Wall's story II

[Barrett Dorko]

I titled this (and previously) as I did because I’ve read a few things lately that reiterate Aristotle’s description of a tragic arc; inciting incident, climactic struggle and, finally, resolution.

I found this remarkably close to what I’ve read of Wall’s description of our instinctive response to pain.

Pain produces a need state, like hunger or thirst. Hunger is resolved by eating, thirst by drinking and pain is resolved with movement. Of course, eating and drinking instinctively is probably best. Moving instinctively follows.

How does this relate to practice and patient education? Wouldn’t it dictate a use of abductive reasoning and reinterpretation of muscular activity?

Am I way off on this?

[Nick]

I don't think you're way off at all.

As we discussed a long time ago: http://somasimple.com/forums/showthr...nsummatory+Act
You are also right that I've grown quiet and, I guess, frustrated with people ignoring the obvious. I clearly don't have the same perseverance as many here.

Wall's points, though, definitely bear repeating again and again:
In "Pain: The Science of Suffering", Wall states that pain is "best seen as a need state, like hunger and thirst, which are terminated by a consummatory act."(p.155)

He asks, "What are the appropriate motor responses to the arrival of injury signals [or pain]?" And answers with three phases of response triggered by built-in mechanisms: reflexive withdrawal, guarding / avoidance, and resolution. He adds, "if the sequence is frustrated at any stage, the sensation and posture remain."

So, what frustrates the sequence?

A significant portion of cerebral function is devoted to inhibition.

One reason is simply the motivation to avoid pain. Sometimes resolving it requires moving through it.

Another is we've been taught to sit still, sit up straight, and not to move...and if we hurt, we better be even more careful to hold the spine erect. This began at least as early as pre-school to prep us for an industrial-age education that would turn us into good factory workers. A few professions have the special authority to admonish others even into adulthood for the state of their posture and all it supposedly reflects about them. Guess which ones?

[thrill96]

Originally Posted by Barrett Dorko

I titled this (and previously) as I did because I’ve read a few things lately that reiterate Aristotle’s description of a tragic arc; inciting incident, climactic struggle and, finally, resolution.

I found this remarkably close to what I’ve read of Wall’s description of our instinctive response to pain.

Pain produces a need state, like hunger or thirst. Hunger is resolved by eating, thirst by drinking and pain is resolved with movement. Of course, eating and drinking instinctively is probably best. Moving instinctively follows.

How does this relate to practice and patient education? Wouldn’t it dictate a use of abductive reasoning and reinterpretation of muscular activity?

Am I way off on this?

Barrett,

I too have been giving this a lot of thought in relation to performance and pain. I read an article a few days ago and posted it on my Neuroscience and Pain Science for Movement Professionals Facebook page. Here is the abstract with my bolds:

Pain, dissociation and subliminal self-representations.
Bob P.

Center for Neuropsychiatric Research of Traumatic Stress & Department of Psychiatry, 1st Faculty of Medicine, Charles University, Ke Karlovu 11, 12800 Prague, Czech Republic. petrbob@netscape.net

Abstract
According to recent evidence, neurophysiological processes coupled to pain are closely related to the mechanisms of consciousness. This evidence is in accordance with findings that changes in states of consciousness during hypnosis or traumatic dissociation strongly affect conscious perception and experience of pain, and markedly influence brain functions. Past research indicates that painful experience may induce dissociated state and information about the experience may be stored or processed unconsciously. Reported findings suggest common neurophysiological mechanisms of pain and dissociation and point to a hypothesis of dissociation as a defense mechanism against psychological and physical pain that substantially influences functions of consciousness. The hypothesis is also supported by findings that information can be represented in the mind/brain without the subject's awareness. The findings of unconsciously present information suggest possible binding between conscious contents and self-functions that constitute self-representational dimensions of consciousness. The self-representation means that certain inner states of own body are interpreted as mental and somatic identity, while other bodily signals, currently not accessible to the dominant interpreter's access are dissociated and may be defined as subliminal self-representations. In conclusion, the neurophysiological aspects of consciousness and its integrative role in the therapy of painful traumatic memories are discussed.

For me, this related to what you and Wall have been discussing involving the instinctive movement that resolves pain, and I believe can enhance performance (but I'm working on that).

I think how this relates to practice is what many on SS have been saying about an "interactor" model vs an "operator" model and how enter in through the left side of the neuromatrix with whatever input we have at our disposal to allow processing and subsequent output. I like this statement from the abstract:

The findings of unconsciously present information suggest possible binding between conscious contents and self-functions that constitute self-representational dimensions of consciousness.

This unconsciously present information can be 'undelivered info' that needs to be linked to the conscious and self-functions (read: Diane's "critter brain" reference?) for resolution . Maybe SC is a road map that can direct the two? I'm not sure and I've been working through it on my own for some time.

Hmmmm....

Will

[John W]

Hunger is resolved by eating, thirst by drinking and pain is resolved with movement. Of course, eating and drinking instinctively is probably best. Moving instinctively follows.

I'm struck by the current evidence suggesting that many choose to eat instead of move to resolved their psychcoemotional pain.

[Barrett Dorko]

Hi Nick,

Thanks for replying here. Frustration generates different behaviors at different times in the same people. I saved my silence for work in the SNFs where other therapists quickly assumed I was arrogant and unfriendly. Mainly, I was just disgusted at what I saw them doing and heard them saying.

I recently came across this unattributed quote:

Sometimes it is better to be silent than to tell others what you feel because it will only hurt you when you know they can hear you but they can't understand you.

Somehow I think the "eating while remaining still" thing is in there.

I've more to write about Wall's story but will save it for now.

I'm looking at page 155 in the book but don't see these words.

[Ben Sabo]

Barrett, Wall's comments on pain being a need state are on pg. 152 in my paperback, Nick might have a different edition?

Wall talks about the hierarchy of attention, how sensory events are prioritized, and how distraction therapies can interrupt pain's monopolization on attention. I want to take a stab at the application of all that:

In practice, any "operator" model of therapy is primarily providing a distraction, because only the patient's brain can resolve their need state by executing an appropriate motor response. I'm thinking in particular of the tendonitis voodoo thread... where the wrapping of the arm provides a sufficient distraction (to attention, not the joint), then the subject/victim/hero-worshiper moves their arm with the addition of this novel sensory input.

Even more ecto-based approaches like Simple Contact, DNM, Edgework, etc. also provide a distraction (in the sense that you're basically restructuring the hierarchy of attention) which hopefully allows the brain of the patient to resolve its pain issue by interrupting pain's monopolization on attention with some novel, non-threatening input. The difference being, of course, that the objective of those treatments is not to assume the monopoly on attention by claiming to "remodel" or "heal" soft tissue structures.

As a side point, I'm also thinking in terms of being unable to eliminate the placebo response from any treatment... "The placebo response is the fulfillment of an expectation", according to Wall (or whoever provided that definition,) but could it also be defined as the effectiveness of a distraction? Or, the ability of any treatment or action to provide a sufficient distraction in a given situation to a specific individual at a particular point in time?

Am I improperly conflating "placebo response" with "distraction?"

Anyway, tying back into the initial thought on distraction therapies... any distraction is temporary. The question any therapist should be asking themselves is: once the distraction they provide is removed, is attention of the patient's brain being redirected back to the patient, or to the therapist/operator/handler/magician/savior? At least, that's the question I've been asking based on my current understanding.

In other words, does the therapy in question (or, the claims being made by the therapist) establish and promote a dependent relationship, either on a single therapist, or on therapy in general? If so, then it would seem to be cultivating a dependency on distractions, and will not move the patient towards true resolution of their need state. You may as well tell them to go sit on the couch and eat junk food while watching Jersey Shore.

Please correct me if I've gone off track.

[PatrickL]

hi Ben,

could placebo be defined as the effectiveness of a distraction?

Nice thoughts. I know you asked Barrett specifically, but you got me thinking so I thought I'd put my thoughts out there.

I would think that it could be, but only to the extent that the distraction creates hope/expectation. I think there can be distraction without placebo though. Something about the term distraction doesn't sit well with me.

Wall talks about the hierarchy of attention, how sensory events are prioritized, and how distraction therapies can interrupt pain's monopolization on attention

Do you think wall is referring to conscious attention or non-conscious attention, if there is such a term? This seems like it could be an important distinction.
1. Conscious distraction- If I have a neurotag for my low back pain mapped somewhere in my brain, my thought is that shifting conscious attention away from the pain might reduce pain, by way of an altered cognitive input however the low back pain neurotag would probably remain. Pain would likely persist once the cognitive distraction is removed.
2. Non-conscious distraction- if the non-conscious mind is distracted, by our treatment, it seems that this is the treatment mechanism. This is what it's all about... the holy grail is it not? I.e. Give the non-conscious mind something safe and new to process to facilitate corrective movement, and form new painless neurotags.

Whether the distraction is conscious (in isolation probably not therapeutically useful) or non-conscious (therapeutic), I see the placebo response acting over the top of it all, influencing/helping with the re-organization/disintegration of the problem neurotag... Its relative impact varying with the degree of hope/expectation the client has/feels.

The story/explanation we give our clients could simultaneously set up a placebo response and provide a conscious distraction. This could be where it is possible to conflate them.

Just thinking out loud. I'd appreciate any guidance here.

[Barrett Dorko]

Ben,

You're on track as far as I can see, and I found what you've said to be very helpful.

Your prompting also got me to look deeper into the book where I found the passage on page 147 in my edition.

I especially like that he mentions the reaction of a stoic to a painful message. It sounded familiar.

[keithp]

Originally Posted by Ben Sabo

...Anyway, tying back into the initial thought on distraction therapies... any distraction is temporary. The question any therapist should be asking themselves is: once the distraction they provide is removed, is attention of the patient's brain being redirected back to the patient, or to the therapist/operator/handler/magician/savior? ...

In other words, does the therapy in question (or, the claims being made by the therapist) establish and promote a dependent relationship, either on a single therapist, or on therapy in general? If so, then it would seem to be cultivating a dependency on distractions, and will not move the patient towards true resolution of their need state...

When we look at the the neuromatrix, and the three inputs to body–self, we need to be aware of the existence, and potential impact, of cognitive related brain areas, sensory signaling systems and emotion related brain areas. It seems as though the "operator" is only concentrating on the sensory signaling systems, without direct regard for cognitive related brain areas or emotion related brain areas. It is by coincidence only that they may reduce attention (distraction) to a patient's pain experience for a short period of time. It would seem that it is the true interactor who addresses all three aspects of neuromatrix inputs simultaneously. Or so should be their hope.

I would agree that anything else would indeed "cultivate a dependency on distractions", stealing the locus of control from the patient themselves.

Respectfully,
Keith

[Diane]

@Keith:

[Ben Sabo]

Hi Patrick,

I addressed Barrett since this is his thread, but not to the exclusion of anyone else.

I think there can be distraction without placebo though.

I follow that, but can a therapy be provided without some element of distraction, even if only by way of sensory input? I hope it doesn't seem like I'm making a semantic case; I simply made a mental connection between placebo and distraction and wanted to explore it. Thanks for sharing your thoughts.

Do you think wall is referring to conscious attention or non-conscious attention, if there is such a term?

I may be wrong, but I understood Wall to be describing the effect that conscious distraction can have on non-conscious attention. It seems like he kind of shifts from conscious to non-conscious attention with the context assigning the meaning. Your example of shifting conscious attention with only temporary relief makes sense, though. What you consciously choose to give attention to will have an influence on your non-conscious processes, but ultimately it's the non-conscious processes which determine if pain is assigned priority in the hierarchy of attention or not.


Barrett,

It was your thread that encouraged me to open the book again in the first place, and revisit some thoughts I had. Thanks for the feedback, I'm looking forward to the rest of Wall's story.


Hi Keith,

Yeah, that's pretty elegant. Thanks for preventing me from trying, and failing, to reinvent the neuromatrix. The way I understood it, the "distraction therapies" Wall mentions are a reference to those attempts that only concentrate on the sensory signaling systems, where the sensory distraction IS the therapy.