Deconstructing/debunking the idea of "trigger points" & myofascial pain

Wow. I hadn't read this posting in a while, but it is essential reading for anyone who attempts to assess and treat/influence pain states that are felt in different areas of our & our patients bodies. A better understanding of the biology of why certain places in our body hurt when they are pressed on is essential to the effective treatment of these pains. Great posting Diane Jacobs!

An exerpt:

"no tissue other than neural tissue (i.e., neurons, direct ectodermal derivatives) can directly signal the brain (also direct ectodermal derivative) to provoke it into mounting a pain output/perception for our conscious awareness to,.. um, be aware of, consider. In other words, quite apart from the "trigger point" issue, is there really any such thing as "myofascial pain"? I would argue that no, there isn't. Only neural tissue can send sensory-discriminative information to the brain, and only the brain can mount that sort of cognitive-evaluative-motivational-affective-sensory-discriminative display known as "pain". Other kinds of tissue in the body are usually innocent victims, not guilty culprits."

Here's the posting link:

http://humanantigravitysuit.blogspot.ca/2011/07/why-i-dont-buy-idea-that-trigger-points.html

Remember to read the links from within this article.  Also great learning/reading.

Upcoming Webinar "Chronic Pain: Is it all in the Brain?"

The Canadian Institute for the Relief of Pain and Disability (CIRPD) is presenting a series of Webinars over the next 3 months.
On April 16, 2013, 1:00pm PST there will be a webinar entitled "Chronic Pain: Is it all in the Brain?" led by Dr. Fernando Cervero

Overview:
What changes happen to the brain when a person transitions from acute to chronic pain? Dr. Cervero will discuss these changes and help us understand that effective therapies must deal with both the cause of the pain and the change in pain perception that happens too.

Dr. Fernando Cervero will join us to explain these changes in pain perception and identify the brain mechanisms that cause them.

This webinar will help you:
To understand that the transition from acute to chronic pain involves the generation of increased excitability of the brain centres involved in pain perception.
To identify which brain mechanisms generate pain hypersensitivity and how these mechanisms cause chronic pain.
To understand how effective therapies for chronic pain must deal not only with the causes of pain (injury, inflammation etc) but also with the enhanced sensitivity of the brain to pain perception.

To register, see this link.

http://www.cirpd.org/GetInvolved/Webinars/Pages/ChronicPainIsitAllintheBrain.aspx

Sounds like a good one.  Will probably try to gather a group of people together at GF Strong to view it together.

Botox and the Brain

No big surprise, but interesting to read this research, from Neuroscience Research Australia (NeuRA)
http://neura.edu.au/news-events/news/don-t-let-botox-go-your-head-or-should-we

Botox reduces spasticity locally, at the site of injection, but also altered brain activity in the cortex – the brain region responsible for movement, memory, learning and thinking.

Read the full posting, and also the abstract from the Muscle and Nerve journal.

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."