstances pain is experienced in the absence of peripheral input (or no pain is experienced in the presence of peripheral input), the transmission of nociception into the CNS is still a very common 'cause' of pain."

    To this Bas replied:
    "I disagree somewhat. The brain is absolutely essential and central to pain. Peripheral input is of course present at all times, but it is the brain that interprets the input as a "threat" or as "negligible". It gives value to the input from the periphery. No matter HOW much nociception there is, it is ultimately the brain that "causes" the pain. After all the periphery as the patient perceives it, is entirely a virtual construct of the brain."

    I really like the "periphery is just a virtual construct of the brain" concept. It is not far removed from The Matrix movies, which i think is cool! Anyways, within the context of pain this all fits nicely to me so long as there is no mesodermal pathology requiring healing or repair. Then it seems to fall apart. All of the discussions I've been reading make a point of limiting the scope of discussion to pain for which there is no pathology requiring healing or repair. This seems odd to me, and seems to leaving out a fairly major player in the injury/pathology/pain/therapy game.

    I interpret this as- the mesoderm's contribution to the output of pain is irrelevant, accept for those circumstances when it is relevant. Does anyone see the hole in this thinking? Am i missing something at a fundamental level? If nociception is neither sufficient or necessary to cause pain, it shouldn't matter if there is pathology requiring healing or repair. If such pathology does does matter, it seems to me that nociception can be sufficient to cause pain.

    Can anyone clear up my thinking here?

  • #2
    Patrick,

    Do you recall the bloke who went hiking alone on Hinchinbrook Island and fell, became stuck in rocks with at least one smashed leg? It was some years ago; and it was quite a long time before anyone found him. He went through all the fears imaginable but pain wasn't the real issue. It was survival. His brain recognised a very real threat to survival, and kept the pain level low key; it was only when he was rescued that the pain hit hard.

    Now to me that is nociception plus plus, but the brain's concern was escape from a large threat to survival, which is its aim in life: keep the organism ticking over and safe.

    If he hadn't been alone and his mates had been there, the situation would have been different, I think.

    Nari

    Comment


    • #3
      Yes, Nari is right.
      Another example is the guy who went climbing by himself in the grand canyon - a rock dislodged and trapped his hand against the wall. He couldn't get it free so ended up a week later cutting it off with his pocket knife. A movie has been made about it.
      Also, Oprah interviewed a couple people on her show a few years back who had become trapped in single vehicle car accidents, in places that were hidden to view. To survive they cut off their own legs with whatever they could find. And escaped. And survived.
      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


      • #4
        Thanks nari and diane,

        These examples demonstrate to me that pain output is indeed a top down process rather than bottom up. In these instances survival was more important than the injuries, so pain output is reduced. Right? This makes sense to me. But when I contrast this with the many times I've read that treatments that address the nervous system (education, DNM, ideomotion) tend to be less effective (at reducing pain) where there is tissue requiring healing or repair, something doesn't add up. This seems to be an argument in favour of a bottom up rationale for pain output.

        Or in keeping with a top-down rationale it points to an assumption that for most patients with an injury requiring healing or repair, the injury itself represents the greatest need state for that person at that time i.e. Regardless of treatment, pain is less likely to be decreased while the brain's number one priority is protecting the injured area that requires healing / repair. It points to an assumption that the brain knows that pain is necessary to protect a body part where there is a need for healing / repair. And the brain will continue outputting pain as long as it thinks the injury needs protection. Does this sound right?

        Comment


        • #5
          Originally posted by PatrickL View Post
          Am i missing something at a fundamental level? If nociception is neither sufficient or necessary to cause pain, it shouldn't matter if there is pathology requiring healing or repair. If such pathology does does matter, it seems to me that nociception can be sufficient to cause pain.

          Can anyone clear up my thinking here?

          I think I can see why PatrickL asked the question which also confuses me a lot.

          The examples that NAri and Diane mentioned are all very helpful to illustrate that Brrain can decide when it's the best time to output pain. However it seems not to answer Patrickl's questions?

          Also I really want to know that after a certain period of time of prioritising Survival as the key thing, how about the aftermath??? How we deal with the peripheral injury as Patrickl said: it shouldn't matter if there is pathology requiring healing or repair.......

          I would say I cannot completely agree with "nociception can be sufficient to cause pain" as I would think there are lots of other factors (NeuroMatrix) should work together contribute to letting nociception to be "sufficient" to inform Brian to output pain.

          Regards,

          Weni

          Comment


          • #6
            Originally posted by PatrickL View Post
            Thanks nari and diane,

            These examples demonstrate to me that pain output is indeed a top down process rather than bottom up. In these instances survival was more important than the injuries, so pain output is reduced. Right? This makes sense to me. But when I contrast this with the many times I've read that treatments that address the nervous system (education, DNM, ideomotion) tend to be less effective (at reducing pain) where there is tissue requiring healing or repair, something doesn't add up. This seems to be an argument in favour of a bottom up rationale for pain output.

            Or in keeping with a top-down rationale it points to an assumption that for most patients with an injury requiring healing or repair, the injury itself represents the greatest need state for that person at that time i.e. Regardless of treatment, pain is less likely to be decreased while the brain's number one priority is protecting the injured area that requires healing / repair. It points to an assumption that the brain knows that pain is necessary to protect a body part where there is a need for healing / repair. And the brain will continue outputting pain as long as it thinks the injury needs protection. Does this sound right?
            This is exactly when the human brain needs to be taught how to be the dominant/alpha brain over the critter brain.
            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


            • #7
              Originally posted by weni888 View Post
              I think I can see why PatrickL asked the question which also confuses me a lot.

              I would say I cannot completely agree with [B]"nociception can be sufficient to cause pain
              I agree with this too weni. I was just trying to resolve a conflict i saw between that statement and the notion that pain is less reducible while tissue is healing/repairing.

              Implicit in the statement that treatment is less effective while there is tissue requiring healing or repair, is the notion that injured tissue drives ongoing pain. Maybe it is clearer to say that where there is tissue requiring healing / repair for which the brain has prioritized as needing protection, treatment is less likely to reduce pain.

              It still boils down to need states and threat values I guess. Its all still a bit confusing for a newbie like me!

              Comment


              • #8
                Take a few examples of injury:

                A paper cut: trivial but painful. Most people would not get anxious over it and ignore the pain after a few moments. It heals rapidly.

                Finger tendon severance: Painful with anxiety plus and a need for immediate repair.

                Footballer gets injured during a finals play but keeps going because to him, the pain is less of a problem than having to retire. (he probably falls in a heap at the end).

                Here the person's reaction is one factor which complicates the brain's interpretation of pain. Ongoing anxiety and distress reinforces the threat and that delays resolution of the injury. With persisting pain and no injury, emotions play a huge role and the brain gets into a bind about its protective role.

                Does that assist in looking at the complexities of nociception and pain?

                Nari

                Comment


                • #9
                  This just in: Media Stories - full pdf download at Body in Mind blog, The champion cyclist – The Australian. I think it pertains to this thread!
                  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


                  • #10
                    Thanks Nari,
                    I appreciate the time you have taken to explain these examples. I'm certain (i think) that I understand the statement pain is neither sufficient or necessary to cause pain. I get that it's all contextual and driven from top-down.

                    I was just curious how that stacks up against a quote like this one from Barrett:
                    "In my experience, knee pain often contains a good deal of mesodermal irritation and problems that require healing or repair, thus ideomotion is unlikely to help as much as it might elsewhere." (This is from a thread called do-it-yourself ideomotion. I'm not fancy with creating links etc sorry).

                    Sorry to use Barrett again, but in the 'more than placebo' thread(#58) he said:
                    "When I say pathology I’m talking about something that requires healing or repair for complete resolution. Whether or not these pathological changes are relevant to the patient’s complaint of pain is something we can guess at after management that doesn’t address the repair or healing is begun."

                    So Barrett appears to take the approach of using ideomotion to resolve the proportion of pain attributable to mechanical deformation, while leaving the door open to attribute any residual pain to the pathological changes.

                    Here's one from you nari (#54 more than placebo thread):
                    "There's a problem with the definition of non-pathological, but I assume it to mean no apparent reason for peripheral pain to occur."

                    Can I glean from this that the reverse is true? That pathology can be the reason peripheral pain occurs?

                    I'm certain I've read similar comments on other threads... they just seem to clash somewhat with the notion that nociception isn't sufficient/necessary to cause pain. I'm not saying that is the intent of barrett's and your posts, just that it reads that way to me, so Im looking for some clarification.

                    Comment


                    • #11
                      "There's a problem with the definition of non-pathological, but I assume it to mean no apparent reason for peripheral pain to occur."
                      I'd ignore that one.
                      Not sure why I phrased it in such a way, except for it to be specific - eg limb pain sensation as opposed to spinal. It should read: pain felt in the peripheral limbs. Sometimes I don't think things through enough before posting.

                      Nari

                      PS: Pat, if you look at the toolbar above the posts, there is a little square box with a sheet of paper and arrow in bottom right side. Highlight the text you want for a quote, cut and paste in your reply post, highlight the pasted text and click on the little toolbox thingy. Voila -
                      Last edited by nari; 26-03-2012, 05:45 AM.

                      Comment


                      • #12
                        Patrick, here is the link again, by Weni, in this thread. Please read.
                        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


                        • #13
                          I think I'm failing to articulate my thoughts properly. I'm not doubting the truth of the statement nociception is neither sufficient or necessary for pain. This concept is all good with me, and all the examples provided help reinforce my understanding.

                          My question is this. Given that nociception is neither sufficient or necessary for pain, why is it that within the context of discussing treatment on SS, there is often a distinction drawn between pathological (requiring healing/repair) vs non-pathological input? The distinction is usually along the lines of 'pain is harder to reduce where there is healing/repair going on'. Implicit in the distinction is the notion that nociception from tissue injury makes it harder to get a reduction in pain during treatment. This flies in the face of the concept nociception is neither sufficient or necessary for pain. If nociception is neither sufficient or necessary for pain, the distinction between pathology and non pathological inputs seems redundant. So my question is, why is the distinction made?

                          If I try to reason through this I'm left with two thoughts. 1. Nociception is sufficient/necessary for pain (but i know this not true, and the examples provided support this). so option 2...the output of pain is more resistant to treatment when there is tissue requiring healing/repair because the brain knows that the injured area needs protection while it heals.

                          Comment


                          • #14
                            If there is an injury and healing going on then I would hope and expect that some pain be present.
                            Dave

                            Comment


                            • #15
                              If we apply judgement then it could be classed appropriate and inappropriate pain. Appropriate - Useful, functional pain warning of further injury if ignored.
                              Inapproriate - Not useful, unhelpful pain not warning of potential harm.
                              Of course we can still pay mind to the useful pain but want to reduce its effect so we can get on with life. So it can be that we treat the mind, take the pain relievers, treat the body take the anti-inflammatory meds but still have enough useful pain to modify our behaviour.
                              The thrust of this site is however the persisting useless pain and how to get that controlled by the minds action over the brains function. Therein lies many fun days at work!
                              Kind thoughts,
                              Steve
                              Peering over the shoulders of giants.

                              Know pain. Know gain.

                              Comment

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