The Pain Game

Mental challenges keep you on your toes and your brain spinning. And just when you think you have a grasp of a concept, you can't put words to it - OR in my case, twisting words and concepts and trying to understand what is actually being said and then trying to convey thoughts and hopefully not failing. I decided to step out of my comfort zone and trust a person I follow on Twitter. Via the recommendation of @jorge_ze I visited Edupain. What was Jorge doing to me? He already knew I was overly challenged in responding to his tweets - Tweetdeck wasn't translating. I understand a few words here and there (enough to be wrongly dangerous)!

I got some help from @lightchronic in learning how to have pages translated. Wish there was an add-on for that! And, then, in trying to share pages while not overburdening my followers with Spanish, @lightchronic came through again letting me know a link I shared worked fine and was in English.

Por mi nuevos amigos: Gracias para trabajar sobre dolor. No comprendo Espanol muy bueno y me tengo dolor de la cabeza cuando estudio tus blog. :) Creo fisioterapia importante para ayuda con dolor y physiotherapist importante para mucho gente. Lo siento para tu que gente en Espana no tienen fisioterapia para dolor. [And yes, I did all that on my own and THEN double checked in translator to make sure I didn't say something horrible!]

Via a post in the Edupain blog, I came upon this really neat paper by Nijs and colleagues that actually gives some practical guidelines on explaining central sensitization to patients. During the same time, I had been in an email discussion with @AussieLouie about - take 3 guesses and the first 2 don't count! Adriaan Louw et. al recently published in Archives of Physical Medicine & Rehabilitation The Effect of Neuroscience Education on Pain, Disability, Anxiety, and Stress in Chronic Musculoskeletal Pain I considered myself lucky in the sense that Chris Kramer shared the article with me. This opened the door of discussion with Louie and he shared an article recently published entitled, Use of an Abbreviated Neuroscience Education Approach in the Treatment of Chronic Low Back Pain: A Case Report. Thinking and discussing pain and interventions that impact the pain experience is always stimulating for me.

The hot debate this week was over on Mike Reinold's blog - last count was 79 comments on trigger point dry needling authored by @PranaPT. How can I summarize 79+ comments? I can't... but the debate was two-fold: reliability of assessing trigger points and how trigger point dry needling fits into what we know about pain science. (As a side note, the neuromatrix of pain diagram does indicate "trigger points" as providing input to the brain.)

This whole week I've been inundated with the thoughts of others and their interpretation and perception of pain and how they have chosen to implement what they know about pain into their practice. The "easy" part of pain is that patients will tell you they hurt. The difficulty lies in determining which factors might be involved in perpetuating the pain experience.

I'm sure many of you are aware of this figure (Melzack 2001) which helps with understanding the vastness of the pain experience. My intuition tells me it is missing a genetic component, peripheral mutations, spontaneous firings, how body awareness can be altered/reduced, and how the pain experience can be explained for individuals with phantom pain from nonexistent limbs. If there is a newer model, I'd love to be enlightened!

All these conversations have been rattling around in my brain. It was the frustration of our Spanish colleagues that really hit my heart. First, physical therapists need to understand pain science and second, we really do need to be able to connect with our patients to help them to understand too. Last night, I had the inkling of an idea. David Butler and Lorimer Moseley have done a fabulous job telling a "pain story" and bringing the diagram of the above down to a level of a lay person via Explain Pain. We all learn by doing. And although a book is good, it may not connect with all individuals to readily understand the concepts.

There is nothing better than looking for an image and then finding a public one of a colleague! So... here is @mpascoe playing the exact game that I think could be repurposed to add value to discussions with patients about pain. I didn't ask for permission ahead of time - figured if it was public, it was public. Hope I figured correctly, Mike.

Why not create a little plastic brain (like the travel Operation game)? Have it similarly wired like the old Operation Game. The red light bulb would represent the brain interpreting something as pain. The difference with the Pain Game is simply there are only two metal connections and multiple wires. The wires would represent various factors that impact the pain experience. The wires would be labeled and could be different colors or groups of different colors. Each labeled wire would represent a factor involved in a pain experience. Wires would either be conducting in nature or nonconducting. If a conducting wire hits the connection in the brain, the light shines. Pain output. Obviously, nonconducting wires would also need to be included. It is just as important to convey factors that can reduce pain output because I think this creates a positive impression and hope that the pain experience can be changed. Change the input = change the output. So... the "napkin" drawing of what's in my head for the moment.