Today I continue yesterday’s discourse. Enjoy. Remember, the Good Works side of our spiritual life.
BEYOND WESTERN MEDICINE: PAIN MODELS AND TREATMENT EFFICACY
Michael Jon Kell, MD PhD
Theory: In order to better understand why linear-based Western medicine fails to relieve the pain and suffering of many pain patients, both with ongoing and apparently healed tissue injuries, our attention should be turned towards the rising sun–the oriental world. In particular, we turn to the analytical studies of one of the most noted physicians of all times–the Buddha.
The Buddha is thought to have lived, studied and taught between the period of 563 – 483 B.C.E. in North India near Nepal.4 His teachings were recorded several centuries after his transition, the earliest volumes composing the Pali Scriptures of Sri Lanka and SE Asia. His major area of academic and pragmatic interest was in understanding the unavoidable consequences of the conditioned nature of a man’s life, e.g., that the very nature of life is intrinsically unsatisfactory because nothing is permanent or substantial. Each is born, grows, gets ill and dies. We often do not get what we desire and we cannot keep it even when it comes. We are bombarded by objects and events we do not want. Every man, woman and child seems caught in a endless loop of linear (or circular) cause and effect called kamma in Pali and karma in Sanskrit. After much study and meditation, the Buddha finally arrived at a complete understanding of man’s situation and succeeded in traveling and pointing out to other the ‘Ancient Path’ to liberation and freedom from this life of linear cause and effect.
His solution to this problem came about as soon as he perceived that man’s situation cannot be adequately understood from the standpoint of linear events. Man’s situation was in fact composed of and dependent upon both linear and non-linear causal relationships as shown in Equation (2):
When this is, that is,
From the arising of this comes the arising of that,
From the stopping of this comes the stopping of that,
When this is not, that is not.
This formula is best viewed as the interplay of two causal patterns, one linear and one non-linear. The linear principle–expressed in lines 2 and 3–connects events in time; the non-linear principle–expressed in lines 1 and 4–connects objects and events in the present or synchronically. These two causal elements continuously interact and influence each other such that any present event or object is influenced, to one degree or another, by input acting from the past and input acting from the present. Consequently, every act has repercussions in the present moment together with reverberations extending into the distant future. Depending upon the circumstances associated with each act (beliefs, physiology, emotions, expectations, past state dependent memories and so on), these reverberations can last for a short or very long time. Thus every event takes place in a context determined by the combined effects of past events coming from a wide range of time and experience, together with the physical, mental and emotional actions of the present. These effects can intensify one another, can coexist with minimal interaction or can cancel one another out. Thus, even though it is possible to predict that acting upon angry feelings will lead to emotional pain, there is no way to predict when or where or how the result will make itself felt.
The complexity of this system is enhanced by the fact that both causal principles meet in the CNS and consciousness of the individual. Through its innate views, beliefs, prior experiences, selective memories and interpretations, the mind keeps both principles functioning. Through the minds’s sensory powers it is affected by the results of the causes which have been consciously and unconsciously set into motion. This creates the possibility for the causal principles to feed back upon themselves within the mind and body–both as negative and as positive feedback loops. Such central reactions can intensity and maintain not only ongoing sensory stimulation, but also intensify and maintain the impression of sensory input even in the absence of actual, additional sensory input.
The practical difference between the Buddhist concepts of causality and the traditional Western ones in alleviating pain and returning daily functioning can be easily seen. For example, we have repeatedly observed improved treatment success in patients following introduction of a more complex notion of causality, even when other physical-based modalities have not been changed. Treatment success improves because the pain models 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 RSD. 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 and substituting the combined 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.”
Included below are some brief comments on how successful this change in paradigm has been in addressing the needs of persons referred to our office as ‘being intractable’.