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Re: LBP Treatment Approaches
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Re: LBP Treatment Approaches - July 2, 2005 2:36:00 PM
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nari
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Zack
Every pain experience IS 'psychological'; in the same way,if you feel angry and upset,you would not deny there is a 'psych' component, would you?
Paiin is no different; it is an emotion.
So, every acute pain experience has the potential to becomes persistent pain. When you see patients with a gr2 ankle sprain, or a OA knee, the potential is there; and their CNS is testing you, as part of the whole internal and external environment. If their CNS registers danger, correctly or not, pain will most likely persist.
Danger can be anything from a breakup with the partner to illness or unwanted social isolation
Does this make sense?
And we do not have to be psychoanalysts; we haven't the training, but we can listen and educate on pain processes. It works, not 100% of course, but effectively enough.
Nari
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Re: LBP Treatment Approaches - July 5, 2005 10:08:00 AM
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karmzack
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From: Hawaii
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Nari, your post makes some sense. Is it true that pain is an emotion? I always thought there were two broad types of pain; emotional pain and physical pain which can be affected by emotion.
[QUOTE] we can listen and educate on pain
[/QUOTE]I wonder what is more effective, listening or educating? When you listen and show compassion for a patient’s state of pain it evokes emotions of relief, satisfaction, and joy that a healthcare provider cares about their pain. It is possible that arousing positive emotions are more effective inhibitors of pain than calm states of relaxation. Perhaps the patient felt disheartened by past providers showing insensitivity to their pain, reinforcing the pain behavior.
When you educate you are developing understanding, not necessarily emotion, within the patient.
So if you have 15 minutes to spend with a patient, your time would be better spent listening to the patient rather than educating. (I’m just thinking by writing now).
Then again, if you perform massage, evoking pleasure, you will have the inhibition of pain through emotion, not necessarily through the actual physical stimulus of touch.
I have little understanding of pain. Is my train of thought way off?
_____________________________
Zack Solomon MPT, OCS, CSCS
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Re: LBP Treatment Approaches - July 5, 2005 1:41:00 PM
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nari
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Zack, if you can get hold of David Butler's 'The Sensitive Nervous System' or Shacklock's 'Clinical Neurodynamics', there are good sections on pain physiology.
There is no such thing as physical pain and there are no pain receptors, just busy little receptors sending afferent chemical messages ALL the time,the skin of course being a crucial part of all this conveyor belting. So when you perform massage, touch is crucial. You are affecting the brain's interpretation of whether you are being nice or nasty, and thus having an effect on neuromodulation.
Then again, you can do the same without touching -words and thoughts can be highly provocative in a positive and negative sense.
Only 15 minutes with a patient does not leave much time for anything, but the first visit could be spent listening; the patient might figure that this guy is really interested in what I am saying and feeling. When patients start to ramble, they can be directed back into some relevance, but even rambling can be useful- talking about what is important to THEIR scene. You are right about that!
Just think, the next time you have a patient with LBP which has hung around for months on end - you may decide to treat the lumbar spine directly or not, but whatever you decide, you are treating the BRAIN..not a bunch of bones tied up with string and sticky tape.
Just some thoughts!
Nari
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Re: LBP Treatment Approaches - July 6, 2005 5:39:00 PM
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jbeneciuk
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From: Jacksonville, FL
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Nari:
Just beginning to read "Clinical Neurodynamics"
**Regarding your statement to Zack previuosly,
"there are no pain receptors"
*Why does Shacklock speak of "pain activated through nociceptors that are located in the connective tissue" (p.18) ?
JBeneciuk
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Re: LBP Treatment Approaches - July 7, 2005 3:42:00 PM
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srcase
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From: Michigan
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FYI: For those who can't go out and buy a bunch of new books right away, there is a decent chapter on Pain in the book: Management of Common Musculoskeletal Disorders by Darlene Hertling. It is a book that most PT's probably already have. I just discovered this chapter yesterday and was pleasantly surprised that is starts with a quote by Melzack.
jben, if i understand it correctly, neurophysiologically speaking, pain is a perception created by a certain threshold of firing of afferent nerves, which can be decreased or inhibited by higher centers. So, it's not a chemical process where receptors in the cell wall receive substrates and trigger a reaction. Is that what you meant?
Sarah
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Re: LBP Treatment Approaches - July 7, 2005 6:56:00 PM
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karmzack
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From: Hawaii
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Isn't a free nerve ending just an unencapsulated receptor?
I believe most modern physiology text books recognize the existance of nociceptors.
_____________________________
Zack Solomon MPT, OCS, CSCS
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Re: LBP Treatment Approaches - July 7, 2005 7:40:00 PM
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Diane
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From: Vancouver, B.C., Canada
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Nari will probably be up soon and will answer. Meanwhile, I'll throw in a few things about the nerves:
1. Yes there are nocioceptors.
2. They are thin and unmyelinated.
3. They relay information to the cord about the conditions of the tissues within which they dangle, which is everything including other larger faster nerves.
4. They continuously report chemical, mechano or thermal info, as do A-deltas, which are thicker and myelinated and more abundant in skin.
5. None of info in point 4 is considered "pain".
6. Pain is considered to be the big picture that the brain creates when it mixes upcoming sensation with cognition, context, beliefs, prior experience, current priority (E.g., you won't feel the scratch much if a cougar is trying to kill you... your brain will singlemindedly fight the cougar, not be concerned with incoming sensation from nocioceptors in the heat of the moment.)
7. Pain will be felt later, once the cougar is off you, and you have time to experience your scratches/bites. The brain will create pain to deal with the next level of perceived threat, i.e. the need to slow you down to permit healing.
Hope that helps,
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Re: LBP Treatment Approaches - July 7, 2005 10:34:00 PM
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nari
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From: Australia
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Can't really go past Diane's explanation...
and I am not sure why Michael made the sentence slightly ambiguous, suggesting there are pain inputs from the nociceptors.
Diane, you are giving the poor *****cats a hard line! ;)
Nari
PS Good grief I got censored...
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Re: LBP Treatment Approaches - July 8, 2005 6:03:00 AM
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Diane
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Nari, you can try to get your word around the sensors/censors by spelling it like t-h-i-s. But never mind, I think we know what word you were typing, five letters long, prefix to "-cats."
About the nocioceptors, it might be helpful to de-Cartesianize the process by considering this excerpt from "The Challenge of Pain" by Melzack and Wall. They are about to go into exquisite detail in Chapter 5 about peripheral nerve and spinal mechanisms, and take great pains to emphasize that the theory of pain must fit the facts as have been gathered and all the weird kinds of pain people can have, so they make a point of emphasizing the difference between specificity and specialization:
[QUOTE]“The psychological and clinical phenomena of pain provide a framework for the physiological problems we will now consider. Two terms are especially critical in our attempts to understand the physiology of pain: specificity and specialization.
“Specificity implies that a receptor, fibre, or other component of a sensory system subserves only a single specific modality (or quality) of experience; it assumes a rigid, fixed relationship between a neural structure and a psychological experience.
“Specialization implies that receptors, fibres, or other components of a sensory system are highly specialized so that particular types and ranges of physical energy evoke characteristic patterns of neural signals, that these patterns can be modulated by other sensory inputs or by cognitive processes to produce more than one quality of experience or even none at all. It is the latter approach - specialization of function - that provides the conceptual framework of this chapter.”[/QUOTE]Hope that helps,
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