Movement as antigen

If you are involved in rehabilitation, the title of this newsletter should make you draw breath, stop and think. It’s also the title of a plenary lecture at NOI2010 in Nottingham by Dr Mick Thacker. Mick is a researcher, clinician, educationalist, international rugby player and dragonfly collector who started his PhD under the great Patrick Wall and finished it under the great Steve McMahon. I think his talk will have far reaching consequences.

Neurocentric to neuroimmune
Antigens are usually thought of as substances that stimulate immune responses. What is Mick Thacker all about? I interviewed him last week in his favourite coffee shop in London’s Borough Market.

Mick believes and knows that the traditional neurocentric view of pain, learning and performance is outdated without inclusion of the immune system. Neuroplastic activity and the responses of the acquired immune system have great overlap. I ask, “If pain is learning and learning is synaptic, then is pain an immune response in the brain?” Mick responds, “well it is, let’s not forget the nervous system, but the patterns and sequences of firing in synapses in cord and brain synapses are very strongly influenced by the acquired immune system. This is a glial response, producing cytokines and other immune associated molecules, essentially a sterile inflammatory response. In Mick’s view, much chronic pain could be conceptualised as an ‘inflammation in the brain’. Mick scoffed a chocolate truffle and I thought “this is right on the edge.”

The system that knows who you are
A definition of the immune system that I picked up from a Thacker lecture some years ago is “a system that can identify self”, or “a system that knows who you are”, and will respond when the self is challenged. The definitions inspire deep contemplation. This is easy to follow with infection – the innate immune system will respond and usually be a saviour. But there is a deeper issue here. I ask Mick, “what happens when a person’s self is challenged, perhaps with a loss of meaning in life, searching for meaning, or with the mass of demanding and invasive thoughts so characteristic of people with chronic pain?”
“Same thing”, he says. “The immune system will respond, synaptic activity will be influenced by the immune system.”

Movement as antigen?
“So Mick, tell me more about movement as antigen – that’s a bit novel”, I said with yet  another truffle devoured and he went on… “well motor synapses are immunosensitive too and there has to be a way we can influence them. It’s about applying the right amount of antigen, in this case movement. Too much input can make athletes and patients sick as we know, but graded and contextually variable movement (graded antigens) would provide beneficial immune responses. Take kinesiophobia – the fear of movement, I suggest that this is a immunosensitivity to movement, even an immune response to the thought of movement. I admit to thinking “holy shit!” at this stage. I thought of writers such as Eckhart Tolle who always emphasized the place of destructive thought and the need to separates our “self” from thoughts.

“So where do the pain literacy strategies that we use to decrease threat so effectively fit in?” Mick scoffs his fourth chocolate truffle and continues. “Aha, while strategies like Explain Pain were based on neurones and synapses, education is actually a stimuli (antigenic), like appropriate movement to providing more appropriate immune responses.” I thought with better knowledge of the immune system we can improve these strategies, not only from improved pharmacology – but including public education about the immune system and reinforcing the place of known immune healthy behaviours such as laughter, multiple coping strategies, exercise in management.

Time was running out. I ask, “If we injure our back, we know that there will be rapid immune responses which contribute to the inflammation?” Mick nods. “And we know that these responses will also be in the brain, perhaps in the form of a neuroimmune distortion of the back representation in the brain. So how does my back tell the brain area that it is in trouble?” Mick thought, lovingly fondling the last truffle on the plate and said, “Dave – we will discuss that and a lot more at the conference.”

It will be such a pleasure to welcome Mick Thacker in Nottingham – a true intellectual and humanist in the world of rehabilitation. I believe his work will permeate many of the scientific talks and presentations at the conference, including the art, music and poetry which will be an essential part of the NOI2010 conference experience.

PS Mick Thacker has recently lost 10kg in weight.

Last month’s notes on Hashish pain
Thanks for your stories of placebo response from last month’s notes on the Hashish view on Jaw Pain. Congratulations to Adam from the United States who has been sent a copy of Explain Pain. He wrote…

I had a retired psychology professor as a patient. He was very interested in hypnosis, which when you think about it, may be the placebo effect at full throttle. He told me the story of a dentist that would hypnotize a patient, then perform a tooth extraction or something that would normally be painful and require novacaine.

He claims to have witnessed a procedure where the patient had no pain and was even able to control the amount of bleeding throughout the procedure. This may be embellished, it may not. Regardless, those people that can be hypnotized can feel no pain just like someone who gets worked up into some sort of frenzied, adrenalized, or spiritual state.

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