Stories of electrical systems

The further I go, the more I know people with persistent pain, the more I realize how difficult it is to make people understand how chronic pain is a physiological problem (related to an organic function) rather than anatomical (related to the structure of the body).

We need to see what's broken in our body and, when we find something wrong, we cling with all our tenacity to that thing that, in an ideal body (where ideal would be better "fake"), not there should be, even minimal: that little thing there, becomes responsible for all our pain, even if it is not. But we see and we like this, it comforts us.

Maybe because my pain was abominable, migrant, "referred" not only to muscles and bones, but also to internal organs that were fine, so when it was explained to me that persistent pain is a problem of physiology and not of anatomy, the fact was obvious to me: "Here is an answer, finally".

But it is not so immediate for everyone.

To simplify, we can say that health professionals have a tendency to look for our pain in the building blocks (bones, muscles, etc.), while persistent pain is in the electrical system, in our nervous system (composed of the brain, spinal cord, from the sense organs and from the set of nerves that connect these organs with the rest of the body).

In short, we have a nervous system, which regulates all the functions of our body, and which nobody (none among the health professionals who have not been able to give us a solution) considers.

But how can the electrical system be seen? And how do you know if I suffer from persistent pain and not from an unknown disease that will lead me to the grave (which I know very well is the fundamental question for all of us)?

First of all, to put you at ease, there is one thing called differential diagnosis.

Differential diagnosis is a procedure that aims to eliminate pathologies based on the presence or absence of some symptoms, using a correct medical history, physical examination and various laboratory tests. The ultimate goal is a correct diagnosis. The health professionals you rely on are able to carry out a differential diagnosis, each for their own skills and, in the event of the slightest doubt, they are obliged to send you to another professional figure. If at the end of the process they tell you that you have nothing, you have nothing ... Nothing that will kill you, at least. Forgive me for being honest, but this is the topic.

One of the first things the practitioner will do is ask you to evaluate your pain. In fact, patient self-portrayals of pain are one of the most reliable sources of information and can help understand what kind of pain you are suffering from.

Some simply ask you questions about your pain, while others can use a more formal pain questionnaire, asking you to choose the words that best describe your pain (such as burning, tingling, sharp, dull, etc.).

After that, which seems to be unknown to most, there are tests that a person suffering from persistent pain can undergo. It is often possible to demonstrate a malfunction (or injury) of the nervous system in one or more modalities, by testing the affected areas with different types of touch, the temperature (using an ice cube or an alcohol swab) ... also take note of the presence and distribution of abnormal pain responses. These tests, a professional who deals with persistent pain, should know how to do them and explain to you what they are for, what they tell about your body and your pain.

But the proven proof of my pain?

Well ... All the questionnaires, questions and tests that are made to you are not the result of the madness of your physiotherapist or your doctor, but of the research on persistent pain, which has allowed us to understand how it works and therefore to develop questions and tests to recognize it and diagnose it. Your body, it is not true that it says nothing about pain. In reverse. It tells a lot. The proven proof you have it under your nose, even if it seems impossible to you.

Well ... yes. There are neuroimaging.

Thanks to neuroimaging in recent years it has been understood that the brain of patients suffering from chronic pain shows alterations with respect to function, structure and chemistry.

Neuroimaging is a relatively new technique that uses various methods for mapping the structure or function of the nervous system.

The use of brain imaging and other technologies has led to the understanding that chronic pain is mediated by the CNS ... It remains that the use of these tools as a standard diagnostic tool for persistent pain is inappropriate (according to IASP), because there are no protocols validated and this is potentially harmful to patients.

In short, even if in neuro-images we see, in people with persistent pain, the activation of certain areas of the brain, it is not possible to quantify the pain from the outside.

I can't tell you if you'll ever see pain. But I can tell you that the evaluation of chronic pain is made on the basis of your medical history, clinical examination, questionnaires ... It may seem trivial to you in our medical system made up of a thousand thousand specific tests for everything, but everything that comes to you proposed by a professional who really knows persistent pain, it is the result of research and clinical reasoning (ie the exercise of a set of complex skills, such as critical, reflective, creative thinking), not by chance.

Your body clearly tells the story of its pain. You need to know how to listen and have the knowledge to understand it, above all.

 

Schmidt-Wilcke, T. (2015). Neuroimaging of chronic pain. Best Practice & Research Clinical Rheumatology, 29 (1), 29–41. doi: 10.1016 / j.berh.2015.04.030
Davis KD, Flor H, Greely HT, et al. Brain imaging tests for chronic pain: medical, legal and ethical issues and recommendations. Nat Rev Neurol. 2017; 13 (10): 624-638.

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In search of the lost symptom

"The drug removes the symptom, but it does not help to deal with what has led to being sick. Psychotherapy removes the symptom and allows us to face the difficulties that led to the development of the symptom ".

Mh.

Calm. Let's keep our heads. As a basic assumption, it can work.

Psychotherapy has led to a demand for renewal in relation to a tendentially mechanistic vision, in some way functionalistic, of the human being. However, we cannot consider psychotherapy a panacea for all ills or, at least, not in the case of persistent pain. If psychotherapy has changed the view of the human being, which therefore is not a machine, it seems to have jammed on one of its fundamental premises. Pain is considered as an expression of dissociation from emotional trauma: it seems to be an axiom. But is it really an axiom? Persistent pain challenges it, in a scientific way.

Although there are predictive psychosocial factors (emotional trauma, adverse socio-family conditions ...), these are not a sufficient condition for the development of persistent pain (not all those who have persistent pain, have experienced such conditions): pain necessarily has a demonstrable and verifiable biological basis (including nociplastic pain, for which structural and functional cortical changes are appreciable - the famous pain "which is nowhere to be seen").

If pain is a problem on an organic basis, it is not human to think of treating it with exhausting psychotherapy sessions in search of lost trauma, which may not exist (and often does not exist). Rather, it would be useful to renounce the premise pain = dissociation and stop considering people with persistent pain as sick people: they have a disease, they are not their disease, provided that persistent pain is a disease, rather than a (psycho) physical condition.

Scientifically, neurosciences question the premises of psychotherapy. A person with persistent pain is not a sick person, he is a person who lives a (psycho) physical condition, but he is not to be identified with his problem, with his difficulty, with his painful condition, he is a person who needs to be treated, but not in medical terms: he needs to be accepted, tout court. The aim of “cure medically intended” is to lead to the condition prior to that of the disease: it is often not possible. Psychotherapy, accepted all these assumptions, should be genuinely open to these new demands.

The Science of Pain, is a new science, which looks at an ancient problem with new eyes. It is not possible to think of finding innovative solutions while remaining anchored to old prejudices. Psychotherapy, which at the dawn of the twentieth century became the bearer of a revolution, has the possibility of renewing itself by playing a new and very important role, giving people with persistent pain different looks and alternative tools to deal with their own experiences in a constructive and effective way , detaching itself from the old vision of which we have spoken that, in this case, demonstrates its ineffectiveness.

In the case of persistent pain, intervention on the symptom is not useful, because we act with the idea that it is the manifestation of something, of the famous "repressed trauma", while pain is not the symptom, but the manifestation: if you enter into this perspective you can try to understand how it affects the life of those who live with it constantly and therefore it becomes possible to work at different levels on pain and its manifestations, undermining the idea that there is something to cure, to try rather to understand how it is possible to increase self-efficacy and live well with pain.

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(We chose to talk about psychotherapy, not psychology, because it intervenes directly on the epistemological constructs of the personality and on the functioning of the persons themselves).

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Article written with Andrea Ghirelli, trusted friend, educator, family mediator, systemic relational counselor.

 

Sources:

Chronic pain epidemiology - where do lifestyle factors fit in? by Oliver van Hecke, corresponding author Nicola Torrance, and Blair H Smith Br J Pain. 2013 Nov; 7 (4): 209 – 217. PMC4590163

A Broad Consideration of Risk Factors in Pediatric Chronic Pain: Where to Go from Here? by Hannah N. McKillop, and Gerard A. Banez2 Children (Basel). 2016 Dec; 3 (4): 38. Published online 2016 Nov 30. doi: 10.3390 / children3040038 PMC5184813

Preventing Chronic Pain following Acute Pain: Risk Factors, Preventive Strategies, and Their Efficiency by Kai McGreevy, MD, Michael M. Bottros, MD, and Srinivasa N. Raja, MD Eur J Pain Suppl. 2011 Nov 11; 5 (2): 365 – 372. PMC3217302

New concepts of pain, by Anne-Priscille Trouvina SergePerrota on Best Practice & Research Clinical Rheumatology

Bardolino Chiaretto Bentegodi, 2018

 

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