Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Painful Paradoxes, Dilemmas & Premises For The Understanding of Pain

542 views

Published on

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

Published in: Health & Medicine
  • Be the first to comment

Painful Paradoxes, Dilemmas & Premises For The Understanding of Pain

  1. 1. Pain DOES NOT BEGIN WITH THE STIMULATION OF RECEPTORS AND IS NOT THE END PRODUCT OF A LINEAR SENSORY SYSTEM! @SigMik
  2. 2. Meaks The notoriusWarm-up gig for
  3. 3. What the hell is that? Oh, just my mind.
  4. 4. Can I ask you a question? It depends. Knowledge is case specific.
  5. 5. Can I ask you a question? It depends. Knowledge is case specific. Why does my back hurt? N=1
  6. 6. PARADOXES An unacceptable conclusion Derived by apperently acceptable reasoning from apperantly acceptable premises
  7. 7. KNOWLEDGE PARADOXES Specific cause = specific solution? The problem is not that nothing works, The problem is that anything can work
  8. 8. KNOWLEDGE PARADOXES The more i learn, the more i fix? Can everything be fixed?
  9. 9. KNOWLEDGE PARADOXES It doesn’t Even have to be true, But it can still potentially be of great value WHY? How?!
  10. 10. 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
  11. 11. The pLot Is it possible to find sense in chaos? Depends on certain premises
  12. 12. The pLot Firstly: YOU ARE NOT THE CENTER Of THE UNIVERSE
  13. 13. The pLot Secondly: you have to be willing to live with uncertainty Accept informed probabilities, Not definite certainties
  14. 14. 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
  15. 15. Models are tools for thinking E.G. THE SAB & BPS model What is a Model? ” George E. P. Box
  16. 16. What is a GOOD Model? ” George E. P. Box Explains existing phenomeNon and provides reliable predictability
  17. 17. 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?
  18. 18. Normative model Causal model Descriptive model How the fuck Why the fuck What the fuck Different situations rests on different premises
  19. 19. 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
  20. 20. Why the fuck Different situations rests on different premises history + Culture = Identity Causal model
  21. 21. 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
  22. 22. 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
  23. 23. 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
  24. 24. WHAT THE FUCK Different situations rests on different premises secondly: biological plausibility? Thirdly: Maybe Interesting, But So what? DESCRIPTIVE model
  25. 25. cultural consistency Conceptual hygiene prescriptive Basic science Normative model Causal model Descriptive model
  26. 26. 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
  27. 27. Why the fuck Understanding of X, y, Z Crosses all domains! How the fuck What the fuck Normative model Causal model Descriptive model
  28. 28. 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
  29. 29. 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!
  30. 30. What is pain?
  31. 31. Fundamental consequences Are we machines or ecosystems?
  32. 32. True or false?
  33. 33. 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
  34. 34. CLOCKS vs CLOUDS
  35. 35. Bricks are relevant for a building
  36. 36. But doesn’t say anything about the meaning BILDE -REDS503 @FLICKR
  37. 37. From THE bio-psycho-Social model To The Socio-Psycho-Biological model?
  38. 38. 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
  39. 39. 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”
  40. 40. 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?
  41. 41. Limitations of language New definition of pain?
  42. 42. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage
  43. 43. Pain is damage
  44. 44. 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
  45. 45. Limitations of language …all DEFINITIONS and models of understanding are wrong, but... Different models of understanding are useful for different purposes (and different realities)
  46. 46. Limitations of language Humanistic (clinical) definition Pain is whatever the person says it is
  47. 47. 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”?
  48. 48. 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!
  49. 49. 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
  50. 50. What Goes on here? Humans are ecosystems
  51. 51. “Brains are necessary, But not sufficient For the perception of pain”
  52. 52. ”the structure of the neuromatrix is predominantly determined by genetic factors, although its eventual synaptic architecture is influenced by sensory inputs.”
  53. 53. Activity in the water stream is like synaptic activity The swirls in the river Is like “blobs” in the brain
  54. 54. A brain without synaptic activity Is like a river without water
  55. 55. What pain is not Pain is not a structural injury Pain is not brain activity Pain is not a chemical
  56. 56. 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
  57. 57. 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
  58. 58. Was that it? I guess

×