NOI Notes - "Pain off the Radar"

This is a useful posting from the NOI group. Particularly interesting for clinicians at GF Strong who work with clients with neurological conditions like SCI, stroke and MS.

http://noinotes.wordpress.com/2012/12/20/missing-out-at-christmas/

It really underlines how some of the patients we work with really aren't well represented in pain research. As a result, establishing useful pain treatments can be even more difficult.

From the NOI Posting:
"What can we do about it?
In our very own small way, we are planning to do something. We have had our first course in neurological disease and pain last month and introduced therapies such as graded motor imagery and therapeutic neuroscience education for these once untouched neuropathic pains. There are more courses planned in Australia and later for overseas. We are well on the way in planning for pelvic pain courses under neuroimmune refreshed biopsychosocial thinking. And we will fund imagery studies on face pain, pelvic pain and therapeutic neuroscience education for stroke pain, but I think we can all start by listing awareness on groups that are missing out on the very first stage of treatment – "an understanding of why I hurt".  Tell us who you think is missing out."

Understanding the biology of the pain states that exist for some of our patients, and how we successfully work with patients to reduce their pain will be very important information for us to share in order to move forward.

Another Course: Graded Motor Imagery - One Day Seminar with Sam Steinfeld, BSc, BMR (PT), Sunday February 10, 2013

This one is being offered through Vancouver Coastal Health.  Good for us!

Sam Steinfeld has been teaching NOI - Neuro Orthopedic Institute - courses in Canada since 1997.

Graded Motor Imagery (GMI) is an emerging new rehabilitation strategy for chronic pain states. GMI comprises a sequence of strategies including laterality restoration (being able to identify left and right limbs, or movement to the left or right), motor imagery and mirror therapy via use of a mirror box.

Evidence for the use of GMI comes from basic sciences (neuroscience) and clinical trials. It can offer substantial improvements in pain and disability in complex regional pain syndrome and phantom limb pain and anecdotally, the GMI programme, or parts of it may offer improvements in a range of chronic pain states such as brachial plexus lesions and osteoarthritis.

Course description

The GMI course provides the most up to date basic sciences, clinical trials, and clinical use of the programme. The course is a series of lectures, practical sessions and clinical applications.

Course objectives:

1. Knowledge of the basic sciences underpinning the use of GMI, including the neuromatrix paradigms, neuroplasticity and mirror neurones

2. Practical knowledge and skills on the use of laterality reconstruction, motor imagery and mirror therapy.

3. The skills to adapt the GMI programme to various patient groups

4. An awareness of the ongoing research programmes in GMI and the basic sciences validating its use 

5. Perhaps a desire to contribute to ongoing research programmes. 

Course Program – 8:00am to 4:00pm

• Registration 8:00 to 8:30am 
• Introduction and history of GMI 
• Neuroscience 1 The neuromatrix paradigm 
• Neuroscience 2 Mirror neurons
• Neuroscience 3 Plasticity and contextualization
• Graded exposure principles and application to GMI
• Neuroscience Education as GMI ally – what do you tell them?
• Laterality reconstruction: theory, principles and techniques
• Motor imagery: theory, principles and techniques 

This course is open to health professionals involved in pain and stress management. While there are no prerequisites for this course attendance at an Explain Pain course would certainly assist, as would study of the information and resources provided at www.gradedmotorimagery.com.

Logistical Information:

Vancouver, BC | 10 February 2013 
Venue Multipurpose room 1 + 2, Level 1, Jim Pattison Tower 
855 West 12th Ave, Vancouver BC Time 8:00 am – 4:00 pm 
Cost $250 per person 

Host Vancouver Coastal Health 
Morning coffee and lunch will be provided. Parking $15/day or with VCH ID staff rate $8.50/day. 

To register or for more information:

Direct your enquiry via e-mail to either: 

Dolores.Langford@vch.ca or, Catherine.LeCornuLevet@vch.ca  

Complete and forward the form below along with payment by cheque to: Catherine Le Cornu Levett, Rehab Services, Level 1 Jim Pattison Tower 855 West 12th Ave Vancouver BC V5Z 1M9

Upcoming Course: Pain Science and Innovative Physiotherapy for People in Pain with Neil Pearson, March 16 & 17, 2013

This one has just been posted on the PABC site. It will definitely be a good one and will likely fill up fast.

Outline:
The objectives of this two-day course are to bring physiotherapists up-to-date on pain neuroscience research and clinical practices, and to enhance physiotherapy practice by providing practical methods to integrate pain science into our daily physiotherapy practice.

Day 1 provides detailed current physiological understanding of pain, chronic pain and the lived experience of pain. This information is the biological foundation from which we can better understand the positive effects of our current physiotherapy treatments on outcomes of pain, function and quality of life. It is also the foundation from which we can analyze and develop new physiotherapy interventions for people in pain.

Day 1 also includes a review of neurophysiology of peripheral, central and autonomic systems, recent and ongoing research of neurophysiology and neuroplasticity, as well as treatments that will promote positive neurophysiological changes, and language with which to provide people in pain with an optimistic and realistic perspective of pain management.

Day 2 provides practical sessions combined with a deeper look into current interventions provided by physiotherapists for people with pain - specifically discussing situations in which the person does not respond as we would expect to our traditional biomechanical and exercise-based approaches. Given the recent academic disputes related to myofascial techniques and to acupuncture, the day will start with a discussion of these interventions, specifically related to pain biology.Exercise in the face of persistent pain will be considered in light of recent outcome studies. Specific movement practices, and their associated outcome studies will be analyzed, including yoga, Tai Chi and Qi Gong for people in pain. The NOI group’s graded motor imagery techniques will be reviewed, and participants will discuss how these innovation could be beneficial with in broader populations rather than only for those with complex regional pain syndrome.

Link for the course description is here:
http://www.bcphysio.org/content/pabc-education-pain-science-and-innovative-physiotherapy-people-pain-neil-pearson-march-16-1

Direct link for registration is here:
http://painscience.eventbrite.com/

First person Neuroscience and the Understanding of Pain

A great article by Michael Thacker and Lorimer Moseley that takes a step back to think about where we've come from and where we need to go.

http://cdns.bodyinmind.org/wp-content/uploads/tha10468_fm.pdf

Some quotes:

"We were invited to reflect upon brain–mind–pain interactions and to opine on whether modern neuroscience adequately considers pain phenomena and experience"...

"Our perspective is that pain is emergent. Emergent properties are those that are possessed by entire systems.  A system comprises several distinct parts, and these parts interact with one another to give the system its emergent properties."...

"Clearly, the conceptual gap between pain as an injury, a dysfunction or even a disease and pain as a state that emerges from the whole person is vast. If we are to bridge this gap, we need conceptual frameworks that provide a way of integrating first- and third-person perspectives into our thinking about pain."

NOI Group - Pain, Plasticity, and Rehabilitation

The latest NOIgroup (Neuro Orthopedic Group) newsletter includes some great clinical reviews of Graded Motor Imagery work out in the clinics.

http://noinotes.wordpress.com/2012/10/24/learning-from-the-shadows/

Also, have a look at this 2-day seminar/workshop being hosted by NOI (Brendan Haslam, David Butler) in Melbourne this November.

http://www.noigroup.com/documents/noi_ppr_course_flyer_bh_2012.pdf


This lecture, practical and interactive course is about developing management strategies for the neurological patient with pain. It will help you to understand how the pain system works, the notion of pain as an output, and how this fits with neurological diagnoses/conditions. The relationship of pain to other homeostatic and response systems such as the immune and endocrine systems, cognitions and language will be introduced.

We know from research that neurological populations (such as Stroke, Spinal Cord Injury, Parkinson’s Disease and Multiple Sclerosis) experience higher incidences of chronic pain than that of the neurologically intact population. The addition of pain compounds the already disabling effects of the neurological condition, 
causing greater functional difficulties in task performance. Despite this, clinical guidelines remain consistently vague with regards to recommendations as to how to address this significant problem, and it is too often neglected in patient care.

This course will cover assessment and management strategies for this population, utilising strategies such as graded motor imagery, sensory retraining, neuroscience education and neurodynamics. You will learn how to utilise these strategies to influence pain and other outputs as appropriate, develop ideas of progression, and, importantly, learn how these fit within the rehabilitation model utilised in neurological rehabilitation, in both the acute and long-term setting.

Course aims
1. To introduce the concept of pain as one of many output systems that may be perturbed in neurological patients.
2. To expand the clinical framework of neurological rehabilitation to incorporate pain rehabilitation, via the paradigms of neuromatrix and pain mechanisms.
3. To reconceptualise pain in terms of modern neuroscience and philosophy.
4. To introduce an array of established and novel treatment strategies targeting the neurological patient with pain, based on clinical reasoning and evidence from clinical trials and neurobiology.
5. To introduce the role of education in effective pain treatment, based on current research.

Course Programme – Day 1
• Pain in the Neurological Population: incidence, classification and impact
• Biopsychosocialism and use of paradigms
• The output and homeostatic pain mechanisms
• Nociceptive, Neuropathic and Neuroplastic Pain: What does it all mean?
• Making sense of Peripheral and Central Sensitization

Course Programme – Day 2
• Graded Motor Imagery: “Sliding under the radar”
• Therapeutic Neuroscience Education: “Taking the threat out of pain”
• Facilitating Representational Change 1: Utilisation of Sensory Retraining in treating pain 
• Facilitating Representational Change 2: Incorporating Neurodynamics into Sensory Retraining to influence outputs

All I can say is that I want to be at the next one of these that is run, and I hope someone else reading this might want to go too.  

Review of Conference with Moseley and Hodges on Pain and Motor Control

A great post by Todd Hargrove on a talk by Lorimer Moseley he recently went to in Portland.
http://www.bettermovement.org/2012/review-of-conference-with-moseley-and-hodges-on-pain-and-motor-control/

A short excerpt...
Before the brain creates pain on the basis of nociception, it will essentially ask a key question: how dangerous is this really? To answer that question, it will consider many different kinds of inputs, which can be divided into four basic categories:

1. proprioception (information from joints, muscles, tendons and skin about the positions and movements of the body parts)

2. interoception (information from nociceptors about the thermal, mechanical and chemical condition of the tissues)

3. exteroception (the five senses)

4. cognition (knowledge, memory, feelings, perceptions, belief, logic, attention, expectation, etc.)

If the brain processes the different inputs and concludes that some form of protective action is necessary, it can choose between several different kinds of protective outputs, such as pain, immune responses (e.g inflammation) or protective movements such as flinching, limping, muscle guarding, stiffness and other motor control changes. (Now which kind of protective output would you rather have, movement or pain?)

One important point to consider is that any output will almost immediately become a new input into the system. For example, a protective movement will modify the proprioceptive and exteroceptive inputs to the brain. Pain will create new thoughts, feelings and knowledge about dangers to the body. Inflammation will sensitize nociceptors. And so new outputs are created which then immediately become inputs again.

The point is that this is an incredibly complex and dynamic system that loops back on itself every second in an unpredictable and inherently personal and individualized manner.

Our Words Can Really HURT

Following from the last post...
Lately I have really been thinking hard about what David Butler, PT has been speaking of for a long while now.  The idea of therapists' crucial role as linguists - how we speak to our patients and how we speak to each other.  Our words are essential tools in educating and providing therapeutic value.  Thoughts are nerve impulses that affect the neurochemistry  within our nervous system.  The words we use affect how our patient's think/believe/feel about their pain states. 

http://forwardthinkingpt.com/2012/10/18/our-words-can-really-hurt/

The Problem with MRI's

An excellent post from the Better Movement (Todd Hargrove) blog.

http://www.bettermovement.org/2012/the-trouble-with-mris-and-my-brother/

Though undoubtedly an important diagnostic/imaging technique that can be useful...

"many studies have shown that almost no matter where you point an MRI on a body, you can find something wrong there, even parts that are completely free of pain."

"many doctors assign too much importance to abnormal findings on an MRI. There are several recent articles discussing this."

"the problem is that ”finding out what is in going on the tissues” can really scare people about the condition of their body, which can make pain and disability worse. "

Very important for patients and therapists to think about, huh.

"MRIs are obviously useful and sometimes completely necessary tools that can be used to accomplish a great many good things. But like any tool, they can be abused, and it seems that there is currently an epidemic of MRI abuse."

The Amazing World of Psychiatry: A Psychiatry Blog

Well,  just when you think you have too much interesting material to read, along comes another great blog...

http://theamazingworldofpsychiatry.wordpress.com/

A recent post ("Building a Model of the Insular Cortex") gets into the features and facets of our insular cortex, the part of the brain that is involved in integrating sensory information as well as appearing to play a significant role in emotions.

http://theamazingworldofpsychiatry.wordpress.com/2012/10/15/building-a-model-of-the-insular-cortex-part-2/

Manual Therapy in a Neuroplastic World

An excellent summary of David Butler's concepts ("Manual Therapy in a Neuroplastic World"), written by Erson Religioso III, on his blog...

http://www.themanualtherapist.com/2012/10/manual-therapy-in-neuroplastic-world.html

Very much worth reading through.

Explaining the idea of a manual therapist being a:
1) biopsychosocialist
2) brain reinhibitor and sculptor
3) immunotherapist
4) linguist

As always, read on...

Pain Self-management Brochure from Pain BC

Pain self-management brochure from Pain BC - informative for people in pain and an excellent resource to which we should refer our patients in pain.

http://www.painbc.ca/sites/default/files/pdf_files/Pain%20BC%20brochure%2012-09-13.pdf

AsapSCIENCE Videos...Short, fun, interesting doses of (neuro)Science

AsapSCIENCE  produces short videos that help explain science in a fun and interesting way.

http://www.youtube.com/user/AsapSCIENCE

Here are a couple examples:

THE SCIENCE OF PROCRASTINATION AND HOW TO MANAGE IT

(very useful!)

THE SCIENTIFIC POWER OF MUSIC

The Central and Peripheral Nervous Systems of a Human Being

12 TED Talks on Understanding the Brain

Yikes.  There's some seriously good content in here...
Ramachandran, Merzenich, Blakemore, Sachs... and well, eight others(!)
Enjoy.

http://blog.ted.com/2012/09/24/12-talks-on-understanding-the-brain/

Memories of Music are Different

A really interesting article:

Scientists Confirm that Memories of Music Are Stored in Different Part of Brain than Other Memories

http://www.medicaldaily.com/articles/11670/20120822/scientists-confirm-memories-music-stored-different-part-brain.htm

Researchers in Berlin studied a man who has lost all of his memories but has retained his ability to remember and learn songs.

If this topic interests you, check out Oliver Sachs "Musicophilia" for many more stories about the unique relationship of music with our brains.

DizzyFix App: Guided help for treating people with BPPV

Here's an interesting app: "You place your phone on the patient’s forehead. DizzyFix’s diagrams walk you through the steps needed for the Dix-Hallpike and Epley’s maneuvers, including a real-time display of exactly what path and angle to move the patient’s head through, and a timer to introduce appropriate pauses.

Here is an article on this:

http://thischangedmypractice.com/2012/09/24/dizzyfix-app/

And the app itself:

http://itunes.apple.com/ca/app/dizzyfix/id368171014?mt=8

Lorimer Moseley - 4 part interview on Pain (2010)

Lorimer Moseley's interview on ABC from 2 years ago, on Pain, part 1 through 4. Range from 7.5 to 9.5 minutes each.  Invest the 30-35 minutes in these, and listen, listen, and re-listen...EXCELLENT INTERVIEW!  Understanding this content is crucial, and learning how to teach and integrate this material is crucial too.

Part 1:

Part 2:

Part 3:

Part 4:

TED Ed - How do Pain Relievers Work?

Another in the series of TED-Ed videos. 

The Science of “Chunking,” Working Memory, and How Pattern Recognition Fuels Creativity

Recently discovered www.brainpickings.org, which is a treasure chest of interesting posts.  Seriously, if you can't find several postings that interest you, you may not actually have a pulse and/or brain.

This recent posting is particularly interesting.
http://www.brainpickings.org/index.php/2012/09/04/the-ravenous-brain-daniel-bor/

"The main purpose of consciousness is to search for and discover structured chunks of information within working memory, so that they can then be used efficiently and automatically, with minimal further input from consciousness."

"Perhaps what most distinguishes us humans from the rest of the animal kingdom is our ravenous desire to find structure in the information we pick up in the world. We cannot help actively searching for patterns — any hook in the data that will aid our performance and understanding. We constantly look for regularities in every facet of our lives, and there are few limits to what we can learn and improve on as we make these discoveries."

Read on.  Very interesting.

Deep versus shallow models of Treatment

Continuing on with this thread, as it really does feel like we have been a little lacking in the social and psycho parts of our biopsychosocial models for pain.  Or is it a socialpsychobio model?  

Thanks again to Diane Jacobs, for the great post.

http://humanantigravitysuit.blogspot.ca/2012/09/deep-versus-shallow-models-of-treatment.html

Deep versus shallow models of Manual therapy

http://humanantigravitysuit.blogspot.ca/2012/09/deep-versus-shallow-models-of-manual.html

I suspect that this posting will resonate most directly with PT's, but it is also important for any therapist that works with their hands.  It is written by Diane Jacobs, a PT who has been very active in promoting an interactor model of manual therapy.  

From Diane F Jacobs, PT and Jason L Silvernail, DPT, DSc, FAAOMPT; Therapist as operator or interactor? Moving beyond the technique. J Man Manip Ther. 2011 May; 19(2): 120–121.
"the context of the treatment including the technique, the provider, the participant, the environment, and the interaction between these factors may contribute to patient outcomes.’ It is precisely this interaction between various factors that we need to consider, and not simply the performance of one or more techniques as an ‘operator.’ We believe this interactive model to also be scientifically congruent with the emerging explanatory model of the multifactorial, biopsychosocial pain experience, the neuromatrix."

Enjoy the post and I invite you to explore deeper into these ideas, her blog (http://humanantigravitysuit.blogspot.ca/), as well as SomaSimple (http://www.somasimple.com/), a great place to learn more about these concepts.

Soulless Bodies and Bodiless Souls

This is a tremendously important and interesting  post from Todd Hargrove at BetterMovement.org

http://www.bettermovement.org/2012/souless-bodies-bodiless-souls/

Hargrove speaks of reviewing many different approaches to manual therapy. "Some ideas are good, some are not so good. And some are rather obviously wrong, but somehow extremely resistant to correction in the face of huge amounts of conflicting evidence. And they seems to pop up everywhere, in different therapies that have different origins, like a weed that always needs to be pulled. Of this latter group of ideas, two different patterns of thinking really stand out in my mind."

1) Structuralism:

the tendency to treat the body as a mindless piece of meat, while ignoring the role of the brain in giving it all the qualities we actually care about, like how it moves and feels. Much education for PTs remains mired in structuralism, and fails to incorporate new and interesting information from neuroscience and pain science.

2) Vitalism:

the idea that there is some essential force or energy (chi, prana, elan vital, the breath of life) that is unique to life, that can be manipulated by a therapist to optimize a client’s health. Much education at massage schools, alternative medicine schools include a healthy dose of vitalism, and has little grounding in basic physics and neuroscience.

Excellent food for thought as we try to move forward in our disciplines and to create a schema that works and makes sense for our patients and makes sense relative to basic science.

Read the whole posting, as he really does explain some of the reasons why we tend to think in these dualistic ways.

NEUROMATRIX Model of Pain

Written for PT's by an American PT, this post summarizes the importance of understanding the Neuromatrix Model of Pain and integrating it into our practice.  It is equally important for everyone on the interdisciplinary team to understand it as well.

http://forwardthinkingpt.com/2012/08/28/attention-pts-look-at-this-image-its-important-real-important/

Neuroplasticity & the Feldenkrais Method

An excellent 10 minute interview with Michael Merzenich, a well known neuroscientist at the University of California. So many great thoughts, ideas, and ways to think about movement and neural processes.

http://www.bettermovement.org/2012/merzenich-interview-on-neuroplasticity-and-the-feldenkrais-method/

I love this quote:
"It is better to try to move to a point in space in 100 different speeds in 100 different ways … than to move 200 times in the same way to get to that point in space.

…
We are trying increasingly to build this into all of our cognitive training exercises that we do. Because we know that that’s really what the brain wants – to be able to set up the conditions by which it can solve the task in almost any circumstance."

Engaging the idea of sharpening our movement mind. Choosing movements that are novel, interesting, curious, exploratory and functionally relevant.  We should pay attention while doing them.  In other words, don’t just go through the movements, make sure they have some meaning, or the brain will properly ignore them.

Sounds like fun, huh!

Making Sense of Touch - The role of C-tactile fibers in gentle touch and emotion

Recently had this post forwarded to me by a colleague.  This article really illustrates how diverse our sensory system is, and how diverse it's connections are into our brains.
C-tactile fibers appear to only respond to gentle touch, and have a greater emotional connectivity.  This is being explored with regards to our social bonding behaviours, in our development/infancy right up to adult life.

http://the-scientist.com/2012/09/01/pleasant-to-the-touch/

General Guide to the Contributing Mechanisms of a Pain State

This post is really just to introduce a general guide that we can use to interpret how a patient describes their pain. One might go through the different sections (in different colours on this slide) and place a tick next to the relevant mechanism.

http://bodyinmind.org/flowchart-contributing-mechanisms-pai/

It’s Time to Quit fooling ourselves…It’s time to Move Forward in the Treatment of Pain

This is an excellent post from Joe Brence, a DPT from Pittsburgh, PA (USA). He is a treating physical therapist who also performs literature reviews for www.forwardthinkingpt.com , www.theptproject.com, and sportex.net and clinical research investigating the neurophysiological effects of manual therapy techniques. He is highly interested in the incorporation of pain science (using a biopsychosocial model) into clinical practice and believes its understanding is vital for us to define ourselves as evidence-based clinicians. 

http://bodyinmind.org/captemove-forward-in-the-treatment-of-pain/

Pain Science Division of the Canadian Physiotherapy Association

A long time coming, seeing this link on the Australian "Body in Mind" (www.bodyinmind.org) website made it clear that this knowledge should be posted on this blog too. This is written by Neil Pearson, a very well known and respected Physiotherapist and Yoga practitioner who works in Penticton, BC.

Here's the link and the content....

http://bodyinmind.org/canadian-physiotherapy-pain-science-division/

The Pain Science Division (PSD) of the Canadian Physiotherapy Association (CPA) was founded in 2008, through the dedicated work of a small group of Canadian PTs. Diane Jacobs brought Dave Walton, Nick Matheson, Sebastian Asselbergs, Eric Matheson and me together, initially forming the Canadian Physiotherapy Pain Science Group (CPPSG). In 2005 we approached the CPA, requesting to become one of its divisions. There was considerable resistance and before we had a chance to submit a formal proposal, the CPA declared a temporary moratorium on accepting new divisions. We had met with little acknowledgement that pain science was important or missing in PT. The influential people at that time probably hoped we would go away, or as one of them suggested, “…figure out that when a person in pain wasn’t getting better, we just needed to do a better mechanical assessment”.

We decided to become influential outside of CPA, continuing as the CPPSG. Between 2005 and 2008, our group started an online newsletter, reviewing new pain science research, discussing and explaining the role of physiotherapy in pain management, and gently challenging PT paradigms. These newsletters became popular, and we gained some influence and understanding from a larger group of Canadian PTs.

In 2007, our group decided it was time to convince CPA that we should be a recognized division. By then, the work of Lorimer Moseley and David Butler had started to infiltrate more of Canadian PT practice, and there had been a shift in the influential people in CPA. We had changed too, realizing that we needed to present a slick professional proposal, with statistics in order to be accepted. Thanks to the work of Diane Jacobs, Debbie Patterson, Lesley Norris, Dave Walton, Mike Sangster and I, our proposal was not only accepted but considered by the CPA CEO as the gold standard for future division proposals.

Our work since 2008…
A newsletter, between 4-6 times per year.
A successful online basic pain science and pain management course, called the Virtual Pain Symposium.
2-3 educational teleconferences each year for CPA members.
An open access online directory of Canadian PTs interested in pain science and pain management.
Developing an online repository of assessment tools for PT pain management and research.
Our membership is just less than 10% of Canadian PTs.
Creating working relationships with the Canadian Pain Society (CPS).
Elected a new Chair – Dave Walton, PT, PhD, and Newsletter editor – Susan Tupper, PT, PhD.

At this time, the PSD has a number of goals – increase our membership, increase PT post-grad pain science and pain management education and resources, and enhance our position within external groups such as the CPS. To succeed at the latter we need to continue collaboration with key members of the CPS, continue presenting research and education symposia at the annual CPS conference, and continue convincing the Canadian PTs and CPA that pain is an important PT health care issue. The 2012 Canadian Pain Summit, and call for a National Pain Strategy is ideally suited to help us position Canadian PTs as leaders in pain management in the eyes of the public and government. The CPA and PSD are working hard in this regard. More info on the Summit and www.canadianpainsummit2012.ca.

After stepping down as PSD, I stepped up my work with other pain groups. I am now a board member of Pain BC – a non-profit aimed at improving pain care in our province. I accepted a position on the executive committee of the Canadian Pain Summit as the only non-MD health professional. I contribute to the Canadian Pain Coalition's newsletter (our key patient advocacy group) writing their “Ask a PT” column. And I continue working with the Arthritis Association and our local hospitals providing public pain education sessions across the country. Thanks to much of this work, the Canadian Pain Society is awarding me their Excellence in Interprofessional Pain Education Award in 2012. 

PAIN BC Webinar: Myths and Facts About Sleep and Chronic Pain

Pain BC and CIRPD in collaboration with the Canadian Pain Coalition are pleased to announce the second session in our new webinar series, "Myths and Facts about Sleep and Chronic Pain". The webinar will feature Dr. Jonathan Fleming, MD, a consultant in the Sleep Disorders Program at the UBC Hospital and Associate Head for Education in the Department of Psychiatry at UBC.

The series, "Chronic Pain, Improving Life While Living It" is an opportunity for people living with pain and their families to hear from top researchers and practitioners on ways to live well with chronic pain. In this webinar, Dr. Fleming will review the findings from a variety of studies addressing the intricate, reciprocal relationship between pain and disturbed sleep, discussing the known mechanisms whereby pain disrupts sleep and disturbed sleep exacerbates pain. He will also describe the control of normal sleep and describe evidence-based strategies for maintaining a normal sleep-wake rhythm.

DATE: Tuesday, August 14, 2010

TIME: 11:00 am - noon (PDT)

Register Now:
https://www3.gotomeeting.com/register/818802774

2012 Pain BC Conference - "The Evolution of Pain Management" - October 20/2012, Vancouver, BC

Please save the date and register for this conference now!
Inter-disciplinary evidence-based education from the frontline, for the frontline.

The pain management landscape has changed dramatically in recent years and continues to evolve at a rapid pace. A paradigm shift is underway as the difference, and the link, between acute and chronic pain become more clearly understood. There is a growing recognition of the scope and severity of persistent pain, as well as the critical role self-management plays in a patient’s outcomes and return to function. New information is constantly emerging, with significant opportunities to improve practice on the front lines.

On October 20th, 2012, the province’s leading clinical experts and scholars in pain management will assemble for a landmark event to share the latest developments and cutting-edge research. Sessions will focus on practical learning for health care practitioners from all disciplines. Breakout sessions will include best practice approaches, emerging research and interactive discussion on how participants may apply the learning in the context of their practice. These sessions are ideally suited to those practitioners who wish to acquire the latest knowledge and tools to most effectively understand and manage their patients’ pain.

Topics will include:

· The Role of Hope for People Living with Persistent Pain

· Practical Pain Assessment and Management for the Bedside Practitioner

· Supporting Pain Self Management In Acute Care Settings

· Addictions: Pain Management for the Opiate Experienced Patient

· Avoiding Medication Mayhem: Pharmacological Approaches for Chronic Pain

· Pain Management In Older Adults

· Getting Your Patient Back To Work

· Prevention of Post-Surgical Chronic Pain

· Getting Your Child Back To School /Work

· Pain Management in Palliative Care

· And more…

A panel of patient experts will share their stories over lunch.

Space is limited – last year’s event sold out. Register early! http://painbc2012conference.eventbrite.ca/

Cutaneous Fields of Peripheral Nerves

A great link to remind us all of the cutaneous fields of our various peripheral nerves.


http://www.neuroguide.com/nerveindex.html

NEUROPATHIC PAIN Conference - October 2012

This looks like an excellent conference. Held in Moose Jaw, SK on October 12 - 13, 2012. Brought to you by: 

Continuing Physical Therapy Education, School of Physical Therapy and,

Continuing Professional Learning, College of Medicine, University of Saskatchewan

CONFERENCE DESCRIPTION: The goals of Interprofessional Management of Neuropathic Pain are to support the development of interprofessional teams that provide evidence-based management of neuropathic pain and use technologies to support both team buiding and patient care. The program will include case-based plenary and breakout sessions.

TARGET AUDIENCE: The target audience includes family physicians, specialists, physical and occupational therapists and assstants, pharmacists, nurses and nurse practitoners, social workers, message therapists, and psychologists. Other health professionals are welcome to attend.

http://www.usask.ca/cme/conferences/major/neuro.pdf

The Power of Thought – Neuroplasticity and Rehabilitative Medicine

The human brain is amazing. This is the fundamental premise of Norman Doidge’s book, The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science. This book is the first and only of its kind to date – an overview of all the prevailing research in the science of neuroplasticity. However, the pertinent question in rehabilitative medicine is, How amazing is the human brain? Amazing enough to heal my patients?

Our brains have the capacity to change perpetually, plastically, throughout life, after injury, and in response to the whole gamut of emotions. Doidge says, “The brain is far more adaptable, all-purpose, opportunistic” than has been previously understood. Following are some ideas about neuroplasticity from Doidge’s work as well as from the research of other neuroplasticians.

http://thehealthprofessional.ca/the-power-of-thought/

FREE Online Neuroscience/Neurology courses

An excellent opportunity to improve your neurology/neuroscience knowledge, with FREE online courses run through Duke University and the University of Pennsylvania.


Medical Neuroscience Course starts March 25, 2013 and is 8 weeks long.
https://www.coursera.org/course/medicalneuro


Basic Behavioral Neurology Course start date TBA, 4-5 weeks long.
https://www.coursera.org/course/neurobehavior

Neuroscience Core Concepts - Essential Principles of Neuroscience

This link from BrainFacts.org is a summary of the fundamental principles that we should know about the brain and nervous system.  Points and links to support the following:

1.  The brain is the body's most complex organ.

2.  Neurons communicate using both chemical and electrical signals.

3.  Genetically determined circuits are the foundation of the nervous system.

4.  Life experiences change the nervous system.

5.  Intelligence arises as the brain reasons, plans, and solves problems.

6.  The brain makes it possible to communicate knowledge through language.

7.  The human brain endows us with a natural curiosity to understand how the world works.

8.  Fundamental discoveries promote healthy living and treatment of disease.

Enjoy!

http://www.brainfacts.org/about-neuroscience/core-concepts/

The NeuRA Blog - official blog of Neuroscience Research Australia

It seems a little silly to blog about a blog, but here goes....
This one has just started up this past week, and is already posting some very interesting information.


the NeuRA Blog:
The official blog of Neuroscience Research Australia.

http://blog.neura.edu.au/

Their homesite is also worth looking at:

http://www.neura.edu.au/

Chronic Pain and Acquired Brain Injury Workshop - Sept 14, 2012

This looks like a very informative and interesting day. Put on by the Fraser Valley Brain Injury Association.

Friday September 14, 2012
Garden Park Tower
#101-2825 Clearbrook Rd
Abbotsford, BC
8:30 am to 5:00 pm


Featuring:


“The Intersection of Chronic Pain and Brain Injury”
Dr. David Fordyce, Neuropsychologist
Rehabilitation Institute of Washington


“MTBI, Chronic Pain, and Depression: Symptom Overlap and Distinctions”
Dr. Barbara J. Schrock, Ph.D., ABPP
Board-Certified in Clinical Neuropsychology
Lead Neuropsychologist, Sharp Rehabilitation Center


"Psychopharmacology of Neuropsychiatric Sequelae of Traumatic Brain Injury”
Robert M. Stowe, MD, FRCPC
UCNS Diplomate in Behavioral Neurology and Neuropsychiatry
Clinical Associate Professor of Psychiatry and Medicine (Neurology)
University of British Columbia


“The current continuum of services for ABI clients with complex care needs including 
chronic pain requiring tertiary care in FH - The final phase of Riverview Redevelopment”
Rick Gremm, BSW
MSc. Resource and Systems Leader
Fraser Health, Mental Health and Substance Use

Continental Breakfast, lunch and refreshments included.
$100.00 for full-day workshop
Sponsor opportunities and Exhibitor booths available
Contact Fraser Valley Brain Injury Association at 604-557-1913
or email info@fvbia.org for details

Healing Hands: Mirages and Illusions

The MIRAGE multisensory illusions box can create a powerful illusion that the hand or fingers are being stretched or shrunk. This is done by pulling or pushing on the fingers or hand while a live video image of the hand is stretched or shrunk at the same time. A chance discovery appeared to show that these illusions can reduce the experience of pain in osteoarthritis patients.


Read about some of the early research into this:
http://bodyinmind.org/mirage-and-osteoarthritis-pain/


The original BBC news article and video (from a year ago) are here:
http://www.bbc.co.uk/news/health-13068924

The Kinaesthetic Senses (Journal Of Physiology)

An excellent review of kinaesthesia - the senses of limb position and limb movement.
The term ‘kinaesthesia' was coined by Bastian (1888) and refers to the ability to sense the position and movement of our limbs and trunk.

http://jp.physoc.org/content/587/17/4139.full

7 Things You Should Know About Pain Science

Along with using "Explain Pain" (Butler, Moseley) and "Understanding Pain, Live Well Again (Pearson), this web based resource is invaluable in helping teach clinicians and people with pain about the pain experience.


http://www.bettermovement.org/2010/seven-things-you-should-know-about-pain-science/


The whole site (www.bettermovement.org) is great, but particularly the information about pain.

NEUROPHYSIOLOGY Basics

I am a sucker for sites like this.  Provides basic, accurate neurophysiology information, and good diagrams/drawings. Kind of like a straightforward online textbook.


http://www.neurophysiology.ws/index.htm

Pain and the Body Schema

Recently re-read this article and am still impressed by its content.
A very influential article in the development of Graded Motor Imagery programs.


"Pain and the body schema: Evidence for peripheral effects on mental representations of movement"
http://brain.oxfordjournals.org/content/124/10/2098.full.pdf

BrainMind.com

http://brainmind.com/


So I was recently introduced to this website via a colleague who suggested I watch a Youtube video re: the parietal cortex processing of somatosensory input, as well as how it mixes it up with visual and other input.  It's kind of like your own brain watching you work with your own hands...


Here's the link for that video:
http://www.youtube.com/watch?v=X7hq47Rf2eY
It is REALLY interesting!

That video is part of a six-part series available on 3 DVD's through BrainMind.com
http://brainmind.com/Books.html (scroll down page).  The series goes through 1) Brain Overview, 2) Left Hemisphere, 3) Frontal Lobes, 4) Parietal Lobes, 5) Temporal Lobes, 6) Limbic System.


You can also watch the rest of the six part series on Youtube.  They are easily found from the first link above.


The site really is a deep resource.  If you love reading and learning about neuroscience, consciousness, evolution, brain injury, stroke, then you will really get into it.

iPain 101 - a great iPhone/iPad App - An Easy to Understand Patient Education Application About Pain Management

iPain 101 has just recently been brought to my attention.  Spent the $1.99 to download and it really is worth it.


What is it?
An Easy to Understand Patient Education Application About Pain Management


What is pain and why do people feel it?


Where exactly does it come from?


What is the precise physiology behind pain?


And, most importantly, how can pain be eliminated or at least reduced?


This app helps summarize the multitude of “pain” studies in ten simplified lessons and five true patient case studies.

http://itunes.apple.com/ca/app/ipain101/id414135724?mt=8

How Brain Training Can Make Us Smarter

Neuroscience is showing us that the brain needs exercise in much the same way our muscles do, and the right mental workouts can significantly improve our basic cognitive functions. Thinking is essentially a process of making neural connections in the brain.

To a certain extent, our ability to excel in making the neural connections that drive intelligence is inherited. However, because these connections are made through effort and practice, scientists believe that intelligence can expand and fluctuate according to mental effort.

This article describes this in more depth:
http://www.howlifeworks.com/Article.aspx?Cat_URL=health_beauty&AG_URL=brain_training&AG_ID=291&cid=7190br&aid=1049985

The article features information about "Lumosity" - a brain training program designed (by experts in neuroscience and cognitive psychology from Stanford University) to actually help people improve and regain their mental sharpness.

Lumosity is an online place to exercise your mental skills. They have integrated these exercises into a Web-based program that allows you to systematically improve your memory and attention skills. The program keeps track of your progress and provides detailed feedback on your performance and improvement. Most importantly, it constantly modifies and enhances the games you play to build on the strengths you are developing--much like an effective exercise routine requires you to increase resistance and vary your muscle use.

http://www.lumosity.com/app/v4/personalization

Focused symposium: Teaching people about pain

This symposium brought several world leaders in pain education together.

Taking this symposium will enable you to gain a basic understanding of what is currently known about the biology of pain and to be familiar with principles of conceptual change theory and evidence based strategies to teach people about pain. 

It takes about 1.5 hours to get through, but is worth the time investment!

http://www.wcpt.org/node/46728

Neuro Images - Take a Break and Appreciate the Beauty of the Nervous System

Just a couple examples of the fine pictures/photos at the Neuro Images Tumblr Blog.  There are also historical pictures and very interesting art.

http://neuroimages.tumblr.com/

Quadruple fluorescence image of the mouse retina, showing optic nerve axons and glia stained red and green, respectively, actin in endothelial cells of the blood vessel walls stained blue and nucleic acids stained orange.

Scanning electron micrograph of the human cerebral cortex.