Discs don’t hurt!

Discs don’t hurt!
More and more people are catching onto the therapeutic neuroscience ‘movement’ in the last few years and it seems that the key conceptual changes required for effective change are becoming somewhat clearer. Perhaps the most powerful is that tissue injury does not equal pain, stated provocatively here as ‘discs don’t hurt’. Most, if not all readers probably know that, and many may integrate the information into clinical behaviours.

The genitals, love and discs
We all (clinicians, patients and the public) say it – “muscle pain, disc pain, joint pain” – all potent wording of a structure attached to a brain response. Yet, it is worth pausing a moment – discs never hurt… all that discs and the products they may release can do is send volleys of impulses into the central nervous system which, depending on whatever else the CNS is constructing, may be a part of a pain schema or neurosignature. You see, if you believe a disc can hurt then there should be a direct link from the disc to your mouth. Or along the same lines, you should believe that genital stimulation can create love.

Conceptual change points
Concepts are the basis of knowledge. Over the last year we at NOI have discussed and argued the key conceptual changes that are usually necessary to help a person in chronic pain or stress and they come down to a small number including:
(a) pain is an output of the nervous system not an input
(b) pain is one of many coping outputs of the nervous system
(c) new knowledge of plasticity gives us hope and novel strategy
(d) knowledge of pain and movement is an effective pain liberators
(e) the nervous system moves and slides as it conducts
But this ‘pain and tissue injury don’t relate’ filters through and is the most potent of all. These key conceptual changes are the basis of the NOI 2010 conference in Nottingham.

I note in the education based seminars at the NOI 2010 conference next month in Nottingham that workshops such as Adriaan Louw’s on Educating the pre-operative patient. Analysis of current methods and pracital applications and Lorimer Moseley’s workshop on making a habit of explaining pain are becoming more focused on a small number of powerful conceptual change points.

Practicalities
Obviously, it can be difficult to say to a person that there is no such thing as disc pain and we all regress to saying “disc pain”, “joint pain” etc. when the correct English should be, when appropriate, “disc contribution to a pain experience”. A bit of a mouthful really, all we hope for is that when the term “disc pain” is mentioned, that clinicians have the bigger picture. The articles referenced below are support to what we all know – that the changes seen on fancy imaging are more likely to be age related or in Gordon Waddell’s words “disc bulges are normal”. If the reader was one of my students and the patient said “my disc hurts”, they would accept that initially (or maybe ask where they got that idea from), but the big reasoning question is, “Well lots of people have what this person has on scanning, what is it that has turned this person into a patient?” Biomedicalism fails here.

PS – the LAFT
In Explain Pain, Lorimer and I tried to change the name of disc to ‘LAFT’ – ‘the living active force tranducer in an attempt to take away the ‘slip out’ image of a disc. I must admit failure – though occasionally a befuddled student will call and say, “no one understands anything about LAFTS”. I often nod.

Explicando el Dolor
The newest addition to NOI is Explain Pain in Spanish. Translated by Rafael Torres-Cueco from Spain, Explicando el Dolor looks, feels and behaves like Explain Pain with one difference…

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