3/19/2010

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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

3/19/2010

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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”

3/19/2010

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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)