Descripción del dolor y su relación con estrategias de supervivencia Pain description and its relation with survivor strategies Carlos Rodriguez López

1. HANDFUN
MEETING 2013
Carlos Rodríguez López

2. PAIN:BIOLOGICAL AND EVOLUTIVE
STRATEGIES

3. PAIN:BIOLOGICAL AND EVOLUTIVE
STRATEGIES
¢ Neurological pathology and its connection with
pain.
¢ We work on patient´s demand. Don´t we??
¢ We have to be sure about what the patient needs.
That goes in our therapeutic intervention
¢ The patient has something that´s hurting and he/
she expects you to fix it. END OF THE STORY.

4. PAIN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES

5. PAIN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES
¢ Our brain´s bright, we should trust him but,
when pain arrives everything changes.
¢ “ Main function: learning”
¢ But how can we teach him:
— Words
— Enviroment
— Our behaviour
…

6. PAIN: BIOLOGICAL AND EVOLUTIVE
STRUCTURES

7. PAIN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES
¢ How does pain work?
¢ Symptom exagerating behaviour. Who would like
to exagerate their symptoms?
¢ Pain depends only on what the brain thinks
¢ Story 1. Biologically corrupt perspective: “make
pain up”. L. Moseley
¢ Any credible evidence about your body will make
changes on our brain´s beliefs

8. PAIN:BIOLOGICAL AND EVOLUTIVE
STRATEGIES

9. PAIN:BIOLOGICAL AND EVOLUTIVE
STRATEGIES
¢ Pain is an output of the brain.
¢ We should listen carefully to our patients: what
are their beliefs about their pain? It´s all about
meaning!!
¢ Signature, neuromatrix..
¢ Nora Kern: disability neuromatrix

10. PAIN:BIOLOGICAL AND EVOLUTIVE
STRATEGIES

11. PAIN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES. CASE 2
¢ Pain is 100% real, but not a perception of how the
body is

12. PAIN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES.
¢ We can retrain the brain to regain precision: we
have to teach him something else! He´s good at it
but it depends on us to do it properly.
¢ When pain or disability appear in the brain,
changes take place.
¢ Pain is NOT a conscious version of nociception

13. INN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES

14. DISABILITY: BIOLOGICAL AND EVOLUTIVE
STRATEGIES
¢ INN perspective: Only with adaptable peripheral
nerve structures you have the ability to reach
out. Sometimes its mainly a mechanical thing
and not so much a central issue.

15. DISABILITY AND PAIN: BIOLOGICAL AND
EVOLUTIVE STRATEGIES
¢ If you have lost this ability in your structures for
some time, your brain is no longer thinking of
this strategy, that means no more reaching out-
ideas but asking for, moving closer towards,
ignoring etc.
¢ Think about pain. Can we contribute with our
intervention to a lack of brain thinking on
strategies to solve problems?

16. PAIN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES
¢ Old studies about allodynia
¢ Sweeney J, Harms A. Persistent mechanical
allodynia following injury of the hand: treatment
through mobilization of the nervous system. J
Hand Ther. 1996;9:328–38.

17. PAIN: BIOLOGICAL AND EVOLUTIVE
STRATEGIES. CASE 3

18. PAIN: BIOLOGICAL AND EVOLUTIONARY
STRATEGIES
• We need the knowledge so that we can put the
patient into the realness of truth:
“One day this
pain will make
sense to you”