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Pain
- “I believe he is suffering from memories” -Sigmund Freud
1) Greg Lehman is giving away his latest pain science workbook, Recovery Strategies. It’s a very indepth source on pain with a self-assessment at the end.
2) Which bias do you want to confirm? Derek Griffin thinks we should use this research to support SiMs not DiMs. Support your patients beliefs that they’ll get better. “Humans update self-relevant beliefs to a greater extent in response to good news than bad news.”
3) Expecting severe pain may make it more intense
4) Pain science education is much more than what the practitioner knows. The key component is communication. Especially being able to read people and perceive how they’re reacting to what you’re saying. Very similar to how a comedian develops their jokes.
6) Exercise is medicine. “Our data suggest that low levels of sedentary behavior and greater light physical activity may be critical in maintaining effective endogenous pain inhibitory function in older adults”
7) “Unexpectedly, we found that RVM GABAergic neurons facilitate mechanical pain by inhibiting dorsal horn enkephalinergic/GABAergic interneurons. We further demonstrate that these interneurons gate sensory inputs and control pain through temporally coordinated enkephalin- and GABA-mediated presynaptic inhibition of somatosensory neurons. Our results uncover a descending disynaptic inhibitory circuit that facilitates mechanical pain, is engaged during stress, and could be targeted to establish higher pain thresholds.”
8) It’s a relationship. Not all relationships are advantageous. “When influencing pain with treatment, a patient’s perceived working alliance during treatment does predict pain reduction and improvement in physical functioning. It is recommended to inquire about a patient’s working alliance during treatment in patients with chronic musculoskeletal pain”
9) “One stops being fearful when they are flush with exposure.” –Christine Ruffolo
10) Chronic migraines are complex. “Psychiatric symptoms and pain catastrophizing were strongly associated with severe migraine-related disability. Depression and chance locus of control were associated with chronic migraine.”
11) Don’t let your knowledge make you arrogant. “There is a trend towards thinking we need to simplify the pain message in order for patients to ‘get it’. I think this is a mistake. I also think it conveys a subliminal message that they cannot possibly understand what we do – that somehow we are more capable. People pick up on these cues and it immediately erects a barrier to effective communication.”
12) Pictures to decrease pain? “Pictures of varying emotional content and arousal value all reduced affective and sensory perceptions of pain. Viewing photographs of loved ones reduced pain intensity more than viewing other picture types. The association between picture type and decrease in pain intensity was mediated by picture valence.”
13) “Dr. Charles Kim, MD and professor at New York University, told Everyday Health that being physically active could greatly enhance people’s lives. “People who exercise and maintain a good aerobic condition will improve most pain conditions,” he says. Heat therapy, fish oil and mediation are several other alternatives to popping a pill.”
14) My old boss used to walk by me, smile, and say “CBT” after he used safe exercises, humor, and positive communication to help chronic pain patients feel better. Here’s some research showing it rewires the brain.
15) Read this great article on predictive coding by Todd Hargrove
“By learning more about the science of perception, we necessarily learn more about pain and how to treat it.”
“To some extent, we perceive what we predict.”
“top-down “shakes hands” with bottom-up, and disagreements are discussed and compromises are struck”
“If the error (or disagreement) is relatively small, it is disregarded as being random noise or “close enough.” Higher levels of the nervous system are not informed of their prediction errors, and the world is perceived exactly as expected. If the error is large, higher levels are notified of their mistake so they can update their model of the world.”
“The strength or confidence of the prediction has a big effect on how prediction errors are treated.”
“The bottom line is this – a great deal of what can help with pain in the short term is violating an expectation that something will hurt.”
“Getting better at movement is therefore very much about improving your internal models for movement and your predictions for what kind of sensory feedback you will get during the movement.”
16) Cafe Wall Illusion. Are these lines parallel? Are you sure?
The main reason I do this blog is to share knowledge and to help people become better clinicians/coaches. I want our profession to grow and for our patients to have better outcomes. Regardless of your specific title (PT, Chiro, Trainer, Coach, etc.), we all have the same goal of trying to empower people to fix their problems through movement. I hope the content of this website helps you in doing so.
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