Hide & seek. Pain may not be hiding where you think it is…

Hide & seek. Pain may not be hiding where you think it is…

Following on from the great work from my colleague Dr. Nathan Harten’s last blog; I will continue educating you on the latest neuroscience on persistent pain.

You may have been allluded to our brains wonderful capacity to protect to a ‘perceived’ threat.

Perceived you say?

Lets delve into this further…

There needs to be credible evidence of danger over safety for a pain experience (1).

Let’s pause and reflect on that for a moment…

Danger or safety in pain circumstances

It is advantageous to have fast acting danger messages to make us pull our hand away from a hot pan right? Danger over safety is highly relevant here. What about an ankle that had been sprained ten months ago? That ankle is still hurting to load, difficult to localize the pain, and you have exhausted Google & the pharmacist for an answer. Not advantageous at all is it?

Pain is not a true marker of tissue damage…

Let’s pause and reflect again on this statement…

Pain is an output constructed by the brain (1), by many contextuals. Contextuals ranging from:

Is this pain going to interrupt my job?

Is this what an ankle sprain feels like?

Can I still play in the football grand final?

How long am I going to be out for?

Should I just rest?

All of these constructs add to a pain experience (3); storing memories, emotions and motor patterns in a highly organised network, AKA your central nervous system. Even your immune cells (microglia) and endocrine system (HPA axis) are activated! (3) plus more!

Persistent pain is more than just where it hurts

So you see pain isn’t all just about where it hurts. Especially persistent, chronic pain (1). Somehow, your brain is still warning you. It still wants to protect you from a perceived threat and make you hurt.

This may sound like a rhetorical question, but is this protection advantageous at all?

Please take the time to reflect on your own experiences of pain…

Maybe the threat of losing your job is adding to a pain experience?

What if you are a professional athlete, trying to protect your pain from the coaching staff, perhaps because your contract is up at the end of the year?

Are you still blaming the driver who hit the back of your car?

All of the highlighted words are ‘threats’, and thus the brain will scrutinise all of the aforementioned and will decide whether it’s important or not to let you know; and to make you hurt.

Becoming aware of perceived threats and dangers are so important to understanding your pain (1, 3).

I hope now you think of pain as a biopsychosocial paradigm (Bio meaning the biological tissues, psycho meaning thoughts, feelings and beliefs; social meaning the environment) and not just about the tissue that hurts (2).

So I challenge you to challenge your beliefs on pain. This may be a line in the sand that you are willing to make.

Address what threats are in your life (work, financial). Learn how your stress system works. All of this is great at assisting you in the short term, but it can get a bit much if it’s 24/7 (think of having to listen to your car alarm all day!). However this is a topic for another day and another blog!

Feel free to seek help from someone else! Know that you are safe to move when you are experiencing chronic pain (even better with an exercise physiologist!).

Finally, know that we are neuroplastic and bioplastic… meaning that you can heal!

 

References

  1. 1. Butler, DS & Moseley, GL 2013, Explain pain, 2nd edn, Noigroup Publications, Adelaide, South Australia.
  2. 2. Gatchel, RJ, Peng, YB, Peters, ML, Fuchs, PN & Turk, DC 2007, ‘The biopsychosocial approach to chronic pain: scientific advances and future directions’, Psychological bulletin, volume 133(4), pp. 581-634.
  3. 3. Moseley, GL & Butler, DS 2015, ‘Fifteen Years of Explaining Pain: The Past, Present and Future’, The Journal of Pain, vol16, no. 9, (pp. 807-813).
Movement Revolution: Exercise effect on knee pain

Movement Revolution: Exercise effect on knee pain

Now as a disclaimer of sorts, I am going to straight out say that the following is purely qualitative & subjective. One is sure The New England Journal of Medicine won’t be calling to publish the following…

We are born to move!

Lets begin,

Neuroscientists have hypothesized for years that we humans are prediction machines, we are born to move! Movement can even be seen in the early stages of gestation. The child learns by observing the mother’s facial expression(s) & fine motor cues, and learns from making errors.

But still, movement is regularly neglected as a first line agent for pain & even metabolic conditions. Often replaced with pharmacological interventions. Now, one can understand that a hypertension patient would be prescribed a angiotensin converting enzyme. But, we know MORE can be done!

Motivation for this blog is due to seeing more knee pathologies, and especially how correctives have been neglected for surgery as a frontline intervention. Now, I am not trying to put your ACL into excessive anterior translation (get it?).  And I don’t need to discuss any sham stories.

Let me explain… Check out the schematic below

Without needing to be Wilder Penfield, you can see the highlighted blue & green regions in the cerebral cortex. This is your motor and sensory regions in your brain! Now, it doesn’t seem like your motor & sensory areas represent a huge amount of your cortex. But if you knew (or you may already know!) that the gyri & sulci (plural) are densely packed with neuronal cell bodies, millions in fact! And if I direct you to the tonotopic organization of the motor & sensory cortex; you can see how much dedication and richness there is to regions such as the hands & lips et cetera.

So, now you have brushed over some neuroanatomy…

What’s the big deal?

My argument is that are motor & sensory cortices are highly neglected as a conjunctive therapy to other modalities. One can manipulate another’s motor & sensory system to drastically improve pain, especially if there is maladaptation which is oftenly seen in chronic pain, but somehow neglected.

Don’t get me wrong, touch (which is somatosensory) is fundamental for the healing, learning process.

However, as humans, we are prediction machines. We hypothesize, use our narratives to justify our cognitive biases, plan, make executive decisions.

Sprinkle a little dopamine in the Ventral Tegmental Area and 3..2..1..GO!

 

I am really pushing a movement revolution!

Trepidation: Should we be using more than just medicine to help treat depression?

Trepidation: Should we be using more than just medicine to help treat depression?

I attended an insightful evening at SAHMRI on depression. I don’t want to sound all melancholic at the start of this blog. However, quantitatively speaking, Australia is the unhappiest country in the world (per capita). We also have the highest prescription rate/use of antidepressants in the world (per capita).

Now I am really sounding melancholic.

Why do we have high rates of depression?

I was really saddened that Australia, a wonderful, optimistic, culturally diverse nation is so depressed. Are we trying to put a band-aid on by taking an antidepressant with the notion that quote un-quote “she’ll be right mate”? Are we ill-informed by our health & medical team? Or does one think or feel that a pill is the only way to remission? Or are we literally still stuck in time?

Maybe my past tense reference was justified…

Here’s the problem…

Depression is so much more complex than the first hypothesis from the 50s, which brought us the discovery of the first antidepressant, Fluoxetine (Prozac). The problem is that all that has changed in the last forty years is that we now have ten or more antidepressants rather than just one. The reason I am so passionate about the right co-care and management is because of the side effects of these medicines. For example, the growth factors in antidepressants can contribute to obesity, another morbidity that inundates our health care system.

So what can we do to help treat depression?

Recent advances have shown that our genes can be switched off by our environment, sedentary lifestyles and psychologically stressful events.  This includes our BDNF (brain derived neurotrophic factor) genes, which are the fertilisers for our brain. They help protect and grow our neurons.  However, positively, we can also switch this gene on by exercising and meditating. Therefore our actions and choices can potentially lead to melancholy or greater health.

I guess this is more of a personal release than an education problem solving blog. Please pardon the lack of clarity/direction. But it many ways I feel this is the current position we are in.

It all starts with the little things:

  • Move more…
  • Find space, breathe, form boundaries and find silence/solitude…
  • Hug more…
  • Connect more (interpersonally)…
  • Connect with nature…
  • Nourish your body… (remember where amino acids are derived from… FOOD. And what do amino acids make? Neurotransmitters!)
International Women’s Day 2017

International Women’s Day 2017

Wednesday the 8th of March marks International Women’s Day. A day to recognize all the wonders of the female phenotype that spreads one’s estrogen and oxytocin around the universe!
Although I am a lover of the classics of Greek philosophy. Aristotle was all to wrong to postulate that women had no place in the metaphysical realm of thought… Inspirational women such as Rosalind Franklin, through her genius bold work on  X-ray crystallography helped solve the mystery of the double helix; and all of those 20,000 and so A, T, C G’S we know as DNA. Now, to not suggest one to be naive.
One may not know that, although Watson & Crick have taken all the glory for the discovery of the double helix (which also won them both a Noble Prize in 1962). It was Franklin in fact, who; through her work in X-ray crystallography took the first photo to postulate that DNA was in the shape of a double helix.
AND! with two unsuccessful attempts by Watson & Crick to  develop a successful model (which was berated by Franklin) left them both desperate to finish first. Leaked information of Franklin’s discovery fell nicely into the hands of the two scientist… and the rest is history. Sadly Franklin died at the tender age of 38 (potentially to over exposure of radiation), and thus could not defend herself for her discovery. One will never know what more discoveries Franklin could have made in her precious time…
I used Rosalind Franklin as an example to help celebrate International Women’s Day. With the struggle it has been for female scientist and the like (not helped by egotistic males) to really flourish in one’s craft. And how wonderful it is to see; that women are being recognized all around the world; and not just for their cooking abilities (I just went there..).
Perhaps, Donald Trump can write this blog next year….
Valentines with a twist!

Valentines with a twist!

Happy Valentines day to all the Romeo & Juliet’s out there!
Valentines day is the day to make up for the other 364 days of the year…oops, I mean everyday is a day to connect with your monogamous partner right? Well I don’t want to be all up in your face with cheesy Casanova one liners. I want  to ‘twist’ up Valentines day by redirecting the attention on oneself.
The motivation to turn the tables of gratification to ourselves is based on some reflection over the past weeks…. .Why is is it so easy to give? But so difficult to receive? Or even so, to put ones needs first. Well, unless you’re a narcissist; and then I’ll have to throw the DSM-5 at you! Receiving can often be associated with guilt. With all the co-morbidity’s floating around, one has been really delving deep into why one doesn’t feel intrinsically the worth to put one’s health first?. Now, I just opened up a whole can of complex issues that Sigmund Freud would be rubbing his hands to get to the bottom of. However, I want to stick to the issue of putting your health first.
Here is a scene that has really influenced this blog.
Cameras rolling…and ACTION!
Two Italians ladies accompany each other at the gym on a regular basis. This is a mother daughter combo. With the mother being in her nineties. And the daughter being in her sixties. As I do my thing on the cross trainer I hear them both laughing away on the treadmill & speaking Italian (on a consistency). Now what is so heart felt about these two is not only the bond & connection (as a mother and daughter do) between them both. And there is wonderful research to back up connection with improved immunity, decreased risk of mortality et cetera. It is the intrinsic and reciprocal want for them both to have there needs met; to be well, healthy and thriving.
Now that’s a 24/7 valentines moment right there!
In light of late last weeks Facebook link  on “auditing” or keeping track of your daily/weekly exercise. I really encourage you all from the bottom of my Valentine heart to make your health a priority. Regardless of the extrinsic’s going on in one’s life. In deep reflection. If we set healthy boundaries. Show an abundance of loving kindness and compassion. And lastly, give on a daily basis (without expecting anything in return). Don’t we then thus deserve all of this back intrinsically with humility?
I do hope, or if not me; the wonderful mother & daughter combo give you the strength to be vulnerable and to have YOUR needs met.
valentines-day
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