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No brain No pain
Common sense, pain and suffering
Dr Jens Foell MD MRCGPGeneral Practitioner
Specialist in Rehabilitation Medicine
Pain and suffering
Affective labour
• Pain as social experience
• Countertransference• Approach/avoidance
paradox (Yamada/Decety Unconscious affective processing and empathy: An investigation of subliminal
• priming on the detection of painful facial expressions PAIN 2009)
• Emotional contents in tissues and narrative
• Nonverbal interaction
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http://www.youtube.com/watch?v=n8y04Sr
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http://www.youtube.com/watch?v=n8y04SrkEZUhttp://www.youtube.com/watch?v=n8y04SrkEZU
Diagram by D.Mortimer in Tracey & Manthey , NEURON Vol 55:3 377-91
Folk explanation models
• “Trapped nerve”• “Pulled muscle”• “Wear and tear”• “Stress”
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The Jeremy Kyle Show
BioPsychoSocial Assessment
• Context-sensitive dialogue
• Barriers: Time, language, education, socioeconomic status
• Transfer into different care- and admin-environments
Wade/Halligan 2004
Biopsychosocial assessment
• Unravelling the complex ramifications of pain and perception is a time-consuming and skilled process
• Likely not to be done by one person in one go
• But how can it then be practised?
“The response to a response to a response”
• “A response with physiological, behavioural-motor and subjective-verbal components which may or may not have an underlying pathological basis in the sense of a structural change, but will always have physiological antecedents and consequences” (Flor 2003,
IASP press)
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Pain dialogues
• Explanation models
• Agency issues
• Intra/Interpersonal issues
• Relationship issues
• Spiritual issues
Pain dialogues
• Specificity model• Gate/Control
model• Stress/Diathesis
model• Neuromatrix
model
Common scenarios
• “Pain is a need state, like hunger and thirst, which are terminated in a consummatory act” (Wall 1997)
• Increase medication• Don’t challenge
expectations, move them on
• Request imaging• Physiotherapy• Complementary therapies
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Meaning response
• Reward system uses two integrated networks
• ‘affective’ ventral medial prefrontal cortex–paralimbic–limbic pathway
• ‘cognitive’ dorsal medial prefrontal cortex–cortical–hippocampal pathway.
• “die Wirklichkeit und Dasein des Menschen ist seinSchaedelknochen” (Georg
Friedrich Hegel, Die Phaenomenologie des Geistes)
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