Pamela’s lotion

‘Motion is lotion’ and ‘pace it don’t race it’ are sayings or ‘rules of thumb’ for some people. They are also called heuristics. We use them through life, (‘a bird in the hand is worth two in the bush’ or ‘it’s all water under the bridge’) and they are inevitably used in rehabilitation.

In educational research (a place that rehabilitation does not often look), the use of heuristics has been studied in terms of their role in students acquiring deep learning. Deep learning is knowledge which is elaborated throughout the brain and which can be used for problem solving and continued learning. This is opposed to superficial learning which is just the ‘parrot learning’ that many of us used to pass exams. In education, heuristics are not much use in achieving deep learning.

An obvious (though often not stated) role of rehabilitation is to help a patient to achieve deep learning – a deep understanding of their problem, so that their ‘brains can weigh the world’ and consciously/subconsciously decide whether pain or any other output is necessary. It is in rehabilitation that the use of heuristics may help (a) if the heuristic is ‘powered up’ and (b) if unhelpful ones such as ‘no pain no gain’ and ‘let pain be your guide’ and the downright crazy ‘pain is just weakness leaving your body’ are removed.

Thus ‘motion is lotion’ can be powered up with narrative about oiling joints, making blood flow better, pumping swelling out, refreshing the brain. A colleague, Peter Edgelow talks about ‘draining the swamp’ to get people moving in chronic thoracic outlet syndromes, a nice heuristic powered up by stories of using breathing to flush, nerves freely gliding and sliding, and postural change to empty the swamp of fluid and its alligators in and around the brachial plexus.

An oldie but a goldie in chronic pain management has been ‘your hurts won’t harm you’. Its easy to say, but effective use of this will require a lot of understanding about the science of chronic pain and how the pain constructed by the brain is usually not an indication of tissue damage but more the combined activation of memory, stress, motor, perceptual and other circuits in the brain all powerfully influenced by context. This is the main conceptual change story that Lorimer and I have tried to get over in ‘Explain Pain’. I picked up ‘I’m sore but I am safe’ on the prairies in Canada some years ago and it has become a favourite heuristic. A person in chronic pain who can analyse an evoked pain state and understand that although it hurts there is no tissue damage has undergone some deep learning.

‘If you keep backing away you’ll hit the wall’ can be useful for a person who is so fear avoidant that every pain or thought of activity alter function. But again, a person will need to understand something about the biological meaning of pain production.

Sayings attributed to celebrities can help but as long as the user can think past the celebrity. Michael Jordan said “I can live with failure, but I can’t live without trying” and Confucius says “A journey starts with a single step.” 

And let us finish with Pamela Anderson. I didn’t know she has this long multiple heuristic in her, but one of my students found it.

A little bit of pain is good for you. I feel alive. Everybody needs struggle. Once you overcome an obstacle, you springboard into the future. Life is interesting and short and it’s not supposed to be easy, and if it is, you’re probably just in denial and you’re existing here like a zombie.

Your Turn
So what heuristics do you use and avoid in the clinic and in life? What is you favourite and how do you power them up to achieve deep learning?

A prize of ‘Explain Pain to the best.

NOI Notes from last month: MIRROR NEURONES
Armfulls of thanks to all of the contributors for some stimulating thoughts! Readers took on the idea of emotional mirroring and how as an agent of change you need to stay level headed and positive and not get caught in patient spirals.

Many commented on the need to be more careful when demonstrating activity and exercise, and the importance of visualizing exercise, and after all, “the golfers have been doing it forever”. The “value” and meaning of observed activity will also be important. One writer suggested that we should perform the movement that hurt/hurts the patient in front of them.

There was one dear soul from LA who thought the monkey image was a touch erotic, but we put that down to LA!

We were reminded of a person who had a vasectomy getting pain when watching cricket and seeing someone hit in the testicles and another thought that mirror neurones could be responsible for your neck pain at night if you treat painful necks all day. Maybe.

It really does give a basic science empowerment to virtual reality and we had an interesting and personal letter about breathing patterns, reminding us that our mirror neurone activity will be unconscious and that our breathing style when we are with patients will be mirrored. It may be potent way to spread stress!

A writer touched on ‘free will’ ,the notion that premotor brain areas area are active 2 seconds before a motor output, something also known in pain, where somatosensory areas are active well  before pain is experienced. Mirror neurone activation may close this 2 second gap which may or may not be a good thing.

And how about  the witch story – I  never knew that “witches believe that all life is controlled by the mind”

A few readers picked up the role of mirror neurones in group therapies – some classes run well and some don’t. It just helps us understand  the level of success in classes and perhaps the need to pick group members with at least some commonalities.

“my mother and grand mother had arthritis so I was doomed” another readers reflects on a patient’s comments. She also added “of course – it is how babies learn”. 

And finally there was the suggestion that we may be able to develop  a questionnaire to assess mirror neurone activity and therefore enhance therapies. We are pondering this one now.

Congratulations June Trenholm from Canada – your story about working in groups and the implications of mirror neurones has won you a one year access to Recognise Online.
 
There was zero salivating at any ice cream stories though – we were seriously hoping for some more passion there!

You can read interesting responses here.

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