Definition of Pain

FROM THE IASP (Internation Association for the Study of Pain)

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

Note: The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain-relieving treatment. Pain is always subjective. Each individual learns the application of the word through experiences related to injury in early life. Biologists recognize that those stimuli which cause pain are liable to damage tissue. Accordingly, pain is that experience we associate with actual or potential tissue damage. It is unquestionably a sensation in a part or parts of the body, but it is also always unpleasant and therefore also an emotional experience. Experiences which resemble pain but are not unpleasant, e.g., pricking, should not be called pain. Unpleasant abnormal experiences (dysesthesias) may also be pain but are not necessarily so because, subjectively, they may not have the usual sensory qualities of pain. Many people report pain in the absence of tissue damage or any likely pathophysiological cause; usually this happens for psychological reasons. There is usually no way to distinguish their experience from that due to tissue damage if we take the subjective report. If they regard their experience as pain, and if they report it in the same ways as pain caused by tissue damage, it should be accepted as pain. This definition avoids tying pain to the stimulus. Activity induced in the nociceptor and nociceptive pathways by a noxious stimulus is not pain, which is always a psychological state, even though we may well appreciate that pain most often has a proximate physical cause.

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Overzealous claims in therapy research

Does massage therapy decrease inflammation and stimulate mitochondrial growth? An intriguing study oversold

https://sciencebasedmedicine.org/massage-therapy-decreases-inflammation/

“None of this is to say that massage is useless or that it might not have therapeutic benefit in some circumstances. What this is to say is that this study, contrary to how it’s being portrayed, is not slam-dunk evidence that massage is some sort of “non-drug” treatment for inflammation”

inflammation

 

Todd Hargrove and Multimodal Perception

Another great blog by Todd Hargrove.  The main point of this blog boils down to a careful suggestion, which is that MOVEMENT-based therapy is superior to education-based therapy, for chronic pain.

Hidden-Dalmatian.jpg

“But pain is unfortunately sometimes more like the checkerboard illusion – immune to logic. People often have pain in areas where there is no damage, and sometimes in areas where there aren’t even body parts! Having conscious knowledge about these facts sometimes cannot affect perception. In terms of modules, we could say that the pain module is just not very interested in hearing corrective information from the cognitive modules. It was designed to be strategically ignorant about their conclusions. This is frustrating, but I think an interesting theoretical way to look at the problem of pain having “a mind of its own.” If the pain module won’t “listen” to the more cognitive modules, which modules might be better at speaking its “language?” The movement modules would be first on my list.”

Fibromyalgia – “The mysterious disease of pain, exhaustion and mental fog”

Fibro

https://www.painscience.com/articles/fibromyalgia.php#cfs-me

“Or it’s possible that exercise just really does aggravate some cases of fibromyalgia.

And yet fibromyalgia is among the most likely of chronic pain conditions to benefit from exercise if you do it right. But what’s right? No one knows for sure, of course, but here are some evidence-inspired tips:

  • Moderation, of course: either stick to the Goldlilocks zone, or only leave it for relatively short bursts. The conventional wisdom is regular moderate exercise, never too much or too little, but I think that’s a bit too simplistic. You may want to exercise intensely because it’s fun, for instance, but that must be balanced with more frequent and generous recovery opportunities than you needed back in the pre-fibromyalgia days.
  • Timing is everything: as every fibromyalgia patient knows, there are good days and bad days. It’s important to minimize exercise on the bad days, and equally important not to pounce on the opportunity to get back to it on the good days.4950
  • Aerobic or lifting weights? It doesn’t really matter — they both seem to work.51 Do what pleases you…
  • Make it fun, make it happy. That may sound trite, but exercise may work for fibromyalgia not because of its familiar biological effects, but as a desensitization tool, a brain-changer,52 a way to demonstrate to nervous systems that the world is a “safe and good place.”53 This effect would also go a long way to explaining why one form of exercise seems to work well for one patient, and not at all for another: because its success depends at least partly on how we feel about a workout. “

Chronic Inflammation – source of pain?

inflammation-diagram.jpg

One possible cause of chronic pain?

https://www.painscience.com/articles/inflammation-chronic-subtle-systemic.php

“Fitness: Undoubtedly critical! Regular moderate exercise really is the closest thing we have to a miracle drug or a fountain of youth. The older you get, the more you should avoid the extremes: too much and too little are likely both a problem.

Portrait of Isaac Newton with meme-style caption: “Brother, do you even attempt to raise heavy objects against the force of gravity?”

Do you even lift? You should! Weight lifting specifically is linked to a lower risk of metabolic syndrome.24 It’s a more well-rounded and efficient workout than most people realize.25

Anti-inflammatory nutrition: It’s also possible to some extent to eat an “anti-inflammatory” diet — which isn’t as impressive as it sounds. It basically just means a healthy diet, particularly one that doesn’t give our system major blood sugar regulation challenges.”

Decrease Pain by Moving, through Nervous System Adaptation

brain-pain

Todd Hargrove is able to describe in simple enough terms, how movement can decrease pain through adaptations in your brain and nerves:

We experience pain in relation to movement when the nervous system perceives that the movement is threatening to the body. Like other perceptions, the perception of threat is an interpretation that is subject to change based on a wide variety of information. A program for graded exposure can offer the nervous system new information about a movement that might cause a change in perception. If you can find a way to perform a currently painful movement at a low enough intensity that it does not hurt, you are sending the nervous system feedback that the movement is safe. If you do this repeatedly, perhaps the nervous system will start to disassociate the movement from the pain. This is the same rationale underlying many treatments for anxiety and phobias.

https://www.bettermovement.org/blog/2014/graded-exposure

Strength/Resistance Training

 

Strength/Resistance Training: increases mobility, cognitive benefits, increases cardiovascular health, increases strength

The science behind strength training is taught in superb fashion in “Body By Science” by Doug McGuff.  Even if you’re not interested in a so-called “12-minute a week” program, the teachings about exercise in this book are invaluable.

bbs

FYI: More info on strength training: it leads to the maintenance of functional ability, the prevention of osteoporosis, sarcopenia, lower-back pain and other disabilities, a reduction in insulin-resistance, diabetes, heart disease, cancer, falls, fractures, disabilities, the cardiovascular demands of exercise, depression, an improvement in metabolic rate, glucose metabolism, blood pressure, body fat and central adiposity, blood-lipid profiles, gastrointestinal transit time, cognitive function, and quality of life, and an increase in muscle and connective tissue cross-sectional area, strength, power, endurance, hypertrophy, flexibility, joint stability, posture, mood, and self-esteem.

 

 

Shoulder Decompression Surgery

Interesting take on shoulder decompression surgery by Adam Meakins:

https://thesportsphysio.wordpress.com/2016/09/11/shoulder-decompression-coming-under-more-pressure/

“the effectiveness of this surgery has been challenged for many years, by many people, and some recent research has challenged it further. Budoff’s intriguing paper here which I recently read, demonstrates that by removing the coracoacromial ligament and shaving the acomial arch it now means the rotator cuff has to workHARDER to control and centralise the humeral head on the glenoid, not less! This is completely contradictory to how this surgery is often explained to patients, and it can also explain why some patients don’t do well after this surgery.”

Monica Noy on Cognitive Dissonance

I really admire Monica Noy’s writing.  This piece displays a good deal of bravery on her part.  She dispels craniosacral therapy as quackery, which is all the more impressive seeing as how she studied this very modality intensively throughout her own schooling, and therefore did have, at one point, a vested interest in promoting its use.

You Don’t Win Friends With Cognitive Dissonance.

“Talk about cognitive dissonance.

Palpation reliability – not a thing. It has nothing to do with lack of evidence, and everything to do with a lot of evidence that has consensus of a negative result.

Cranial bone mobility – not a thing. Now some will say that studies show pliability of the suture like that changes something. And studies do indeed show pliability of the suture, but it changes nothing because what does it really mean to have pliability at the suture? How does that pliability become osteopathic cranial mobility? Short answer, its functional for cranial growth and it doesn’t mean shit for osteopathic cranial bone mobility.

PRM – not a thing. Rhythm, rate, expression and mechanism not established, highly debated, lots of alternate hypothesis, some more or less supported by physiology but nothing resembling the currently established parameters.

Normal cognitive function – oh, that’s a thing. And if that’s a thing, a normal thing, what does it really mean to be a human with normal cognitive function? Short answer, it means that if we don’t really truly THINK about it, we will construct a reality that fits our desire. Even shorter answer, we are egotistical first, thoughtfully reflective someways down the road, maybe.”

No association between low back pain and lumbar spondylolysis with or without isthmic spondylolisthesis!

This is huge news.  The link below is to a systematic review which has concluded that low back pain is NOT related to lumbar spondylosis which is a mechanical deformity often found in the lumbar spine.  It is very common.  As of right now, 2016, there are a ton of surgeons, MD’s, chiropractors, and many other health professionals, that will suggest to patients that they are in pain or should be in pain due to these deformities..  This sort of thinking actually increases fear of movement in the patient and/or produces a “nocebo” effect, which is scientifically proven to actually worsen outcomes.  Oh the irony!

“And another structural diagnosis is found to have no association with pain… How many more of these are needed before this message becomes widely accepted in the medical and public arenas?” – Adam Meakins

http://link.springer.com/article/10.1007/s00586-015-3910-5