17. PARADOXES leads to dilemmas
A case for simplicity, but
which simplicity should we listen to?
Simple solutions are everywhere!
Where facts are few, experts are many
18. The pLot
Is it possible to find sense in chaos?
Depends on certain premises
21. The pLot
Secondly:
you have to be willing
to live with uncertainty
Accept informed probabilities,
Not definite certainties
22. Conceptual
hygiene
As little contradiction as possible
”Knowledge is case specific”
”True” knowledge is true
In all landscapes of ”reality”
We need certain models of reasoning
23. Models are tools for thinking
E.G. THE SAB & BPS model
What is a
Model?
”
George E. P. Box
24. What is a GOOD
Model?
”
George E. P. Box
Explains existing phenomeNon and
provides reliable predictability
25. Models are tools for thinking
E.G. THE SAB & BPS model
Explains existing phenomeNon and
provides reliable predictability
What is a
Model?
”good”
Essentially,
all models are wrong
but some are useful
”
George E. P. Box
Therapeutic models – wrong, but useful?
27. How the fuck
Different situations rests on
different premises
Prescriptive
Based on an assumption
On how the world works
We basically do the same,
but from wildly (?)
Different premises
Normative
model
29. Why the fuck
Different situations rests on
different premises
history
+ Culture
= Identity
Causal
model
30. Why the fuck
Different situations rests on
different premises
How to become a man
The etero vs the kaluli
Henrich J, Heine SJ, Norenzayan A. The weirdest people in the world?
Behav Brain Sci. 2010;33(2-3):61–83; discussion 83–135.
Causal
model
31. Why the fuck
Different situations rests on
different premises
THE SOMATIC
DYSFUNCTION
BLOCKING OF QI
HYPOMOBILITY
SUBLUXATION
TRIGGERPOINT
BREATHING PATTERN
BPS-model
neurobollocks
Causal
model
32. DESCRIPTIVE
model
WHAT THE FUCK
Different situations rests on
different premises
FIRST OF ALL:
”Before we say something
is OUT of this world,
first make sure that it
is not IN this world”
Michael shermer
33. WHAT THE FUCK
Different situations rests on
different premises
secondly:
biological plausibility?
Thirdly:
Maybe Interesting,
But So what?
DESCRIPTIVE
model
36. Why the fuck
Understanding of X, y, Z
Crosses all domains!
How the fuck What the fuck
Normative
model
Causal
model
Descriptive
model
37. Why the fuck
Understanding of X, y, Z
Crosses all domains!
How the fuck What the fuck
In which domain does the Pain
discussion take place?
Normative
model
Causal
model
Descriptive
model
38. Why the fuck
How the fuck What the fuck
How much (about reality) do
we need to know??
Normative
model
Causal
model
Descriptive
model
We believe what we do
And we do what we do
Because of our
culture!
42. Our fMRI study concludes that
participants performing memory tasks
showed activity in the parts of the brain
associated with high sounds,
claustrophobia, colors and farting
47. Biography “becomes” biology
“Gains” (salutogenesis)
Trust
Belonging and
nourishment
Respect
Care
Honour and pride
A life sustaining
physiology of meaning,
belonging and hope
“Drains” (pathogenesis)
Threat and betrayal
Isolation and neglect
Humiliation and
integrity violation
Leaving behind
Guilt and shame
A pathophysiology of
disempowerment and
disadvantage
Linn Getz #CauseHealth
tendencies
48. The brain paradigm
Is the brain becoming the new spine?
”you have pain because something is
messed up in your spine”
”You have pain because something is
messed up in your brain”
49. Limitations of language
Do we ALL describe
love, hate, fear & Joy
The same way?
The SAB-model is useful,
but TOO simplistic
so what next?
54. Limitations of language
New definition of pain?
Pain is a distressing experience
associated with actual or potential
tissue damage with sensory, emotional,
cognitive and social components
Williams – 2016 – Upda0ng the defini0on of pain
55. Limitations of language
…all DEFINITIONS and models of
understanding are wrong, but...
Different models of understanding
are useful for different purposes
(and different realities)
57. Limitations of language
Humanistic (clinical) definition
Pain is whatever the person says it is
pain is whatever
the experiencing person says it is,
existing whenever and wherever
the person say it does
Margo McCaffery
Problematic that A person could point at a rock and say ”That is pain”?
58. TID TID
MA
KE
SD
”THE MODERN BRAIN”
STRESSREGULATION PROGRAMS
ACTION PROGRAMS
PAIN PERCEPTION
Cognitive, sensory and
affective dimensions
Voluntary and involuntary action
patterns. Social communication
and management
Cortisol, noradrenalin,
endorphin levels and
immune system activity
BODY-SELF
NEUROMATRIX
INPUTS TO THE BODY-SELF
NEUROMATRIX FROM:
OUTPUT TO BRAIN AREAS
THAT PRODUCE:
Melzack, Katz; Cogn Sci 2013, 4:1–15@SigMik
The neuromatrix
”SENSORY SIGNALLING SYSTEM”
”THE PRIMITIVE BRAIN”
Is not specific for pain!
59. TID TID
MA
KE
SD
STRESSREGULATION PROGRAMS
PAIN PERCEPTION
Cognitive, sensory and
affective dimensions
Voluntary and involuntary action
patterns. Social communication
and management
Cortisol, noradrenalin,
endorphin levels and
immune system activity
INPUTS TO THE BODY-SELF
NEUROMATRIX FROM:
OUTPUT TO BRAIN AREAS
THAT PRODUCE:
Melzack, Katz; Cogn Sci 2013, 4:1–15@SigMik
What Goes on here?
COGNITIVE-RELATED BRAIN AREAS
Memories of past experience,
attention, meaning and anxiety
ACTION PROGRAMSEMOTION-RELATED BRAIN AREAS
Limbic system and associated
homeostatic/stress mechanism
SENSORY SIGNALLING SYSTEMS
Cutaneous, visceral and
musculoskeletal inputs
62. ”the structure of the neuromatrix is
predominantly determined by genetic factors,
although its eventual synaptic architecture is
influenced by sensory inputs.”
63. Activity in the water stream
is like synaptic activity
The swirls in the river
Is like “blobs” in the brain
64. A brain without synaptic activity
Is like a river without water
66. What pain is not
Pain is not a structural injury
Pain is not brain activity
Pain is not a chemical
67. So what?
Why does it matter?
If you really understand pain:
Then you’ll always believe people in pain
Then you’ll understand when pain becomes suffering
Then you’ll understand why communication matters
Then you’ll understand why so many treatments fail
Then your management will change
68. Evidence-based
physiotherapy:
A crisis in movement
Touch people who need touching,
this is therapy. Don’t touch people
who don’t need touching,
this is battery.
Talk with people who need talking
with, this is therapy.
Judge when this becomes
meaningless.
Educate your patient by all means,
but also let them educate you.
The Notorious R. Kerry