More than Placebo

[Jason Silvernail]

Diane-
So my understanding of post 73 is that you have acknowledged that there is a role for examination and treatment of the periphery then?
Or are you still saying that all peripheral treatment is irrelevant?

If placebo controlled trials of anti-inflammatories make sense, then there's no reason to also think similar attempts to reduce mechanical afferents don't also make sense.

I think if your over-arching point is that we need to pay close attention to the brain and what neuroscience is telling us about pain processes, and consider in all that we do, I agree. But that doesn't strike me as new. If you're saying, as I understood it before, that all peripheral treatment constructs are irrelevant and the central changes are all that matter, then I disagree.

I think one can practice from many different paradigms and still make sense from a Neuromatrix point of view - DNM, ideomotion, OMPT, neurodynamics, osteopathy, needles or no needles, massage.

I think it might be worthwhile to list out what components defensible therapy approach should have based on what we now know about pain processing.
It seems to me that it consists of:
-the neuromatrix is being considered as central when pain is the issue being treated
-we are explaining and modifying our approach based on neuroscience as an explanatory model, not other outdated paradigms of human function
-we are adhering to the principles of therapy promulgated by Barrett (eg patient must be able to self-treat)
-we attempt to approach all 6 domains of input and output

I think if any of us are doing all of these, we have a defensible approach. What does the group say?

[EricM]

How sure can we be that the correction of a specific deformation or inflammation, which define the abnormal neurodynamic, is the direct consequence of some specific handling?

[Jason Silvernail]

I don't think we can be very sure at all. I just don't think we should give up trying to do helpful things outside of the brain.

[Barrett Dorko]

Amazing discussion.

Reading Eric's question I'm reminded of the original work in chaos theory begun many years ago. Google sensitive dependence on initial conditions or fractal or butterfly effect or read The Nonlinear Being at the bottom of the list of essays here and you'll see that we will always wonder about the specific or predictable effects or our intervention when dealing with neurogenic problems. No so much with the mesoderm.

Is it any wonder so many therapists run from the patient in pain?

I especially like was has been said about the corrective movement not necessarily being painless, and that Butler has concluded this as well.

[Luke Rickards]

Eric,

That's a very difficult thing to be sure of.

In terms of our discussion of treatment models here, we have two options: we propose, based on our best understanding, that a peripheral component is likely to be involved in a pain response, that the peripheral component is amenable to change via some specific active or passive input, and that treatment which aims to include the provision of such an input is reasonable; or we propose that the presence or absence of a peripheral component to a pain response is irrelevant, that alterations in central processing are the only mechanisms responsible for pain reduction, and that manual treatment with the intent to do anything other than effect cognitive/evaluative change is superfluous.

[Diane]

Diane-
So my understanding of post 73 is that you have acknowledged that there is a role for examination and treatment of the periphery then?
Or are you still saying that all peripheral treatment is irrelevant?

I don't think I EVER said that peripheral treatment was irrelevant. I questioned constructs, and forcefully reject certain KINDS of treatments that my own nervous system finds objectionable, but I do not think I ever said peripheral treatment was irrelevant. Show me where I said that. On the contrary, it gives us another way into the brain, access to the brain's kinesthetic cortex.

I think the apparent chasm of communication and understanding stems from how far I have shifted to mostly a brain-centric view of a patient (body as blob under the brain rather than brain as blob on top of the body - Nari).

From a brain's perspective, it doesn't matter what sort of monkeying around is happening out in the periphery, or how earnestly some therapist has learned their moves and treasures the associated construct - what matters is, does the brain accept it as sufficient, necessary, and so on, to make a change in output? A change favorable to the "I"-illusion it also maintains?

From a manual therapy profession's manual therapy perspective, anyone in it will hotly defend things like constructs, tooth fairy science to prop them up, the endless (and likely quite futile) search for the holy grail of specific effect, etc etc. etc. I get that, But I also don't care a whole lot anymore about any of it. Maybe I'm jaded. I think moving body parts into positions and sitting outside on the skin and imagining the bits of nerves and interacting with them and imagining all sorts of things happening throughout the nervous system I'm visiting with, is quite sufficient, and is all that is necessary, to produce pretty much all the same stuff that others think they actually do, to a "body." And any tooth fairy science I am involved in will reflect that. I hope.

I think if your over-arching point is that we need to pay close attention to the brain and what neuroscience is telling us about pain processes, and consider in all that we do, I agree. But that doesn't strike me as new. If you're saying, as I understood it before, that all peripheral treatment constructs are irrelevant and the central changes are all that matter, then I disagree.

Seriously, what do you think I mean when I talk about human primate social grooming? I'm talking about physical contact, and I even said that I think constructs are necessary, as a social application. For the forebrain. But not for the hindbrain. Is that more clear?

I think one can practice from many different paradigms and still make sense from a Neuromatrix point of view - DNM, ideomotion, OMPT, neurodynamics, osteopathy, needles or no needles, massage.

Anything "makes sense" if you swallow enough of the koolaid that comes with it.

I think it might be worthwhile to list out what components defensible therapy approach should have based on what we now know about pain processing.
It seems to me that it consists of:
-the neuromatrix is being considered as central when pain is the issue being treated
-we are explaining and modifying our approach based on neuroscience as an explanatory model, not other outdated paradigms of human function
-we are adhering to the principles of therapy promulgated by Barrett (eg patient must be able to self-treat)
-we attempt to approach all 6 domains of input and output

I think if any of us are doing all of these, we have a defensible approach. What does the group say?

I concur completely. :clap1:

[Luke Rickards]

That's true Diane, you haven't said peripheral treatment is irrelevant. Unless I am mistaken though, you have said that the particular features of all peripheral treatment other than, I suppose, conveying a sense of therapeutic ritual are irrelevant.

[Barrett Dorko]

I think that Luke is correct here. Perhaps this thread is large enough to contain a discussion of ritual itself.

My understanding is that the difference between ritual and ceremony is that the latter is observed while the former invites participation. Perhaps this is the not so easily seen distinction between methods that address the neuromatrix effectively (ending in a placebo response) and those that don't.

[Jon Newman]

In terms of our discussion of treatment models here, we have two options: we propose, based on our best understanding, that a peripheral component is likely to be involved in a pain response, that the peripheral component is amenable to change via some specific active or passive input, and that treatment which aims to include the provision of such an input is reasonable; or we propose that the presence or absence of a peripheral component to a pain response is irrelevant, that alterations in central processing are the only mechanisms responsible for pain reduction, and that manual treatment with the intent to do anything other than effect cognitive/evaluative change is superfluous.

I think it is important to emphasize that these represent the options or categories that patients may be in rather than competing models of (possible) reality. That is, for a given patient, either option may represent the reality of the situation. And for some patients, it could be both/and.

[Diane]

That's true Diane, you haven't said peripheral treatment is irrelevant. Unless I am mistaken though, you have said that the particular features of all peripheral treatment other than, I suppose, conveying a sense of therapeutic ritual are irrelevant.

I thought I made it abundantly clear that I think that physical contact is important, specifically to the hindbrain and to the kinesthetic cortex.

I don't think I brought up the term therapeutic "ritual" in this thread.

[Luke Rickards]

Jon,

You are correct. Though the models may be seen as competing where one 'reality' is significantly more likely than the other.

[Luke Rickards]

Diane,

You did make that clear. You also said that the features of that physical contact are not important because therapeutic responses are the result of placebo mechanisms. Placebo responses usually refer to those directly related to the contextual elements of therapy (the social ritual) and the patient's interpretation of their meaning.

[Diane]

Diane,

You did make that clear. You also said that the features of that physical contact are not important because therapeutic responses are the result of placebo mechanisms. Placebo responses usually refer to those directly related to the contextual elements of therapy (the social ritual) and the patient's interpretation of their meaning.

I thought I was quite clear that I was taking about placebo response, in the Patrick Wall sense, necessary for pain resolution and for setting neuroplasticity into a preferable direction.

[Diane]

Originally Posted by Luke Rickards View Post
Diane,

You did make that clear. You also said that the features of that physical contact are not important because therapeutic responses are the result of placebo mechanisms. Placebo responses usually refer to those directly related to the contextual elements of therapy (the social ritual) and the patient's interpretation of their meaning.

I thought I was quite clear that I was taking about placebo response, in the Patrick Wall sense, necessary for pain resolution and for setting neuroplasticity into a preferable direction.

I thought it was clear that I linked placebo RESPONSE as defined by Wall into a need for manual physical contact by a therapist.

The only punches that are being thrown here are to do with people being too overly wedded to their favorite treatment constructs, which the hindbrain and kinesthetic cortex could not care less about, and whose perspective I'm trying to represent fairly, because they, their receptivity, and their spreading effect out to the rest of the brain, are usually ignored.

[Luke Rickards]

Wall; The Science of Suffering (his final publication): page 133.

Culture, Learning, and Expectation

The placebo response is the fulfillment of an expectation.

That's the sense that I am referring to.