3/19/2010

No brain No pain

Common sense, pain

and suffering

Dr Jens Foell MD MRCGP

General 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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 3/19/2010

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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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BioPsychoSocial
Assessment
• Context-sensitive
dialogue
• Barriers: Time, language,
education,
socioeconomic status
• Transfer into different
care- and admin-
environments

The Jeremy Kyle Show

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?

Wade/Halligan 2004

“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 sein
Schaedelknochen”
Friedrich Hegel, Die Phaenomenologie des Geistes)
(Georg