Mel, et al:

The Melzack and Wall pain model does incorporate descending pathways of
pain modulation.  Gate control is an ascending pathway.  Meditation,
relaxation, general exercise regimes that increase endorphins, etc., could
be considered either having an influence that "descends" the spinal cord,
or, could be considered as having a direct effect on the pain modulating
centers of the brain.  Auricular acupuncture is an interesting intervention
in that some of the "points" used are directed at "brain" functions, eg, in
the hypothalamus.  So, the question arises, is the "soothing" effect of
gentle stroking mediated through the peripheral system, or is it the effect
occuring at a "higher" level of simple human interaction/empathy?  Or even
better, a combination of the two.

Furthermore, the treatment effects noted by Dean Ornish created by social
interaction (support groups, religious affiliation, extended family, etc),
have been demonstrated to have profound effects on treatment outcomes with
cancer and heart disease.  Where are these treatment effects "centered"?

PTs seem to focus on the "gate" part of Melzacks and Walls theory, but
certainly empathy has a strong treatment effect as well (too often
delegated as a "placebo").  I believe, though I don't have the evidence in
front of me, that explaining how a TENs unit is going to work along with
the application of a TENs unit would have a stronger treatment effect than
just applying the TENs unit--I believe the greater effect comes from the
same "centers" as the effects of simply having a better attitude which
occurs through our familiar relationships, religion, introspection through
meditation, etc.  

So, finally, by trying to "divorce" our treatment effects too much from
these "other" effects, we loose some of the potency of our interventions IN
CLINIC.  Certainly, there is a place in research to try and determine where
the effects come from and further increase the power of these treatments
through better understanding.  

So, as far as Mel's question about recent research and better insights into
the mechanism of pain and pain management, I think some of the insights
from Dean Ornish are appropriate--and these are reasonably well researched
insights.  

Finally, I just love Mel's insights--the discussion about "vertical,
lateral thinking" was the work of a true master.  

Herb Silver, PT


At 06:01 PM 3/16/00 EST, you wrote:
>On 3/16/00, Owen Sant' Angelo<[log in to unmask]> wrote:
>
><< Pain is also meant to decrease during the sessions of frictions itself, 
>through mainly, counter-irritation (trigger-pointing) as per A-beta fibers 
>pain gate closing according to Melzack and Wall. >>
>
>***There is one issue that has always intrigued me about the Melzack-Wall 
>theory, namely that gentle stroking, certain types of meditation, 
>visualisation, and microcurrent application (using currents as weak as 50 
>microamps) can also diminish pain very noticeably.  The stimulation involved 
>in either case would appear to be insufficient to significantly modulate
gate 
>control processes, so does this imply that the gate theory of pain may be 
>seriously limited in trying to explain the full gamut of pain sensation and 
>control mechanisms?
>
>Possibly the all-or-none theory of nerve propagation and information
transfer 
>has created a paradigmatic bias towards that type of physiological modelling 
>for many control processes in the body.  However, the all-or-none theory
does 
>not explain the existence of many EEG rhythms, which appear to be far better 
>explained by the superposition of subthreshold dendritic and other 
>non-propagated discharges in the central nervous system. 
>
>The existence and operation of these types of subthreshold event, as well as 
>of slowly varying potentials and quasi-DC phenomena, in the nervous system 
>might then offer some better insights into the mechanism of pain and pain 
>management. Has anyone come across recent research which addresses such 
>issues?  
>
>For those who may be interested in popularised information on the
functioning 
>of some of the DC control processes in the body, the following book is
useful:
>
>Becker R O   The Body Electric
>
>I covered many more aspects of bioelectrical phenomena in great depth in my 
>applied mathematics Masters many years ago  (Siff MC  Modelling of 
>Electroencephalographic Phenomena  University of the Witwatersrand   1977), 
>but unfortunately it was prepared on a conventional typewriter and I have 
>never scanned it into computer format for sharing with others. Even more 
>relevant is the fact that considerable research has taken place since then 
>and it would be preferable to see more up-to-date discussion on this 
>fascinating topic of nervous communication in the human body.
>
>Dr Mel C Siff
>Denver, USA
>[log in to unmask]
>
>
>



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