Monday, February 18, 2008

Getting past fear

In reference to FABQ and physical therapy:

Cory, I have to confess up front that I've never used this questionnaire with any of my patients.

I completely concur with your conclusion:
Bottom line, change the belief about pain and you change the way a person behaves in response to pain. Change the behavior in response to pain and you can change the pain itself.
This post by Matthias also references Waddell's book and the biopsychosocial model, here.

The brain seems to be attracted to novelty, even if only the novelty of a new idea (it must find the "new idea" nonthreatening of course..). This ties in with Melzack's pain model, where the neuromatrix constantly folds in cognitive evaluative, sensory-discriminative, and motivational-affective inputs, to produce its outputs, one of which might be pain perception.

The other thing the brain finds convincing, possibly even more so, is illusion, whether visual (as with mirror therapy a la Ramachandran, or with videos a la Ehrsson and Lenggenhager and Blanke) or kinesthetic ("movement illusion" as per Collins et al) or perhaps both. (Here's a little study idea I had late last year..)

If the illusion is convincing enough to the brain, it doesn't seem to matter if the "mind" is convinced or not - people seem overwhelmingly capable of suspending any disbelief they may have. The mirror therapy is sufficient proof of that - the amputee patient is fully aware they are looking at their remaining limb move in a mirror image, yet the illusion still works. A large-scale trial of mirror therapy is currently underway at Walter Reed army hospital.

It looks to me like our PT work will just keep on evolving and get easier and easier, the more the brain/ nervous system comes to be understood and appreciated, the more we learn to understand how it perceives and constructs a reality for itself and the human body it is meshed with.

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