NOI Group Forums

[bernard]

NOI group discussion lists was certainly the best place in the world until March 2004.

http://www.noigroup.com/cgi-bin/ubbc...cgi?category=1

It reopenned in July with some royal colors but it sounds too serious now! ops:

[emad]

HI all ;

Currently, Noi discussion is lazy ,no active discussions :cry: :zip:


Emad ?????????

[Barrett Dorko]

If there's any leadership on NOI I don't often see it. For all they say about being interested in sharing information or presenting some original thinking into the profession, the teachers regularly conducting courses for Butler rarely say anything without being paid for it.

What we see there is to be expected given that attitude, and I'm not interested in anybody telling me they "don't have time" to contribute in this way. That just implies that I just sit around all day, and that's not true.

I also watch a lot of TV.

[nari]

I think one of the reasons that it has fallen by the wayside (again) is a lack of follow-through with replies. Several promising threads dissolve because responses are not forthcoming, and when they do arrive, there is not much in them, and the askers of questions get tired of a thread that moves like molasses.
It worked well, until the March 2004 crash.

Nari

[Diane]

I maintain hope that it will reinspire itself, renew itself somehow and go charging forth again. Meanwhile, everything has seasons.

[EricM]

I don't want to turn this into a 'pick on NOI' session because I think they have done some wonderful work, but I thought I'd share some of my experiences from a NOIgroup course I attended last weekend. It was Mobilisation of the Nervous system, level 1, taught by the Canadian instructors. This course is a prerequisite to seeing Butler himself speak later in the year. To me it was poorly done. The material was dumbed down. The instructors spoke to the wall rather than to the class. Their application of techniques was sloppy (compared to Shacklock). And after several hours of lecture on peripheral and central pain mechanisms, we were implored repeatedly not to become "neuro-heads." I suppose that for those completely new to the material it might have been interesting. I expected more.

Eric

[nari]

Eric

An unfortunate experience. I hope you fed back to NOI and the instructors on these issues?

If you can, do the SNS with David. He makes it inspiring for his audience, cracks jokes and gets excited himself about cytokines, synapses and DRGs.

I think it must be difficult to standardise lecturers' abilities around the world.

Nari

[bernard]

Well, NOI is evolving.
They are discovering finally, breathing. :thumbs_up:thumbs_up

take a deep breath

[Diane]

Here is a thumbnail of the underside of the diaphragm..I think it is clear visually how deep breathing would neuromodulate via the phenics back up to the cervical plexuses.. also, the mechanical stimulation of the viscera would surely please the vagus, send some important info up through it..

[Diane]

A very nice noigroup newsletter by Tim Beames:

DECADES OF DENIAL
We have known about central sensitisation (CS) for at least 20 years, since Patrick Wall, Clifford Woolf and others published seminal papers suggesting that some pain and altered sensory states may be due to synaptic and membrane excitability changes in the central nervous system and not necessarily due to processes in tissues. This should have been a great relief to health professionals, but attempts to introduce the notion into rehabilitation, especially the manual therapy world (Butler 1994; Gifford and Butler 1997) were met with slow acceptance and often derision. I can recall introducing it in a conference in Scandinavia in the early 90s with the following speaker saying "well that's well and good but we have to get on with the treatment", and so the next session was on muscle stretching. "You are turning into a counsellor" was another comment. Many prominent physiotherapists and anatomists still deny the state and the current level of integration in most undergraduate and postgraduate programmes appears little more than lip service. Central sensitisation underpins modern biopsychosocial holistic management, yet we have a long way to go to integrate it. It deserves core curriculum status. A hot off the press review article by Clifford Woolf (2010) makes me believe that there may be a growing knowledge gap between science and practice.

ADMITTING THAT THERE IS MORE TO THE STORY
For health practitioners to take on central sensitisation, they usually need to accept that the old peripheral story is not complete. A trigger point may have little to do with issues in the soft tissues, the palpably tender C2-3 nothing to do with processes around the joint, and the irritated gut only partly related to the gut, but are now known to be more due to a central nervous system which has lost the ability to "feature extract" from input and defaults quickly to a pain construction. The pathophysiology of this state is now well described. See Latremoliere (2009) and Woolf (2010) for updates. Of course this can be a challenge – many successful practitioners have a lot of clinical mileage at stake and large investments in continuing education. While many readers of these notes will have embraced it, most of the rehabilitation community is yet to integrate it.

A WORD FROM A BIG PICTURE EXPERT
Gordon Waddell (1998) summed it up nicely when defending modern holistic biopsychosocialism "it is all very well to say that we use science and mechanical treatment within a holistic framework, but it is too easy for that framework to dissolve in the starry mists of idealism. We all agree in principle that we should treat people and not spines, but then in daily practice we get on with the
business of mechanics."

"BUT WHAT ABOUT CHRONIC KNEE OA AND OA HIPS THAT RESPOND
TO HIP REPLACEMENT?"
The hard core biomedicalists often bring this out as evidence of the tissue base of chronic pain. Of course, these are peripheral diseases which are often amenable to peripherally directed management. But even here, the degree of pain does not match radiological finding or degree of inflammation, suggesting a central mechanism as well (Bradley, Kersch et al. 2004). In OA knees (Arendt-Nielsen, Nie et al. 2010) and OA hips, there is impaired central inhibitory controls. This key feature of central sensitisation will improve with hip replacement (Kosek and Ordeberg 2000). This and other data summarized by Woolf (2010) strongly suggests central sensitisation should be a consideration in all acute and chronic pain states.

BUMS INTO GEAR
This NOInotes is unashamedly all about getting readers to update, reconsider and read the Woolf update – here you can read all about CS in rheumatoid arthritis, osteoarthritis, TMJ disorders, fibromyalgia, headache, miscellaneous musculoskeletal disorders, post surgical pain, irritable bowel syndrome etc. etc.

Central sensitisation is treatable, though currently predominantly by medication. The NNT (number of people need to treat to get one with 50% pain relief) in fibromyalgia for a drug like pregabelin is around 6 (Russell 2006). This simply reinforces the fact that the conservative forces of management need to get their bums into gear, review current paradigms and get CS evidence based management strategies including neuroscience education (Butler and Moseley 2003), graded activity and exercise, imagery, mindfulness, and appropriate manual therapies out there and heard. Central sensitisation is so liberating in the clinic – the relentless and often disappointing searches for sources of nociception in the clinic becomes less important and it supports the critical notion that functional restoration can processed even in the presence of pain.

And there is a little bit of muted satisfaction seeing the research emerge which supports the importance of central sensitisation in all acute and chronic pain states.

REFERENCES
Arendt-Nielsen, L., H. Nie, et al. (2010).:"Sensitization in patients with painful knee osteoarthritis." Pain 149: 573-581.
Bradley, L. A., B. C. Kersch, et al. (2004)."Lessons from fibromyalgia : abnormal pain sensitivity in knee osteoarthritis" Novartis Found Symp 260: 258-270.
Butler, D. S. and L. S. Moseley (2003). Explain Pain. Adelaide, Noigroup Publications.
Butler, D. S. (1994). The upper limb tension test revisited. Physical Therapy of the Cervical and Thoracic Spines. R. Grant. New York, Churchill Livingstone.
Gifford, L. and D. Butler (1997). "The integration of pain sciences into clinical practice." The Journal of Hand Therapy 10: 86-95.
Kosek, E. and G. Ordeberg (2000).”Lack of pressure pain modulation by hetereoptic noxious conditioning stimulation in patietnns with painful osteoarthritis before but not following surgical pain relief." Pain 88: 69-78.
Latremoliere, A. and C. J. Woolf (2009)."Central Sensitization: a generation of pain hypersensitivity by central neural plasticity." The Journal of Pain 10: 895-926.
Russell, I. J. (2006)."Fibromyalgia syndrome: Approach to management" Bull Rheum Dis 45: 1-4.
Waddell, G. (1998). The Back Pain Revolution. Edinburgh, Churchill Livingstone.
Woolf, C. J. (2010)."Central sensitization: Implications of the diagnosis and treatment of pain." Pain (in press).

You can subscribe to Noi Notes here.
Here is a link to the Woolf article referenced by Tim.

[Bas Asselbergs]

Thanks Diane - yes, that is a very nice newsletter.
I should put that Woolf article reference under my signature in all my reports.

[pht3k]

yes very nice newsletter. just finished to read my email before i saw your post. i was about to post it too