Today, I am going to provide some medical discourses I gave in the past which touch upon spirituality. They will come in a few part. Enjoy. Remember, the Good Works side of our spiritual life.
BEYOND WESTERN MEDICINE: PAIN MODELS AND TREATMENT EFFICACY
Michael Jon Kell, MD PhD
Abstract: The purpose of this presentation is to address an important, but essentially unstudied area of Western pain medicine–the effect that practitioner-patient belief systems concerning chronic pain have upon treatment options offered and their efficacy. The importance of this area became evident through the evaluation and successful treatment of 60 patients referred for treatment failure of neuropathic pain. In over 90% of these patients, we reversed the previous treatment failures, obtaining good to excellent results in decreasing pain and improving function, by simply reframing a patient’s understanding of his or her pain syndrome. Treatment success improved because the pain model utilized became less restrictive, e.g., rather than describing pain is as a linear, causal, sensory process linking discomfort with actual or perceived tissue pathology; pain is understood to be a centrally integrated, nonlinear, biological response occurring in a conscious individual due to actual or perceived tissue pathology as modified by past memories and current beliefs. The patient’s ‘pain reality’, though interpreted by the patient as a sensory experience, is in actuality, dependent upon overall central psychoneuroimmunoendocrine processes occurring and manifesting within the body of the patient. In other words, though perceived as being sensory in nature and related to an actual or perceived injury, the biological basis of such experiences are dependent upon central integration of primary and secondary sensory, cognitive and motor activity connected with the injury. For example, a patient sustains an injury to his wrist causing severe pain and swelling. When centrally analyzed, an unconscious, state dependent memory is activated, linking the current injury with an emotionally charged, painful event occurring in the past. The combination causes activation of a self-sustaining neural pain memory resulting in centrally mediated motor outflow to the wrist, mimicking the swelling and neurovascular changes typical of a major nerve injury, causalgia. Because secondary physical effects continue, the patient generates a central psychogenic pain syndrome not responsive to treatment. The cure is in resetting the central controller by breaking the linear belief system of the patient. The basic structure of the new model is contained in the linear and synchronic causality model: When this is, that is; from the arising of this comes the arising of that; when this is not, that is not; from the cessation of this comes the cessation of that.”
Introduction: The purpose of this presentation is to address an important, but essentially understudied area of Western pain medicine–the effect that practitioner defined chronic pain models have upon treatment options offered and their efficacy. Such models are important and necessary theoretical structures created by health care providers so to bring order to what would otherwise be a chaotic interplay of seemingly unrelated physical, emotional, intellectual and spiritual factors associated with the patient’s presenting complaints. These models establish the several dimensions needed for patients to understand and address etiological factors behind their presenting signs and symptoms, define the universe of acceptable intervention techniques available to the patient for a particular practitioner created pain model, outline the most probable outcomes of treatment interventions, define the typical course of treatment and create an explanation for possible failure.
As is well known by all pain practitioners, overall treatment efficacy (as determined by relief of pain and improvement in daily functioning) varies greatly between different pain centers apparently applying the same techniques.1 Such differences remain even after attempts are made to account for varying degrees of confounding patient comorbidity and pain diagnosis type (somatic, neuropathic and visceral). Although no comprehensive studies have been uncovered reviewing this area, previous research has documented the importance of individual therapist ‘style’ upon success rates for both pain and addiction patients.2 These studies clearly demonstrate the importance of patient and therapist beliefs upon outcome. Another area of related research concerns the long-term efficacy of placebo treatments.3
Although such research has helped improve treatment outcomes for many suffering patients, it has not addressed the importance of intrinsic barriers to further success caused by the very nature of the theoretical assumptions used in creating such models. One such assumption concerns how a particular model defines and applies causality to the patient’s pain syndrome. For example, most Western-based pain models are founded upon linear rules of cause and effect, e.g., a physical injury excites nociceptive stimuli which travel to the CNS and are interpreted by the brain as an unpleasant, painful sensory experience directly resulting from the injury. Linear, physiological models are generally satisfactory for explaining the acute onset of painful sensation following tissue injury and its gradual decrease as tissue healing occurs. However, often times linear models are inadequate for explaining the continuing discomfort (burning and aching) and neurovascular and cutaneous signs (brawny edema, hair and nail changes, coldness) stemming from a minor nerve injury which has apparently healed. Consequently, these models fail the chronic pain patient and must be modified and expanded if greater success rates are to be obtained.
The logistic construction of a linear model of causality can be seen in Equation (1):
From the arising of this comes the arising of that,
From the stopping of this comes the stopping of that.