A little pre-talk I did for Adam Meakins shoulder course in Vikeså, Norway 2016.

1. Pain DOES NOT BEGIN WITH THE STIMULATION OF RECEPTORS
AND IS NOT THE END PRODUCT OF A LINEAR SENSORY SYSTEM!
@SigMik

2. Meaks The notoriusWarm-up gig for

9. What the hell is that?
Oh,
just my mind.

11. Can I ask you a question?
It depends.
Knowledge is
case specific.

12. Can I ask you a question?
It depends.
Knowledge is
case specific.
Why does my back hurt?
N=1

13. PARADOXES
An unacceptable conclusion
Derived by apperently acceptable reasoning
from apperantly acceptable premises

14. KNOWLEDGE
PARADOXES
Specific cause = specific solution?
The problem is not that nothing works,
The problem is that anything can work

15. KNOWLEDGE
PARADOXES
The more i learn, the more i fix?
Can everything be fixed?

16. KNOWLEDGE
PARADOXES
It doesn’t Even have to be true,
But it can still potentially
be of great value
WHY?
How?!

17. PARADOXES leads to dilemmas
A case for simplicity, but
which simplicity should we listen to?
Simple solutions are everywhere!
Where facts are few, experts are many

18. The pLot
Is it possible to find sense in chaos?
Depends on certain premises

19. The pLot
Firstly:
YOU ARE NOT THE CENTER
Of THE UNIVERSE

21. The pLot
Secondly:
you have to be willing
to live with uncertainty
Accept informed probabilities,
Not definite certainties

22. Conceptual
hygiene
As little contradiction as possible
”Knowledge is case specific”
”True” knowledge is true
In all landscapes of ”reality”
We need certain models of reasoning

23. Models are tools for thinking
E.G. THE SAB & BPS model
What is a
Model?
”
George E. P. Box

24. What is a GOOD
Model?
”
George E. P. Box
Explains existing phenomeNon and
provides reliable predictability

25. Models are tools for thinking
E.G. THE SAB & BPS model
Explains existing phenomeNon and
provides reliable predictability
What is a
Model?
”good”
Essentially,
all models are wrong
but some are useful
”
George E. P. Box
Therapeutic models – wrong, but useful?

26. Normative
model
Causal
model
Descriptive
model
How the fuck
Why the fuck
What the fuck
Different situations rests on
different premises

27. How the fuck
Different situations rests on
different premises
Prescriptive
Based on an assumption
On how the world works
We basically do the same,
but from wildly (?)
Different premises
Normative
model

29. Why the fuck
Different situations rests on
different premises
history
+ Culture
= Identity
Causal
model

30. Why the fuck
Different situations rests on
different premises
How to become a man
The etero vs the kaluli
Henrich J, Heine SJ, Norenzayan A. The weirdest people in the world?
Behav Brain Sci. 2010;33(2-3):61–83; discussion 83–135.
Causal
model

31. Why the fuck
Different situations rests on
different premises
THE SOMATIC
DYSFUNCTION
BLOCKING OF QI
HYPOMOBILITY
SUBLUXATION
TRIGGERPOINT
BREATHING PATTERN
BPS-model
neurobollocks
Causal
model

32. DESCRIPTIVE
model
WHAT THE FUCK
Different situations rests on
different premises
FIRST OF ALL:
”Before we say something
is OUT of this world,
first make sure that it
is not IN this world”
Michael shermer

33. WHAT THE FUCK
Different situations rests on
different premises
secondly:
biological plausibility?
Thirdly:
Maybe Interesting,
But So what?
DESCRIPTIVE
model

34. cultural
consistency
Conceptual
hygiene
prescriptive Basic science
Normative
model
Causal
model
Descriptive
model

35. cultural
consistency
Conceptual
hygiene
prescriptive Basic science
Normative
model
Causal
model
Descriptive
model
THE SOMATIC
DYSFUNCTION
BLOCKING OF QI
HYPOMOBILITY
SUBLUXATION
TRIGGERPOINT
BREATHING PATTERN
BPS-modellen
BRAINSBRAINS

36. Why the fuck
Understanding of X, y, Z
Crosses all domains!
How the fuck What the fuck
Normative
model
Causal
model
Descriptive
model

37. Why the fuck
Understanding of X, y, Z
Crosses all domains!
How the fuck What the fuck
In which domain does the Pain
discussion take place?
Normative
model
Causal
model
Descriptive
model

38. Why the fuck
How the fuck What the fuck
How much (about reality) do
we need to know??
Normative
model
Causal
model
Descriptive
model
We believe what we do
And we do what we do
Because of our
culture!

39. What is pain?

40. Fundamental consequences
Are we machines or ecosystems?

41. True or false?

42. Our fMRI study concludes that
participants performing memory tasks
showed activity in the parts of the brain
associated with high sounds,
claustrophobia, colors and farting

43. CLOCKS vs CLOUDS

44. Bricks are relevant
for a building

45. But doesn’t say anything
about the meaning
BILDE -REDS503 @FLICKR

46. From THE bio-psycho-Social model
To The Socio-Psycho-Biological model?

47. Biography “becomes” biology
“Gains” (salutogenesis)
Trust
Belonging and
nourishment
Respect
Care
Honour and pride
A life sustaining
physiology of meaning,
belonging and hope
“Drains” (pathogenesis)
Threat and betrayal
Isolation and neglect
Humiliation and
integrity violation
Leaving behind
Guilt and shame
A pathophysiology of
disempowerment and
disadvantage
Linn Getz #CauseHealth
tendencies

48. The brain paradigm
Is the brain becoming the new spine?
”you have pain because something is
messed up in your spine”
”You have pain because something is
messed up in your brain”

49. Limitations of language
Do we ALL describe
love, hate, fear & Joy
The same way?
The SAB-model is useful,
but TOO simplistic
so what next?

50. Limitations of language
New definition of pain?

51. Pain is
an unpleasant sensory and
emotional experience
associated with actual or
potential tissue damage, or
described in terms of such
damage

52. Pain is
damage

54. Limitations of language
New definition of pain?
Pain is a distressing experience
associated with actual or potential
tissue damage with sensory, emotional,
cognitive and social components
Williams – 2016 – Upda0ng the defini0on of pain

55. Limitations of language
…all DEFINITIONS and models of
understanding are wrong, but...
Different models of understanding
are useful for different purposes
(and different realities)

56. Limitations of language
Humanistic (clinical) definition
Pain is whatever the person says it is

57. Limitations of language
Humanistic (clinical) definition
Pain is whatever the person says it is
pain is whatever
the experiencing person says it is,
existing whenever and wherever
the person say it does
Margo McCaffery
Problematic that A person could point at a rock and say ”That is pain”?

58. TID TID
MA
KE
SD
”THE MODERN BRAIN”
STRESSREGULATION PROGRAMS
ACTION PROGRAMS
PAIN PERCEPTION
Cognitive, sensory and
affective dimensions
Voluntary and involuntary action
patterns. Social communication
and management
Cortisol, noradrenalin,
endorphin levels and
immune system activity
BODY-SELF
NEUROMATRIX
INPUTS TO THE BODY-SELF
NEUROMATRIX FROM:
OUTPUT TO BRAIN AREAS
THAT PRODUCE:
Melzack, Katz; Cogn Sci 2013, 4:1–15@SigMik
The neuromatrix
”SENSORY SIGNALLING SYSTEM”
”THE PRIMITIVE BRAIN”
Is not specific for pain!

59. TID TID
MA
KE
SD
STRESSREGULATION PROGRAMS
PAIN PERCEPTION
Cognitive, sensory and
affective dimensions
Voluntary and involuntary action
patterns. Social communication
and management
Cortisol, noradrenalin,
endorphin levels and
immune system activity
INPUTS TO THE BODY-SELF
NEUROMATRIX FROM:
OUTPUT TO BRAIN AREAS
THAT PRODUCE:
Melzack, Katz; Cogn Sci 2013, 4:1–15@SigMik
What Goes on here?
COGNITIVE-RELATED BRAIN AREAS
Memories of past experience,
attention, meaning and anxiety
ACTION PROGRAMSEMOTION-RELATED BRAIN AREAS
Limbic system and associated
homeostatic/stress mechanism
SENSORY SIGNALLING SYSTEMS
Cutaneous, visceral and
musculoskeletal inputs

60. What Goes on here?
Humans are ecosystems

61. “Brains are necessary,
But not sufficient
For the perception of pain”

62. ”the structure of the neuromatrix is
predominantly determined by genetic factors,
although its eventual synaptic architecture is
influenced by sensory inputs.”

63. Activity in the water stream
is like synaptic activity
The swirls in the river
Is like “blobs” in the brain

64. A brain without synaptic activity
Is like a river without water

66. What pain is not
Pain is not a structural injury
Pain is not brain activity
Pain is not a chemical

67. So what?
Why does it matter?
If you really understand pain:
Then you’ll always believe people in pain
Then you’ll understand when pain becomes suffering
Then you’ll understand why communication matters
Then you’ll understand why so many treatments fail
Then your management will change

68. Evidence-based
physiotherapy:
A crisis in movement
Touch people who need touching,
this is therapy. Don’t touch people
who don’t need touching,
this is battery.
Talk with people who need talking
with, this is therapy.
Judge when this becomes
meaningless.
Educate your patient by all means,
but also let them educate you.
The Notorious R. Kerry

69. Was that it?
I guess