Interesting post you mailed there... Been away from the net recently and am
not aware how long the TOPIC CHRONIC PAIN has been going on.
Here's my small contribution : just returned from a David Butler -
Neurodynamics Initial Course. Some highly interesting thoughts and
reasoning models on CHRONIC PAIN MECHANISMS... It is not my intention giving
you a resumee on this 3 days course (it would take a bit more
than my 3 cents worth of written English ability) but I can highly recommend
the stuff that this man from down-under explains in both an
entertaining and clear way. Conclusions point in the direction of trying to
answer following questions for each individual case or patient
(sorry if I use the word 'case')
I quote Butlers words here (honouring the nerve-head persons work but knowing
that many out there allready consider this as BASICS in their
education, whatever...)
- WHAT DOES THE PATIENT WANT ?
in terms of finding out WHAT IS WRONG ?
in terms of GIVING HIM/HER AN IDEA OF HOW LONG IT WILL TAKE to get better
?
in term of WHAT CAN I - the therapist - DO (don't give the patient any
golden pills, rather try to find solutions for the next item) ?
in terms of WHAT CAN YOU - the patient - DO ?
In this context, it seems that in many chronic pain patients, the lack of
explanation to the patient is a keystone in his /her development
of chronic pain... These - and other pain-mechanism hypothesises are part of a
broader clinical reasoning framework that is subject to
research in many scientific fields but as a PT I am now more aware that
finding out more on topics like :
- pathobiological (or rather NEURObiological) models and pain-mechanisms
- endocrinology (yes, we are talking 'adrenalin and cortisol' as some
keywords)
- distress and other psychological dysfunctions (not only fight and flight but
also rest and digest are to be taken into account)
- hyperalgesia (some may call it hypersensitivity to pain)
I am aware, that this might look like publicity for Butler's courses, but
nevertheless, reading his work (and that of other neuro-heads and
pain specialist) and visiting his Neurodynamics courser has certainly
broadened MY views on patient management and ways of approach in the
chronic pain patient (be that RA, FM or LBP - whatever).
Some key references could be the following :
- Wall PD (1996) Challenge of Pain, Penguin, London
- Sapolsky RM (1994) Why Zebras don't get ulcers, WH Freeman, NY
- Martin P (1997) The Sickening Mind, Harper-Collins, London
... (I am trying to make some time to get my homepage finished : will have
some more refs on the literature page then...)
It'll be worth waiting for Butler's newest work, coming out in 1999 : The
dynamic Nervous System, NOI Press, Adelaide and Falmouth (in
press).
Anybody made same (or completely different) enlightning experiences after
visiting Neurodynamics courses ?
Greetings from Switzerland,
Erik Goossens
Dipl. PT - PT Educator
CH-4102 Binningen
Switzerland
[log in to unmask] schrieb:
> In a message dated 10/3/98 7:00:22 PM Eastern Daylight Time,
> [log in to unmask] writes:
>
> << Recently in an APA abstract: Chronic pain patients were compared and
> categorized. Patients who have Rheumatoid Arthritis were compared to
> patients
> who have Fibromyalgia. 30% of the patients with RA demonstrated severe
> psychological disorders compared to 88% of patients with Fibro. Amazing.
> Any
> comments about this? >>
>
> Dear Karen,
>
> These percentages seem consistent with what I have seen in my clinic.
> Although, I must question the meaning of "severe" psychological disorders.
It
> seems that the majority of (if not all) patients with fibromyalgia (FM)
suffer
> from depression of varying degrees. I am not a psychologist, but I am
> beginning to feel that FM may be purely a manifestation of depression.
> Sources that I have read describe that the painful tissues show normal
micro-
> anatomy, unlike MFPS. So is FM purely a psychological disorder? Does this
> explain the insomnia?
>
> I have tried many standard and nonstandard treatment approaches for my FM
> patients. Unfortunately, only about 10% of these patients have shown
> significant improvement. Am I missing something? It is interesting that my
> success rate is about the same percentage of FM patients without depression
in
> the abstract you describe. So are FM patients seeing the wrong type of
> therapist? Or is FM a garbage term for undiagnosed conditions?
>
> I find FM a fascinating topic, but unfortunately I'd rather read about it
than
> treat it. Help!
>
> Nick
--------------------
Hi Karen, Hi Nick,
Interesting post you mailed there... Been away from the net recently
and am not aware how long the TOPIC CHRONIC PAIN has been going on.
Here's my small contribution : just returned from a David Butler -
Neurodynamics
Initial Course. Some highly interesting thoughts and reasoning models on
CHRONIC PAIN MECHANISMS... It is not my intention giving you a resumee
on this 3 days course (it would take a bit more than my 3 cents
worth of written English ability) but I can highly recommend the stuff
that this man from down-under explains in both an entertaining and clear
way. Conclusions point in the direction of trying to answer following
questions
for each individual case or patient (sorry if I use the word 'case')
I quote Butlers words here (honouring the nerve-head persons work but knowing
that many out there allready consider this as BASICS in their
education,whatever...)
- WHAT DOES THE PATIENT WANT ?
in terms of finding out WHAT IS WRONG ?
in terms of GIVING HIM/HER AN IDEA OF HOW LONG ITWILL TAKE
to get better ?
in term of WHAT CAN I - the therapist - DO (don'tgive the
patient any golden pills, rather try to find solutions for thenext item) ?
in terms of WHAT CAN YOU - the patient - DO ?
In this context, it seems that in many chronic pain patients, the lack of
explanation to the patient is a keystone in his /her development of chronic
pain... These - and other pain-mechanism hypothesises are part of a broader
clinical reasoning framework that is subject to research in many scientific
fields but as a PT I am now more aware that finding outmore on topics like :
- pathobiological (or rather NEURObiological) models and pain-mechanisms
- endocrinology (yes, we are talking 'adrenalin and cortisol' as somekeywords)
- distress and other psychological dysfunctions (not only fight and flight but
also rest and digest are to be taken into account)
- hyperalgesia (some may call it hypersensitivity to pain)
I am aware, that this might look like publicity for Butler's courses, but
nevertheless, reading his work (and that of other neuro-heads and pain
specialist) and visiting his Neurodynamics courser has certainly broadened MY
views on patient management and ways of approach in the chronic pain patient
(be that RA, FM or LBP - whatever).
Some key references could be the following :
- Wall PD (1996) Challenge of Pain, Penguin, London
- Sapolsky RM (1994) Why Zebras don't get ulcers, WH Freeman, NY
- Martin P (1997) The Sickening Mind, Harper-Collins, London
... (I am trying to make some time to get my homepage finished : willhave some
more refs on the literature page then...)
It'll be worth waiting for Butler's newest work, coming out in 1999 : The
dynamic Nervous System, NOI Press, Adelaide and Falmouth (in press).
Anybody made same (or completely different) enlightning experiences after
visiting Neurodynamics courses ?
Greetings from Switzerland,
Erik Goossens
Dipl. PT - PT Educator
CH-4102 Binningen
Switzerland
[log in to unmask] schrieb:<BLOCKQUOTE TYPE=CITE>In a message dated 10/3/98 7:00:22
PM Eastern DaylightTime,
[log in to unmask] writes:
<< Recently in an APA abstract: Chronic pain patients werecompared
and
categorized. Patients who have Rheumatoid Arthritis werecompared
to
patients
who have Fibromyalgia. 30% of the patients with RA
demonstratedsevere
psychological disorders compared to 88% of patients with
Fibro. Amazing.
Any
comments about this? >>
Dear Karen,
These percentages seem consistent with what I have seen in my clinic.
Although, I must question the meaning of "severe" psychological
disorders. It
seems that the majority of (if not all) patients with fibromyalgia(FM) suffer
from depression of varying degrees. I am not a psychologist,but I am
beginning to feel that FM may be purely a manifestation of depression.
Sources that I have read describe that the painful tissues show normalmicro-
anatomy, unlike MFPS. So is FM purely a psychological
disorder? Does this
explain the insomnia?
I have tried many standard and nonstandard treatment approaches formy FM
patients. Unfortunately, only about 10% of these patients haveshown
significant improvement. Am I missing something? It isinteresting
that my
success rate is about the same percentage of FM patients without depressionin
the abstract you describe. So are FM patients seeing the wrongtype of
therapist? Or is FM a garbage term for undiagnosed conditions?
I find FM a fascinating topic, but unfortunately I'd rather read aboutit than
treat it. Help!
Nick</BLOCKQUOTE>
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Nick,
Thanks for the info. The courses you describe sound very interesting.
Sincerely,
Karen
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