i SAW 02.07 Pain Management

In my last post I described the plan the organizers of the Pain Management BC conference had to pitch three Keynote speakers opinions against each other. Turns out they had a lot in common. This post highlights three recurring themes they, and the other presenters use to address chronic pain; pain neuroscience education, movement as therapy, and manual therapy interventions.

Pain Neuroscience Education (PNE)

  • Neil Pearson PT spoke on the benefits of Pain Neuroscience Education (PNE) whereby a careful explanation of nociception and pain perception can really help reduce pain. He showed a 2011 PNE research paper by Adriaan Louw concluding that there is compelling evidence to support PNE. He also referenced a lovely You Tube video from the UK’s Nottingham University that uses illusion to reduce arthritis pain by 50%.
  • Wesley Buch MD. talked about kinesthesiophobia and how massage can help reduce pain in four different ways: by bringing a presence to the ‘invisibility’ of their pain, by addressing the touch deprived, smudged or damaged perceptions, by bringing about a form of somatic release, and finally by offering manual and verbal encouragement.
  • Fellow kiwi, Mark Finch, uses what he calls his three ‘e’s to help get results; explain, empower and change the experience. Onya mate.
  • Tell your patients this: “If the cell body of a motor neuron were the size of a tennis ball, its dendrites would fill a room and its axon would extend, like a half-inch garden hose, nearly half a mile.” ~ Jack Nolte PhD. Essentials of the Human Brain.

Movement Interventions for Pain Relief

  • Todd Hargrave uses the movements of the Feldenkrais method, along with PNE, to improve the self-image of his patient’s. Two quotes from Todd; “I’m not after flexible bodies, I’m after flexible brains” and “We move in accordance with our-self image”. He also quoted a Ted talk by V S Ramachandran saying that “pain is an opinion”.
  • Violet Reynolds uses Hanna somatics to address what she terms sensorimotor amnesia.
  • Therapeutic yoga is a Neil Pearson favorite.
  • The ‘mindful movement’ phrase came up often in Lynda Turner’s presentation. She talked about a triangle of awareness, consisting of body sensation, thoughts and emotions.

Manual Interventions for Pain Relief

  • Therapeutic massage goes without saying because the audience were mostly RMTs.
  • Check out a 15-minute Ted Talk about the longest cell in the body. The neuronexplores synapses, receptors, the 72 kilometers of brain wiring, the 10,000 types of neuronal cells, and the 1-10 trillion glial (immune) cells that make up the brain. This was part of Diane Jacobs talk. Clinically, she uses light touch and shear forces to address Ruffini corpuscles. These encapsulated end organs send afferent messages via a thickly myelinated neuronal superhighway. Her four-part approach includes listening, interacting, treating and waiting.
  • I’m not going to mention trigger point therapy (oops).

There’s a David inside you

It makes sense to combine manual therapy with movement. At 360 NMT we always stretch what’s short and tight after we do the manual therapy. But, not everything is short and tight. Other tissue, often the antagonists can be inhibited and weak. This needs a different approach. Trigger points can also make tissue short and weak. Along the way we can chat about neuroscience. We can use metaphors too, “I’m Michaelangelo. You came to me as a block of marble. I’m going to chip away, chip away… ”

Send me your metaphors. I like to collect metaphors.