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  • Cory Blickenstaff's and Sandy Hilton's PT Podcast Network

    PT Podcast Network episode 2

    In episode 2, Sandy and Cory discuss the “Imprecision Hypothesis of Chronic Pain” recently published by Lorimer Moseley and Johan Vlaeyen. Potential clinical implications are discussed as well as a rebuttal that has already been submitted. Hard hitting questions are tackled, like “Is pain a stimulus or a response?”, “How does associative learning apply to clinical treatment?”, and “Does Cory have the mental fortitude to beat a 5 year old in Battleship?”
    :clap2::clap2::clap2:
    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

  • #2
    Thanks, Diane! There was a whole lot that we could have talked about and I hope I didn't butcher the topic of associative learning too bad.


    Sent from my iPhone using Tapatalk
    Cory Blickenstaff, PT, OCS

    Pain Science and Sensibility Podcast
    Leaps and Bounds Blog
    My youtube channel

    Comment


    • #3
      I enjoyed this, it's a long listen - not sure how long, I had it on while I was tying up loose ends following the early morning clinic list.

      Contextual surroundings around pain output was discussed. In my experience, it is highly significant and patients might not realise this until it comes up in discussion.

      With regards to embodied cognition, I sometimes wonder if we interfere with embodiment by talking too much about neurology when the patient is still at the stage of thinking in terms of body parts or regions as their pain generator. We shouldn't give inaccurate information, but we may have to meet them where they are and walk them through it.

      Cory makes the point that some patients continue to live with pain and that we have a role in helping them to rediscover agency. Sandy appeared to be reluctant to admit this to her patients, but will refer on in the hope that another practitioner will have a solution. In my experience of patients who have "been everywhere", much anger, resentment and expense can be avoided if the practitioner tells it like it is.

      Sandy says "We do like to win and so do our patients." I know several high functioning winners who have integrated the inconvenience of pain output into their successful and productive lives.
      Last edited by Jo Bowyer; 01-07-2015, 01:23 PM.
      Jo Bowyer
      Chartered Physiotherapist Registered Osteopath.
      "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

      Comment


      • #4
        Thanks, Jo, and I appreciate the feed back on the length.
        Cory Blickenstaff, PT, OCS

        Pain Science and Sensibility Podcast
        Leaps and Bounds Blog
        My youtube channel

        Comment


        • #5
          Another wonderful episode.

          I didn't mind the length one bit, it could easily have lasted twice as long.

          Comment


          • #6
            Thanks, Mike! We most certainly could have continued on for some time, considering the topic at hand. I know that for myself the likelihood that I will start listening to a podcast often depends on the time investment I will be required to spend to listen. Again, I really appreciate the feedback.
            Cory Blickenstaff, PT, OCS

            Pain Science and Sensibility Podcast
            Leaps and Bounds Blog
            My youtube channel

            Comment


            • #7
              Originally posted by BB View Post
              I know that for myself the likelihood that I will start listening to a podcast often depends on the time investment I will be required to spend to listen. Again, I really appreciate the feedback.
              But remember too...many are listening at 1.5 speed, so if you go a bit long, and the info is relevant and interesting, you will likely gain more listeners than you lose

              Respectfully,
              Keith
              Blog: Keith's Korner
              Twitter: @18mmPT

              Comment


              • #8
                Cory,

                I was listening to this today. I happened to be in class and at the dinner discussion talking with Bronnie and Sandy while in Chicago

                There is a lot of interesting information discussed in this podcast.

                "Low front pain." Hilarious and so true

                Can persistent pain be abolished? Sandy says yes and Bronnie says no. The evidence supports Bronnie's stance but Sandy is adamant to provide hope for people. My issue with hope in healthcare is it's hard to get out of healthcare. Healthcare will continue to look for problems and attempt to correct them. I'm not sure I'm willing to refer people to others for hope or context. I could be very wrong here. Sandy talks about patient's having pain without a stimulus (seeing a chair and hurting or walking into a bedroom and hurting). I think any of us can recall or relive a painful experience (in my case a cluster headache, fractured tibia, right plantar heel pain, left hip pain, left knee pain). To think we can rid someone of these engrained memories and experiences seems too good to be true at this point.
                "The views expressed here are my own and do not reflect the views of my employer."

                Comment


                • #9
                  I think they are both right.

                  Bronnie is right in the larger sense. Why would we ever even want to be rid of "pain"? It's protective. People whose brains can't produce it, die young.

                  Sandy is right in the more specific sense, depending on if the "pain" is from a tunnel syndrome or something. Those are not impossible to get rid of.
                  Last edited by Diane; 07-07-2015, 04:47 PM.
                  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
                    Bronnie's coursework was focused toward the more persistent population. Less of pain as protection (step on tack, etc) and more of maladaptive/unhelpful/chronic pain.

                    I know Wall (and many others) have talked about 'resolution' but it doesn't appear to be the case for many. By many reports, resolution is becoming less common since this paper came out.
                    "The views expressed here are my own and do not reflect the views of my employer."

                    Comment


                    • #11
                      Thanks, Matt.

                      IF pain is truly a classically conditioned response, it is typical for an extinguished response to be able to be more quickly regenerated (recovery from extinction).

                      Also, operant conditioning is always at play. I listened to this podcast on the topic this week and they make a good point about the hardiness of avoidance behaviors. The strength of operant conditioning depends upon the continued presence of the desired outcome. In avoidance the desired outcome is NOT getting the stimulus. So it is difficult to extinguish. (Here is their podcast on Classical Conditioning too)

                      Also, Hadler talks about the fact that many chronic pain presentations may be considered a surrogate measure for living life under a pall. Unfortunately, that is a very steep hill to climb. For many of the issues at hand, there does not exist a health care intervention.
                      Cory Blickenstaff, PT, OCS

                      Pain Science and Sensibility Podcast
                      Leaps and Bounds Blog
                      My youtube channel

                      Comment


                      • #12
                        Matt says:

                        By many reports, resolution is becoming less common since this paper came out.
                        Does this say something about the rise of "crossfit boxes" and the like? Celebrity-driven culture? The weakness of the therapy culture? Money? Reportage?

                        It's probably a combination of things. Discussion will help, but evidence remains elusive.
                        Barrett L. Dorko

                        Comment


                        • #13
                          Well, there's also this:

                          The Truth Wears Off

                          There was just recently an example of this published regarding the declining effect of CBT on depression.
                          Cory Blickenstaff, PT, OCS

                          Pain Science and Sensibility Podcast
                          Leaps and Bounds Blog
                          My youtube channel

                          Comment


                          • #14
                            Originally posted by BB View Post
                            I saw this when Byron posted it on FB somewhere this week.

                            A MUST READ. If someone doesn't ponder long and hard the potential consequences of this line of thinking on evidence based practice, they had better read it again - or retire and get out of the way.

                            Respectfully,
                            Keith
                            Last edited by Keith; 07-07-2015, 08:56 PM.
                            Blog: Keith's Korner
                            Twitter: @18mmPT

                            Comment


                            • #15
                              Originally posted by BB View Post
                              Also, operant conditioning is always at play. I listened to this podcast on the topic this week and they make a good point about the hardiness of avoidance behaviors. The strength of operant conditioning depends upon the continued presence of the desired outcome. In avoidance the desired outcome is NOT getting the stimulus. So it is difficult to extinguish. (Here is their podcast on Classical Conditioning too)
                              Thanks for those links, Cory.

                              This is where I suspect that (if I were to take sides) I am less optimistic than Sandy (and Butler/Moseley). As clinicians, we aren't even dealing with pain, so much (as Eric points out) as the expression of pain which is influenced by a lifetime of operant conditioning (as well as classical, too). We only have direct access to a small portion of the patient, and the most prominent piece we do have access to (social, not bio) is where we, as a culture, have the least understanding. Then, if we consider the 'failure of truths' and increasing evidence for a predictive mind, not so much a strict input/output processing system...well, the system is observed as increasingly complex and necessarily impossible to predict with any certainty, leaving us with loosely defined likelihoods that are increasingly unlikely to be of benefit to those who suffer from persistent pain.

                              I appreciate the efforts that the researchers are putting forth on pain - I do - but pain is a quagmire.

                              Respectfully,
                              Keith
                              Last edited by Keith; 07-07-2015, 07:00 PM. Reason: Big thumbs on tapatalk
                              Blog: Keith's Korner
                              Twitter: @18mmPT

                              Comment

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