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  • #31
    Originally posted by Evanthis Raftopoulos View Post
    Sheld,What would such a scenario be like? I'm just curious.

    @all
    What do you guys define as “pain science”? It seems that many of us have different definitions.
    Pain science is science. Joe Brence says it best.
    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


    • #32
      Originally posted by Evanthis Raftopoulos View Post
      Sheld,What would such a scenario be like? I'm just curious.

      @all
      What do you guys define as “pain science”? It seems that many of us have different definitions.
      Young patient came with c/o LBP, left-center l-spine. MOI was ejection from a vehicle going ~45 MPH. Reported pain in all positions and all movements. Going through break up, thought his job "was just ok," pending litigation. 3rd year student focused on the pending litigation and psycho-social aspects. Thought that r/o anything else as far as exam goes was wasting time. "Clearly chronic pain with central sensitization" were his words. I took this as a learning moment for both of us and went through the exam. S & S suspicious of fracture. I couldn't believe patient hadn't had any imaging other than c-spine though c/o local pain for 6 weeks. Referred with suspicion of fx. CT demonstrated fx. If I'm being honest, I think this case in particular really torqued me off. This patient was failed by our system at so many levels.
      Always learning.

      Comment


      • #33
        Sheld, for this specific scenario I’d be more curious to hear the physicians’ rational for not doing further imaging studies following this sort of mechanism of injury.

        About the student’s reasoning:
        was this patient experiencing pain for a while (eg. more than 3 months since the incident)? The student might be right in that the patient experiences chronic pain with central sensitization. But central sensitization is not necessarily caused predominantly by "psychosocial" issues. It is associated with plastic changes/impairement of nociceptive processing in the CNS.

        From your comments it seems that you equate pain science with psychology and sociology (correct me if I’m wrong). If yes, then I don’t agree with that definition.
        -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
        The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

        Comment


        • #34
          Did your red flag go up by tapping his spinous processes with a reflex hammer?
          I still do that once in awhile.
          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


          • #35
            Personal Knowledge

            Research and Theoretical

            Professional Craft Knowledge



            Fig. 2 Three types of knowledge required to be an effective
            clinician. Knowledge in any one category can be translated
            into another category
            Knowledge is dynamic and knowledge in any one
            category can be translated into another category. “In
            practice all three types of knowledge are modified for and
            through practice– different types of knowledge are
            combined, extended, converted from one form to another,
            and most importantly, made specific to the patient and
            context in both time and space.” (Higgs, Fish and
            Rothwell 2008). It is the process of clinical reasoning
            that facilitates integration of all three types of knowledge.
            Pattern recognition also plays a role as it provides a link
            between biomedical knowledge and the specific patient
            context (Edwards and Jones 2007).
            This says it all. It seems to me that in recent years there has been a great deal of emphasis on the Research and Theoretical at the expense of the other two.
            Jo Bowyer
            Chartered Physiotherapist Registered Osteopath.
            "Out beyond ideas of wrongdoing and rightdoing,there is a field. I'll meet you there." Rumi

            Comment


            • #36
              Originally posted by Diane View Post
              Pain science is science. Joe Brence says it best.
              Thanks Diane, in your opinion how well does sociology and psychology fit the scientific paradigm?
              -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
              The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

              Comment


              • #37
                Originally posted by Evanthis Raftopoulos View Post
                Sheld, for this specific scenario I’d be more curious to hear the physicians’ rational for not doing further imaging studies following this sort of mechanism of injury.

                About the student’s reasoning:
                was this patient experiencing pain for a while (eg. more than 3 months since the incident)? The student might be right in that the patient experiences chronic pain with central sensitization. But central sensitization is not necessarily caused predominantly by "psychosocial" issues. It is associated with plastic changes/impairement of nociceptive processing in the CNS.

                From your comments it seems that you equate pain science with psychology and sociology (correct me if I’m wrong). If yes, then I don’t agree with that definition.
                The patient had been experiencing pain for less than 6 weeks. And no, I don't "equate pain science with psychology and sociology." Those quotes are verbatim HIS and HIS reasoning, not mine.
                Always learning.

                Comment


                • #38
                  I can see where a patient like that didn't have lumbar spine films after such an accident. If his primary c/o in the ER was neck pain, then of course they're going to do a series of head and neck imaging. His lumbar region complaint may have been minimal or even non-existent at the time of the accident.

                  I can also see how a 3rd-year student might not have the diff dx skills to consider the possibility of lumbar pathology, but it would definitely have been a good learning opportunity. I would have focused on response to medication. I suspect that NSAIDs would have been at least somewhat effective while recumbent, for example. Mechanical deformation versus chemical irritation would have been a focus of my exam, particularly given the traumatic onset. In cases like this, students should be taught that pathology is likely until you've done everything to rule it out.

                  How did the fact that the patient was going through a break up come up? I don't ask questions about patient's personal relationships except within the context of having help at home with daily activities. From here you can get a sense if family members/significant others are either solicitous or resentful towards the patient because of their disability. Otherwise, personal questions about relationships to determine "psychosocial risk" are a boundary violation, in my opinion. Of course, I do ask about work and how the injury has affected the ability to participate in that, and whether the supervisor has offered some accommodation while injured.
                  John Ware, PT
                  Fellow of the American Academy of Orthopedic Manual Physical Therapists
                  "Nothing can bring a man peace but the triumph of principles." -R.W. Emerson
                  “If names be not correct, language is not in accordance with the truth of things. If language be not in accordance with the truth of things, affairs cannot
                  be carried on to success.” -The Analects of Confucius, Book 13, Verse 3

                  Comment


                  • #39
                    John,

                    Patient didn't have any c/o neck pain. His pain was thoracic and lumbar after ejection and purely lumbar during the course of recovery. I'd expect a trauma CT and maybe c-spine radiographs but the patient reported he told both EMTs and ER doc about left-center LBP as well as his PCP and no follow-up at all was done. "Break-up" question arose when we asked about support system and help in the home environment otherwise I agree with you, it's not our business otherwise. It was an interesting case; I was more concerned with lack of attention to potential for pathology from a 3rd year student and quick dismissal of pathology in favor of central sensitization when MOI and hx didn't really fit. It turned out to be a good learning experience for the student, an eye-opening one for me, and the patient was thankful.
                    Always learning.

                    Comment


                    • #40
                      Originally posted by sheld505 View Post
                      The patient had been experiencing pain for less than 6 weeks.
                      OK, pain experienced for less than 6 weeks does not usually classify as "chronic pain". Perhaps your student was taught otherwise (why else would he insist on that?).

                      And no, I don't "equate pain science with psychology and sociology." Those quotes are verbatim HIS and HIS reasoning, not mine.
                      It sounded like it when you said

                      I've seen outright dismissal of the potential for pathology in the name of pain science.
                      followed by
                      3rd year student focused on the pending litigation and psycho-social aspects.
                      What is your definition of pain science?
                      -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                      The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                      Comment


                      • #41
                        I would not have a problem with asking such a patient how he feels about his current situation in broad terminology. What works for him, what doesn't and what he would like to be able to do.

                        In a team situation, where I worked, everyone respected boundaries but always asked why a particular HP was dong something or other, in order to understand the patient better. We shared information and goals; and were pretty open about it all. There was a neuropsychologist who was very open about sharing her knowledge for others to think about.

                        Solitary HPs are left out of this miscellany of information.

                        Nari

                        Comment


                        • #42
                          Originally posted by Evanthis Raftopoulos View Post
                          Thanks Diane, in your opinion how well does sociology and psychology fit the scientific paradigm?

                          I'm not sure what you're driving at, but IMO psychology is light years ahead of PT in terms of research, eliminating confirmation bias, doing basic study of pain, animal studies, all that good stuff. Sociology, not as caught up. I studied it in uni, but thought it was quite subjective, not political enough. Of course it was just a basic overview class.
                          Political science! Now that can be very juicy.
                          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


                          • #43
                            Thanks Diane,

                            I admit I’ve been struggling at times with trying to grasp how psychology and sociology fit the scientific paradigm.
                            -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                            The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                            Comment


                            • #44
                              Originally posted by John W View Post
                              So, let me get this straight- the guy who's telling us that complicated classification systems are not needed is doing lectures on EBP at international conferences with someone who has developed one of the most complicated classification systems this side of the Atlantic?

                              I'm with ANdy- bemused.
                              John, not sure if that's the case here, but nevertheless, I think it's OK for people who do conferences together to disagree on certain things. I wouldn't expect people presenting at the San Diego Pain Summit to agree on everything with each other.
                              -Evan. The postings on this site are my own and do not represent the views or policies of my employer or APTA.
                              The reason why an intellectual community is necessary is that it offers the only hope of grasping the whole. -Robert Maynard Hutchins.

                              Comment


                              • #45
                                Originally posted by John W View Post
                                So, let me get this straight- the guy who's telling us that complicated classification systems are not needed is doing lectures on EBP at international conferences with someone who has developed one of the most complicated classification systems this side of the Atlantic?

                                I'm with ANdy- bemused.
                                I am now even more unimpressed with this guy than I originally was in the first place. There was just something about that piece that rubbed me the wrong way.

                                Fluffy and seemingly inconsequential in terms of actual content. To me...he said nothing either profound or particularily refreshing.

                                I thought at times it appeared he lacked a grasp of the differentiation between science and practice.

                                If he is indeed with the ring people....his credibility is out the widow as far as I'm concerned.

                                Comment

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