Close Encounters of a Therapeutic Kind – Pain Neuroscience Introduction
By Dr. Julie Beck, DC, MS, CSCS
Dogma is a principle or set of principles laid down by an authority as incontrovertibly true. It serves as part of the primary basis of an ideology or belief system, and it cannot be changed or discarded without affecting the very system’s paradigm, or the ideology itself. -wikipedia
The central dogma of orthodox biology was the belief that DNA controlled life, period.
The anti-climax of the Human Genome Project, the costly effort to sequence our genetic code, taught us that there is more to the story of our individual uniqueness than can be found in our 25,000 protein coding genes. This awakening gave birth to the field of epigenetics (i.e., how environmental, nutritional, lifestyle, stress, sleep and other variables effect how are genes are expressed), leaving the DNA-emperor looking a tad chilly.
Pain similarly has its central dogma(s), and although they may not be as explicitly expressed as its biological-DNA counterpart, they are implicitly entrenched in the education, language, management, perceptions and societal understandings of pain. Here are several pain dogma’s:
- Pain has patho-anatomical origins and patho-anatomical perpetuators [meaning that the origin of pain is in tissue(s), and the primary perpetuator of pain is “damaged” tissue(s).)
- Pain generators can be elucidated via imaging (x-ray, CT, MRI) by identifying imperfections in tissue(s) (i.e., bone, joint, muscle, tendon, etc.) This behavior is strongly entrenched even though there are many evidence-based clinical guidelines that would strongly suggest that MRI and x-rays should not be the first line approach in the assessment of musculoskeletal pain.
- Pain should be treated by surgical means and if surgery is unsuccessful should be managed with pharmaceuticals (primarily opioids, anti-inflammatories and anti-depressants.)
- And potentially the most damaging of all – if no peripheral pain generator (i.e. damaged tissue, inflammatory mediator) can be found, the pain (and patient that has it) is dismissed as a malingerer (fabricating for secondary gain), or the pain is summarily dismissed as “less real” or somehow imagined (“all in your head”). Which is medical scape-goating at its unsavory worst.
The scientific research clearly indicates a disconnect in the medical world – a disconnect between commonly-held beliefs about pain and the treatment of pain, and the evidence that refutes them.1,2,3
A large component of managing chronic pain is clarifying our patients understanding of what pain is and what it isn’t; and by doing so positively influence the direction of their pain trajectory.4,5
I’ll close for now with neurosciences current definition of pain (Moseley, 2003):
“Pain is a multiple system output activated by the brain based on perceived threat.”
In Emerson’s 4th Quarter Element magazine, I will cover how to reframe your discussions about pain with your patients or clients and in doing so positively facilitate the modulation of their pain perceptions.
1.Thorlund, et, al. Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms. BMJ. 2015 Jun 16;350:h2747. doi: 10.1136/bmj.h2747.
2. Deyo RA and Weinstein JN. Low back pain. N Engl J Med 2001 344:363-370.
3. Nachemson AL. Newest knowledge of low back pain. A critical look. Clin Orthop Relat Res 1992 Jun;(279):8-20.
4.Butler, Moseley. Explain Pain. 2003.
5. Louw, Puentedura. Therapeutic Neuroscience Education – Teaching Patients about Pain. 2013