According to Dan Gilbert, the pre-frontal cortex (PFC) is an experience simulator developed this way only in humans. The PFC possesses an impact-bias, as a simulator that generates biases on personal outcomes, it is a predictor., and can do it without any input at all:
Ex. Would liver and onion flavored ice cream taste good?
Ex. Would you rather win 314 million dollars, or get a hot fork stuck in your eye?
According to Gilbert, getting something we want matters more than what it is, the Free Choice Paradigm. There is nothing good or bad, it is the permanence of a condition that is feared, so we become prudent, cautious and thoughtful. And, we have the ability to manufacture the thing that we are attempting to avoid.
LBP patients are notoriously blaming themselves for causing their own back pain. Patients, and their doctors are commonly searching for ‘the cause’, the ‘one event’, the ‘incident’ as the mechanism of injury. Pain = bad.
LBP clinicians are notoriously blaming advanced imaging ‘findings’ for causing low back pain. Clinicians are commonly searching for the ‘disc bulge’, the ‘disc height’, ‘the ‘pinched cord’, the ‘bony changes’ as described illustriously in imaging reports. Picture = bad; Picture = Pain.
Without much argument against the point, clinicians likely agree that ALL non-traumatic LBP is insidious, uncomplicated, likely due to personal behaviors, lifestyle habits, and a resistance of the patient to face the work to strengthen their relationship with physical activity and diet. The patient’s LBP becomes the calling card of self-realization that they are failing to control their own pain problem, and have likely caused it. Can the patient simply skate past accountability by blaming the pain as being the problem and not themselves? Not only patients are skating past accountability, clinicians are too.
I personally saw 3 different physicians over 5 years for my LBP. To date, I have not been diagnosed, never received a treatment plan (short or long term), never been examined in any way, never been asked about my lifestyle (sports, activities… how I use my body), nor asked any historical questions about occupation. The longest time I spent in the doctor’s office was on my first encounter with the first doctor, 3 minutes 14 seconds, and he took no chart notes. I have had X-Rays, re-X-Rays, MRIs for different areas, a CT scan, blood work for ankylosing spondylitis (even though my X-rays did not support it), 3 surgical referrals, and a prostate exam (DRE… who does those anymore?) I got the runaround-run around-runaround. If the doctor can’t find anything on the picture, they are at a loss. Picture = bad again. Explain the convenience of observing degenerative changes and associating them with a complaint of pain, but when there are no observed degenerative changes the pain can’t be explained, and when there are degenerative changes observed with no complaint of pain? Clinical convenience? What about a ‘third answer’ that makes the pictures go away, and where diagnostic accuracy is not about clinical convenience. What if we can re-frame diagnosis to be based on function and not fiction? (fiction: a belief or statement that is false, but that is often held to be true because it is expedient to do so, an allegation, an invention. Wikipedia, 2016)
“Somatosensing [and] microtransduction is the conversion of mechanical forces into biological signals, a process that reveals environmental features to an organism… dysregulation leads to peripheral neuropathies.” (Chatterjee, 2018) Muscle ‘listening’ and signaling can warn the body, just a nociception does.
“Transient signaling can be interpreted as chronic.” (Gupta, 2018) Signal inconsistency.
“The reductionist approach can never fully explain persistent pain.” (Jensen, 2018) Many contributors.
“Recent research has shown that innervation of the lumbar IVDs does not necessarily correspond with innervation of the spinal nerve segment…but are innervated by multiple different segments from the DGR … and the sympathetic trunk constitutes an indirect pathway for lumbar disc nerve conduction.” (Yang, et al., 2018) I keep stating this over and over.
“MRI imaging… techniques are not always helpful because they have a poor degree of correlation with clinical signs.” (Weksler et al., 2007) Imaging supports the diagnosis, but the reverse is rarely true.
The search to clinically define and explain pain might be a ‘painful’ search. Common clinical practice is to use imaging to explain pain, likely due to its efficiency. However, there are many contributors to pain that can’t be seen on imaging such as STMT, SCAD, FMP, frustration, worry, fear of pain, for example. ‘Pain is not the only problem.’ Can you think of any other areas in the brain that might ‘light up’ along with a ‘pain’ signal?
LBP Blog General information
These articles intend to (1) re-evaluate the prevailing clinical practices thought to manage low back ‘pain’, (2) submit and debate novel low back ‘pain’ contributors and mechanisms, (3) meet patient expectations & satisfaction and clinically meaningful results, (4) recommend a conservative non-surgical course of care to over-ride ‘pain’ instantly, and (5) restore ADLs and patient confidence on the first visit at low cost. This article has a companion podcast.
Dr. Dean Bio
Forester Dean is a chiropractic and physiotherapy sports medicine doctor practicing in Los Angeles, California. Dr. Dean is a lifetime athlete, and currently teaches tennis, track, boxing, yoga. The Core X System™ Campus flagship location was opened by Dr. Dean in 2020. www.preformancecxs.org
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