Monica Noy – Recognizing Changes in Pain Science

Cognitive dissonance in osteopathy explained by Osteopath Monica Noy.  Very well written.  Note what she concludes at the end.  Modesty and honesty needed.

“For instance, a patient comes to see an osteopathic manual therapist who has only rudimentary knowledge of psychology and neuroscience. The primary complaint is low back pain that has no known mechanism of injury and for which there are no findings on either MRI or x-ray. The patient receives assessment and treatment according to whatever protocol the therapist has been trained to apply. The patient leaves the treatment session with no perception of back pain. The therapist is asked to provide an explanation for what happened and does so by revealing their interpretation of what they felt under their hands – a temporal bone in external rotation, a compacted SBS, a sacrum with little to no vitality that is in torsion, an internally rotated small intestine – then describes their treatment and normalization of the lesioned structures. The therapist believes that along with pain relief, the patient has also undergone anatomical and physiological changes that in turn liberate “an area of the body, whose release then provides a cascading effect of other releases throughout the body.”

Unknown to both patient and therapist their interaction is observed by a psychologist who knows nothing of osteopathic therapy. She observes the patient is lying down comfortably and appears relaxed, the room is dim and quiet. She observes the therapist first talk to and then touch the patient in various places; the head, the abdomen, the pelvis. The patient appears to be relaxed by the touch. At the head, the abdomen and the pelvis the touch is slow and sustained and gentle. Other motions applied to the patient are rhythmic and oscillatory. The psychologist offers a possible explanation of the outcome with relation to the psychosocial interpretation of belief, touch and caring that the patient is receiving.

Unknown to both patient and therapist their interaction is observed by a neuroscientist who knows nothing of osteopathic therapy. The neuroscientist offers a possible explanation of the outcome with relation to the patient’s neurological sensors in skin, muscle and joints that are activated by touch and motion and provide a sensory stimulation to the brain that may help to down-regulate the prior neurological input that may have resulted in the perception of pain.

Three different interpretations exist at the same and there are undoubtedly more. With just these examples the question is not which interpretation is correct, but which type of interpretation is likely to be less wrong.

You have an osteopathic explanation that relies on improbable levels of palpation interpretation without being able to establish reliability even with a not-insignificant amount of research, versus explanations that are science-based. Though these explanations may not have specific manual research studies behind them, they are supported by known science that can help to explain how neurophysiological or psychosocial factors may play a part in decreasing pain perception related to touch and context.

These less wrong explanations do not make osteopathic treatment or outcome cease to exist, but they do insist it start to tell a different story, one that makes it more modest, more honest and more flexible.”