Education for all is a NNT of 1
Education for All (EFA) is a UNESCO movement. If it really works then it means that the number needed to treat (NNT statistic) or number needed to educate (NNE) should be 1; i.e. everyone benefits. This is the goal of the Explain Pain movement. An aggregate analysis of Lorimer Moseley’s initial work on therapeutic neuroscience education suggests a NNT of around 3, i.e. 1 in 3 benefit. While this figure would make a pharmacological company salivate, we can and must do better. Good clinicians probably are these days. There are many avenues to seek improvement – one may be the introduction of the notion of emergence.
Traffic jams kind of “just happen”- they emerge, often surprisingly. A collection of cars interacts with each other in complex ways. When water molecules interact with each other, a cloud could emerge, when insects interrelate, a swarm or an ant’s nest could emerge and when many brain cells fire together, thoughts, movements, love and pain may emerge. The critical elements of emergent patterns are that the players or agents have reasonably equal status, the pattern is a result of all the agents working together and just a small action of one of the agents can have out of proportion effects – the “butterfly effect”. For example, the actions of just one car may set off a massive jam. Check out the emergent patterns of thousands of birds flying together.
Emergent patterns contrast with sequential/linear patterns such digestion, tissue healing, moon phases and children stories. You can read more about emergence and links to pain in the recent NOInotes and references below.
Emergence and therapeutic pain education
Explaining pain is not easy sometimes. Maybe those patients (and colleagues) who just can’t ‘get it’, or those who seem to know a lot about a lot of things, but can’t pull it all together (i.e. “can’t see the forest for the trees) don’t have emergent schemas?
How hard can it be at times to explain pain to a person in chronic pain who just wants to know what the singular anatomic cause for their pain experience, so that it can be manipulated or strengthened or mobilised or stabilised or just plain cut out?
Renee Descartes was probably pretty linear with his thinking. His linear and sequential idea that pain goes into the body and up to the brain where it’s given some emotion is old, dangerous and needs removal. Maybe the damaging persistence of these ideas in health professionals as well as those people experiencing pain could be related to a lack of a well-developed and frequently exercised emergent neurosignature?
When I mark assignments where the question requires some understanding of emergence (e.g. “Describe pain as a brain output rather than an input”) some students are all over the place with piecemeal answers, others can pull it together – maybe they have emergent schemas? With pain we well know now that there are many agents and contexts which collectively interact to result in the emergent outputs.
Ever think how sometimes you are educating about tissue healing (a linear sequential process) and then jump to a discussion on pain or cognitions (emergent) and see the patient’s eyes glaze over. This switch from linear to emergent schemas is probably hard for many and likely impossible for some when their emergent neurosignatures are under-developed or even completely absent.
Maybe we need to teach our patients (and ourselves) about emergence first? Maybe we need to try and work out if they have emergent schemas first and if they don’t, spend some time explaining emergence first?
We have recently developed an emergence module as part of the NOI Explain Pain course. Research is following but we suspect that teaching people in pain just a little about emergence and helping them to construct an emergent neurosignature could make a real and positive difference to their understanding of their pain experience and realisation of the different ways that they can start to take back control and change their experience.
How helpful might a quick explanation of emergence and the “butterfly effect” be for a person reporting that their entire body and life is falling apart as a result of chronic pain following a minor injury?
How much more powerful could an explanation of pain be for a person who is convinced that surgery and “cutting the painful bit out” is going to fix their problem, if it is accompanied by a discussion about the complex interaction of self and environment and the emergence of pain?
Here’s a thought; if you have a patient who is a keen baker, how might a story about baking a cake be relevant to their understanding of pain?
Lots to discuss here. Share your examples of emergence and pain education.
– David Butler and Tim Cocks
Chi, M. T. H., R. D. Roscoe, et al. (2011). “Misconceived causal explanations for emergent processes.” Cognitive Science 36: 1-61.
Yong, E How the Science of Swarms Can Help Us Fight Cancer and Predict the Futurehttp://www.wired.com/wiredscience/2013/03/powers-of-swarms/all/
Neil Johnson N. (2011). Simply Complexity, a clear guide to complexity theory. Oneworld Publications
Johnson, Steven Berlin. (2001). Emergence: The Connected Lives of Ants, Brains, Cities. Scribner. New York, NY