Pain: A Measurable Experience?
April 28, 2013 § 1 Comment
We usually learn what pain is from our earliest experiences of physical tissue damage although pain may also have a psychological basis.
Painful Elbow (istock)
We can describe pain as a subjective felt experience since it is influenced by an individual’s feelings, mind, and experience. That’s why pain can be so tricky to diagnose and treat. It is so intangible.
When working with adults in my clinical practice, I often use the Visual Analog Pain Scale (pain levels of 1-10) to both evaluate levels of pain and to measure the effectiveness of a treatment protocol. Health insurance companies repeatedly challenge practitioners to justify the need for treatment. Ultimately, the patient loses because it is so difficult to measure or verify the type of pain being experienced which can interfere with patients getting the help they need.
There also is the most vulnerable population to consider, those who may not be able to describe their pain because they are either too young or elderly, minimally conscious, or cognitively impaired.
All together, these factors beg the question, is pain a measurable experience? If pain could be quantified, what impact would that have on diagnosing and managing pain?
Tor Wager’s fMRI Pain Studies
In a series of four studies, Tor Wager and colleagues set out to objectively measure and predict pain intensity through the use of functional magnetic resonance imaging (fMRI) brain scans. Their findings look to be a game changer.
Study #1
In the first study, 20 normal, healthy human subjects were exposed to varying levels of heat and then their brains were scanned in order to identify which brain structures were involved and whether any identifiable patterns would emerge. What they discovered was a neurological signature for heat-induced pain, that is, specific brain regions consistently lit up more than 94% of the time. The signature was discovered to be specific to pain and sensitive to changes in heat intensity. Brain maps were generated from these initial findings and then applied to new participants in Study #2, in an effort to predict pain.
Study #2
In the second study, the neurological signature identified in Study #1 was tested with a new group of 33 participants. This study aimed at predicting pain by measuring the intensity of pain via the ability to discriminate between painful heat and nonpainful warmth across six temperatures. The researchers were able to show that the signature response increased as the pain intensity increased, resulting in the creation of a code using a 100-point Visual Analog Scale that was about 93% accurate. The results suggested that the neurological signature was measuring the subjective sensation of pain as well as the intensity of somatic stimulation. They also found that the signature response discriminated between intense and mild nonpainful warmth. This is a very significant finding because it may be useful in further studies of allodynia or hyperalgesia, two unusual types of pain.
Study #3
The third study was a test for specificity. The researchers took the results of the first two studies involving the mapped neurological signature and the ability to predict pain, and added in the new component of social pain. In this case, 40 participants were studied who had recently experienced a romantic break-up and were still suffering from feelings of rejection. In addition to being exposed to painful and nonpainful heat, they also viewed an image of a close friend and an image of the “rejecter.” Which brain structures would be involved now? While researchers were able to discern that regions for physical and social pain were both activated, the neurological signature still clearly discriminated between physical pain and social pain.
Study #4
This study explored how the neurological signature for pain would respond to the administration of the opiod agonist remifentanil during fMRI scanning. The goal was to elicit analgesia without sedating the participant while they were exposed to a painful heat stimulation or a warm stimulation. They found a parallel response, that as the effects of the drug on the brain increased, the signature response decreased up to 53%.
Why This Study is Important
This study successfully identified a fairly universal and reliable neurological signature brain pattern for heat-associated pain. It also validates earlier studies aimed at measuring sensitivity and specificity for pain using fMRI scans. More studies are needed before it can become clinically useful. Since the study was done with healthy persons, there is much work to be done in assessing individuals who are in pain. Although the task is daunting and there are so many variables, this study makes a very important contribution.
——————
References:
The International Association for the Study of Pain
An fMRI-Based Neurologic Signature of Physical Pain by Tor D. Wager, Ph.D., Lauren Y. Atlas, Ph.D., Martin A. Lindquist, Ph.D., Mathieu Roy, Ph.D., Choong-Wan Woo, M.A., and Ethan Kross, Ph.D. N Engl J Med 2013; 368:1388-1397April 11, 2013DOI: 10.1056/NEJMoa1204471
The researchers used data-mining algorithms to search for brain patterns in subjects who were exposed to different levels of heat. What they found was surprising. Instead of the patterns being unique to each individual studied, they found that pain patterns manifest as neurological signatures across multiple brain structures.
‘A Massive Generation of Sick People’
February 15, 2013 § Leave a Comment
Aging and Health Care
Those are the words Reuben Greg Brewer used when blogging about the recent JAMA study which found that today’s baby boomers are sicker than their parents were at the same age, suffering from chronic illness and disability related to diabetes, high blood pressure, high cholesterol, obesity, a sedentary lifestyle, and dependence upon prescription medications.
How often I have heard my own mother say (who is now 80 and who just underwent her third joint replacement surgery), “These pills are keeping me alive.”
While the gist of Mr. Brewer’s blog trumpets health-field related investment opportunities for the savvy (Weight Watchers, Nutrisystem, Pfizer, Procter & Gamble, Teva Pharmaceuticals, CVS Caremark), it really is a sad commentary on the general state of health in these modern times and a confirmation that chronic illness is big business in the Western world.
What’s wrong with this picture?
Research about the consequences of a sedentary lifestyle and stress is not new, by any means.
Why have we as a society bought into the illusion of “the magic pill?”
Why have the majority of people refused to take responsibility for their own health and wellness?
We are finite beings. We have limitations. We wear out.
What changes are you willing to make now, today, to improve your chances of aging well? Although your body is ready, willing and able to restore function and mobility, beware of waiting too long.
A final thought, will you invest in yourself and/or in health-related companies on the stock exhange, each offering a unique ‘golden opportunity’?
The Embodied Self—An Emergent Process
February 4, 2013 § Leave a Comment
The formation of the human self is a fascinating topic, one that boggles the mind and fires the imagination.
First, it is an emergent process, like baking a cake!
Usually basic cake ingredients include flour, salt, sugar, oil, eggs, milk, and a leavening agent. However, it only emerges as cake once the combined ingredients are subjected to heat.
Photo from the U.S. National Archives and Records Administration
Similarly, researchers in the field of developmental neuroscience suggest that the fire that gives rise to and animates the core self (and mind) is the aggregation of environment, experience, and social interaction.
The Environment
Human beings are conceived and develop within a complex, dynamic, multilevel interactive person-environment system (attachment theory). The development of self involves exposure of our genetic material to an environment that fosters development and growth. One source defines environment as “the sum total of all surroundings of a living organism, including natural forces and other living things, which provide conditions for development and growth as well as of danger and damage.”
The relationship humans have with their environment is a reciprocal one. Throughout life, we both shape and are shaped by the environment. What are the basic environmental conditions required by a child to support its existence, growth, and welfare?
We begin with the obvious. Since an infant is born helpless and dependent upon the care of others, he or she requires a committed caregiver, someone who will supply food, comfort, and protection, at the very least.
A consistent, predictable, and nurturing environment paves the way for optimal brain development because it supports the organized integration of neural synaptic circuits that foster social and emotional functioning, perception, and behavior, all vital to the formation of a coherent sense of self.
Experience
Experiences drive patterns of functional, emotional, and psychological development. Brain development is essentially an experience-driven learning process that gives rise to the mind and the core self. Experience also involves participation in events which accumulate over time, creating a knowledge base. Events are perceived through the senses and invoke body-based responses and implicit memory.
For optimal development, infants and young children require a constancy of experience that is nurturing and consistent. Loving caregivers who have been observed responding to their infant in a contingent manner do it by matching the infant’s facial expressions and vocalized sounds. This behavior allows for a meeting of the minds which is essential to the development of self-in-relationship-to-another. The opposite is also true. An unpredictable, volatile environment can wreak havoc on the development of the brain’s emotional centers, seriously impacting a child’s sense of self.
Social Interaction
Self-in-relationship-to-another begins before birth and continues throughout the lifespan. When an infant or young child experiences consistent, empathetic, and anticipatory attention to its needs, the experience fosters a coherent sense of self, self-agency, and the capacity to achieve and maintain a sense of well-being. Research findings also strongly suggest that the quality of an infant’s attachment experience sets the stage for future relationship expectations and is linked to the development of effective or ineffective coping strategies and social, emotional, or behavioral disorders.
Do you think that the growing body of knowledge of the complexities related to the development of the core self will have a positive effect on society in general? Will it motivate prospective parents to learn effective, empathetic parenting skills? Will it humanize us? Please share your thoughts!
Wow, I’m Sixty Years Old Today! Where Did the Time Go?
January 6, 2013 § 2 Comments
New York August 2012
Maureena & Tim
Yes, another year has rolled around and I find myself another decade older this time. For all you youngsters out there, you will eventually understand the reality of the often repeated phrase, “I don’t feel any older, I am the same person I have always been . . .” yet, truth be told, when I look in the mirror, I see the changes in my body and my face—gravity! Some days, my bones can be a little achy too. However, I am still as keenly interested in everything that makes like worth living: loving relationships, passion for learning, enjoyment of my surroundings, meaningful work and activity, and a good measure of health.
Last year at this time, I was preparing for a parathyroidectomy—the surgical removal of a parathyroid gland that had become dysfunctional. The parathyroid glands play such an important role in body chemistry, bone production, and health. I was fortunate to find an excellent surgeon with a crack team, Dr. Michael Yeh, at UCLA. The surgery was successful and I have been experiencing a good recovery. Surgery, like chronic pain or illness, is always taxing to the body and can be very depleting. My main concern was how to support the healing process and to optimize the healing of the surgical incision. As many of my readers know, scar tissue is a topic I am keenly interested in and I am happy to report that the therapies I used post surgery supported the optimal healing of my surgical incision, leaving few internal adhesions.
I’m so grateful to have accumulated so much experience in the holistic field of medicine which has helped me come back stronger than before. At the present time, my personal health recovery regimen includes chiropractic, acupuncture, herbal medicine, and movement and body alignment practices (Alexander Technique, Restorative Exercise, and Pilates). My goal this year is to become even more aware of my body alignment, knowing that the way I move in my body and how each part communicates with the next, will determine my capacity for regeneration and strength and will help me to correct and limit the patterns that underlie chronic degeneration. No matter what our age, isn’t that the best choice to make?
How will you support your self, your body, and your health this coming year?
P. S. I am so enjoying the gift that cumulative life experience brings to all aspects of my life!
Winter Flows in the Water Element
January 1, 2013 § Leave a Comment
The Transformative Nature of Water
The amazing properties of water are well understood in scientific research. Its ability to change states from a liquid to a gas or a solid (depicted in the beautiful image of the lake with rising fog and clouds above), make it a unique constituent of all living systems. Water is also a solvent, capable of dissolving other substances in order to produce unique solutions vital to sustain our physiological processes and life on this planet.
The Water Element
Winter is the season of the Water Element in Traditional Chinese Medicine’s (TCM) Five Element Theory which depicts the generating cycle of life (Ko). The energetics of winter are yin which foster time for reflection, introspection, and quietude in order to to nurture one’s inner self. My favorite author on this topic is Eldon Haas, author of Staying Healthy With the Seasons. He asserts that giving the appropriate attention and support to the meridian and organ systems assigned to the Water Element during its dominant season will help us to move into spring with renewed vitality and purpose.
The Kidney/Bladder Meridian and Organ Systems
In the Ko cycle, the Kidney/Bladder meridian and organ systems are represented by the Water Element.
The Ko Cycle
The Kidneys represent the deepest energies of the body because they are involved in the generation of vitality, the self, the brain, bones, and marrow. The Bladder meridian and organ system are responsible for separating the pure from the impure which aligns well with the western physiological model of filtering the blood, recycling substances, and eliminating waste.
Water is also associated with bodily fluids in TCM, such as blood, lymphatic fluid, saliva, urine, tears, cerebral spinal fluid, and perspiration. These fluids help the body function optimally by delivering nourishment and moisture and by carrying away waste products.
Salt is the flavor associated with the Water Element. Have you ever found yourself craving salty foods? This may signal an imbalance in your Kidney/Bladder system.
Fear and terror are the emotions expressed by the Kidney organ in TCM. If you find yourself feeling fearful, negative, anxious, or aching, think of an imbalance in this vital system. I’ve seen many patients who experience free-floating anxiety even when their life is going well. This is often due to the dominance of cold qi emanating from the Kidney which reduces the fire of the Kidney’s yang energies which must rise to the brain to support clear thinking.
Deficient Water energy can lead to hyperactivity, difficulty sleeping, and reduced understanding and compassion for others (an inability to listen) while an excess of Water can cause sluggishness, frustration, and a feeling of heaviness. The latter results from a breakdown in the body’s inability to transform water in the body.
When the organ and meridian systems assigned to the Water Element are functioning optimally, the skin is benefited through the release of toxins via perspiration. The color, tone, and clarity of your skin, the sparkle in your eyes or lack of it, and the texture and thickness of your hair also provide clues to a healthy or stressed Water Element.
Supporting The Water Element During Winter
Warm food, rest, warm clothing, and the warmth of friendship and companionship will help you to successfully navigate the winter season. Watch your calorie intake because we are usually less active during the winter. Cook with miso, garlic, ginger, cinnamon, cardamom, onions, cayenne, and turmeric to warm you body and delight your senses! Seaweeds eaten toasted, raw, or in soups can also replenish the Kidneys. Elson Haas, recommends herbal teas concocted from the following western soft and hard roots, barks, seeds, leaves, and flowers: comfrey, burdock, fennel seed, ginger root, fenugreek, chamomile, and peppermint, to name just a few!
Stay healthy and well this season!
Avoiding Relaxation
December 23, 2012 § Leave a Comment
“Relax”, “relaxing” and “relaxation” are words said often in lessons. But not by me. In fact, if you listen carefully, you will find me avoiding these words like the plague.
Many people, Alexander teachers included, link the Alexander Technique with relaxation. I don’t. As far as I’m concerned, the concept of relaxation is a can of worms. And FM Alexander wasn’t too keen on it, either.
Palpation: The Use of Touch in Dis-Ease
November 23, 2012 § Leave a Comment
Dis-ease is a key precursor to illness.
It is a state of subtle energetic imbalance which may reflect deep-seated experiences of anguish, grief, distress, misfortune, suffering, or trial.
If relief is delayed too long, the energetics associated with these states of being may eventually materialize in the tissues of the body, towards a diagnostically identifiable state of physical disease. Hans Selye described this process as “the general syndrome of sickness” and identified energetic signs which usually preceded the appearance of an illness or disease related to loss of adaptation (one’s physiological capacity for stress regulation).
Diagnosing subtle energetic imbalances is a primary component of Oriental (Asian, Chinese, Korean, Japanese) medical theory and practice. A stand-alone system of health care, it utilizes four basic observations: questioning, listening, smelling, and palpation.
Palpation as a Preventative Tool
Hara Palpation Zones
In Oriental medicine’s Hara diagnosis, abdominal palpation is used effectively to pick up on subtle energetic imbalances in body systems which have not yet shown up as symptoms of disease, such as a mass or tumor.
The hara is the body’s energetic and physical center, the core of a person’s vitality. All the primary meridians root in the hara so any tenderness on palpation, tightness, indentation, temperature variation, change in skin color or texture or swelling, indicates an imbalance in a particular organ and meridian system which responds rather quickly to treatment at this stage.
This diagnostic tool is highly valued as it can identify subtle changes even if a person’s tongue, pulse or lack of symptoms seem to fall in the ”normal” range.
But there is something more to palpation that is equally as intriguing—the energetic exchange that occurs between practitioner and patient when acupoints are palpated. Research has demonstrated that acupoints along the meridians exhibit distinctive electrical qualities. Palpation of an acupoint prior to inserting a needle affects the qi of the point, helping the practitioner achieve the best results via depth of insertion, angle, direction, and location.
That’s why I love what I do!
_________________________
Reference:
Hara Diagnosis: Reflections on the Sea by Kiiko Matsumoto & Stephen Birch
