Firstly, I want to pay my respects to Tasso Spanos. We have lost one of the great characters of the NAMTPT. His free-thinking, his love of Janet Travell, his great stories (I especially remember the one about the bank teller’s SCM), and his devotion to teaching and his patients were always inspirational. He will be sorely missed the next time we all get together.
Last time I introduced you to another great therapist, Louis Gifford PT. In part two of this series I want to elaborate on a pain model Louis called the ‘Mature Organism Model’
So, what is the Mature Organism Model (MOM)? If you look at the diagragm you will see that everything neurological below the brain stem is sampling or messaging; messaging in, messaging out. In the case of a painful event, unpleasant messaging is called nociception. It is the job of the brain to make sense of the messaging and create the appropriate response.
I use this model to help my patients understand that the pain that they first became aware of is not the same pain many months later. It brings their attention to a mind/body contribution. It also helps them to understand that pain does not move around; it’s just that we pay attention to the voice of the pain that is shouting the loudest.
When someone is shoveling snow and they feel a pop in their back nociceptive input travels very fast to the higher centers and sharp pain is generated. This is followed by an emotional input. They drop the shovel and head inside saying “I’m so stupid”. All easily understandable.
If the back pain doesn’t get better, they might go see a doctor. An X-ray may be ordered, and arthritis may be found, and anti-inflammatories are prescribed. If the pain still doesn’t go away, then what? An MRI is guaranteed to find something, but whatever it tells you it doesn’t necessarily tell you you’ve solved the case. See previous blogs on MRI findings in asymptomatic cases.
Gifford believes that the brain uses some or all of the following criteria in order to perceive and scrutinize the incoming messaging, then generate the appropriate pain response, based on threat:
- The sufferer’s own knowledge
- The sufferer’s own belief systems
- The local environment, social setting, support systems
- The sufferer’s cultural beliefs
- The sufferer’s past experiences
- The sufferer’s observations of other people’s experiences and behaviours
In kids’, pain is mostly appropriate, but as we age and the brain can be so bombarded with nociceptive messages it can get it wrong and generate an exaggerated or inappropriate response. The collection of bullet point variables above ‘matures’ over time. Gifford uses the term ‘embodied cognition’ (EC) to describe this whole-body approach within the sufferer’s environment. The output means alteration of one’s physiological state and behaviour.
At the time of shoveling were you in a hurry? Were you using good technique? Were you stressed about getting to work on time? Unhappy at how poorly you are paid? Did you just have an argument with your partner? Have you met other people with bad backs? Do you feel like nobody understands your pain? Were you just in a bad mood? The simple act of shoveling snow has now pervasively taken root in the body. Western medicine stutters and stumbles much of the time in many of these cases.
I’ve noticed many times that when patients arrive in my clinic after many months of pain, they are usually quite fearful. Doctors have referred patients to me asking “please talk them off the cliff”. Have you too noticed this exaggerated response to be more common in highly intelligent people? Could it be that they are over-thinking their problem? I will point this out to them at some stage, and it seems to help. People like to be called highly intelligent.
There are far more complex concepts to account for nociception and inappropriate pain response than I have outlined here. For a more detailed review of the Mature Organism Model you can read this excellent piece written by Gifford’s good friend Mick Thacker PhD in 2015:
By the way, you won’t find anything about the Mature Organism Model on the world-renowned group ‘The International Association for the Study of Pain’ (IASP)!
Now we know a little bit about the mechanisms of how things can go wrong. Next time I will review Louis Gifford’s ‘Shopping Basket’ approach to therapeutic interventions. My interpretation will include lines from one of my favourite TV series; outwit, outlast, outplay.
Cheerio for now,
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