Post on 01-Jan-2016
description
• present some extraordinary gifts of neuroscience to rehabilitation
• introduce therapeutic neuroscience education as a new evidence based management tool
Aims
The pain sciences The pain sciences revolutionrevolution
Neuroscience/pain sciences Neuroscience/pain sciences `trendy”`trendy”
– Open or closedOpen or closed
– Many different Many different kinds of sensorskinds of sensors
– Live for two days, Live for two days, like butterflieslike butterflies
– Reflect your Reflect your perceived needsperceived needs
From Bear et al 2001
Your molecular biology degree ……..
Rejoice in your neurones and Rejoice in your neurones and synapsessynapses
•100 billion neurones100 billion neurones• Up to 100,000 Up to 100,000 connections eachconnections each• More possible More possible
connections than connections than particles in the particles in the
universeuniverse• Baby makes 3 Baby makes 3
million synapses per million synapses per secondsecond
• 200,000 km of 200,000 km of cabling in the braincabling in the brain
From: Neuron 10 (1993) Front Cover
Gift 3 – The neuromatrix Gift 3 – The neuromatrix paradigmparadigm
• Melzack’s neuromatrixMelzack’s neuromatrix• representationrepresentation
• Maps in the brainMaps in the brain• The virtual bodyThe virtual body
• Schema – “body of knowledge”Schema – “body of knowledge”
“about 12 years old”
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Many bits of brain get turned Many bits of brain get turned on togetheron together
Courtesy Lozza
The brain activity which occurs when a person suffering chronic pain experiences pain during an attempt at an abdominal contraction
Butler DS, Moseley GL 2003 Explain Pain
A possible pain or movement neurosignature
Note:
•No one “hub”
•Common but will vary
•Turned on together
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Multiple brain areas ignite together creating Multiple brain areas ignite together creating neurosignaturesneurosignatures
2.2. The specific tissue injured The specific tissue injured may not matter for a pain may not matter for a pain
neurosignatureneurosignature
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Multiple brain areas ignite together creating Multiple brain areas ignite together creating pain representationspain representations
2.2. The specific tissue injured may not matter for a The specific tissue injured may not matter for a pain matrixpain matrix
3. Pain representations are 3. Pain representations are easily modifiedeasily modified
The neurosignature can be easily modified:
turned up
turned down
ignited by numerous stimuli including mirror neurones
Key elements of the Key elements of the neuromatrix paradigmneuromatrix paradigm
1.1. Multiple brain areas ignite together creating Multiple brain areas ignite together creating neurosignaturesneurosignatures
2.2. The specific tissue injured may not matter for a The specific tissue injured may not matter for a pain matrixpain matrix
3. Representations are easily modified3. Representations are easily modified
4. Representation smudging4. Representation smudging
Smudging/brain change are Smudging/brain change are normal – reflects the “need” of normal – reflects the “need” of
the individualthe individual
• Occurs as a normal Occurs as a normal part of life (musicians, part of life (musicians, blind persons, breast blind persons, breast
feeding mice)feeding mice)• ie the “self ie the “self
constructing” brainconstructing” braineg. Elbert T et al (1998) Neuroreport 9: 3571
Smudging and injury states
•Phantom limb stories
•The more chronic and painful a problem is – the more the brain neurosignature is smudged
•“Web fingers”
•On computers – hands grow big and shoulders fade
More neuromatrix/smudging More neuromatrix/smudging giftsgifts
Web four fingers, smudging noted Web four fingers, smudging noted after 30 mins, lasts 2 hours if webbed after 30 mins, lasts 2 hours if webbed
for 5 hoursfor 5 hours How about the toes?How about the toes?
Motor as well as sensoryMotor as well as sensory Immune based – makes sense to Immune based – makes sense to
spread pain or revert to gross spread pain or revert to gross movements when the brain thinks you movements when the brain thinks you
are in troubleare in trouble
Stavrinou et al 2006 Cerebral Cortex
The immune bufferring The immune bufferring behavioursbehaviours
Ability to develop coping skillsAbility to develop coping skills
Perception of stressorPerception of stressorSocial interactionsSocial interactions
Belief systemsBelief systemsExerciseExerciseHumourHumourIntimacyIntimacy
DietDiet Rabin BS 1999 Stress, Immune Function and Health, Wiley-Liss, New York
So what can we take from So what can we take from these giftsthese gifts
1. The obvious – the role of early 1. The obvious – the role of early movement and return to movement and return to
functionfunction
Structure Structure specific style specific style – “school for – “school for
bravery”bravery”
Does not work. Bombardier C et al 1997 Cochrane Collab
Review 22: 837
Psychology booklet basedPsychology booklet based
e.g. McClune T et al 2003 Emergency Medicine Journal 20: 514
Neuroscience/psychology Neuroscience/psychology blended styleblended style
Neuroscience styleNeuroscience style
Neuroscience style education is Neuroscience style education is effectiveeffective
Increase pain theshholds during physical tasks Increase pain theshholds during physical tasks Moseley GL et al 2004 An RCT of intensive neurophysiology education in Moseley GL et al 2004 An RCT of intensive neurophysiology education in
chronic low back pain Clin J Pain 20:324chronic low back pain Clin J Pain 20:324
Reduces unhelpful pain related beliefs and Reduces unhelpful pain related beliefs and attitudes, improves exercise outcomesattitudes, improves exercise outcomes
Moseley GL 2004 Evidence for a direct relationship between cognitive Moseley GL 2004 Evidence for a direct relationship between cognitive and physical change during an education intervention in people with and physical change during an education intervention in people with
chronic low back pain. Eur J Pain 8: 39chronic low back pain. Eur J Pain 8: 39
Helps in acute pain statesHelps in acute pain statesOliviera A et al 2006 A psycho educational video used in the Oliviera A et al 2006 A psycho educational video used in the
emergency department provides effective treatment for emergency department provides effective treatment for whiplash 2006 Spine 31: 1652 whiplash 2006 Spine 31: 1652
Pain states in once “mad” Pain states in once “mad” people now easily explainablepeople now easily explainable
Mirror pains – an immune responseMirror pains – an immune response
Non zonal spread of pain – smudgingNon zonal spread of pain – smudging
Delayed onset post injury – peripheral nerve Delayed onset post injury – peripheral nerve responsesresponses
Associated gut, libido, slow healing, Associated gut, libido, slow healing, memory loss – hypercortisolismmemory loss – hypercortisolism
Night pain – peripheral nerveNight pain – peripheral nerve
Reoccurrence post injury – normal brain Reoccurrence post injury – normal brain based survival responsebased survival response
Neuroscience/psychology Neuroscience/psychology blended styleblended style
Neuroscience styleNeuroscience style
The drug cabinet in The drug cabinet in the brainthe brain
David Butler
www.noigroup.com
Info @noigroup.com