Not necessary for pain

Laundry and Logical Fallacies

At the recent EP3, Giando Iannetti provided a quick lesson in a logical fallacy known as ‘Affirming the consequent’ with the following example:

  1. When Lorimer does the laundry he uses more electricity
  2. Lorimer is using more electricity
  3. Therefore Lorimer is doing the laundry

The conclusion 3. is invalid because it can be false even if 1. and 2. are true. In other words, there are multiple reasons Lorimer might be using more electricity (he could be vacuuming or blow drying his hair…).

Giando raised this logical fallacy because of the corollary false argument:

  1. When a person experiences pain, certain parts of their brain are ‘active’ together
  2. Certain parts of this person’s brain are ‘active’ together
  3. Therefore this person is experiencing pain

Giando argued that 3. immediately above is also invalid because his group (and others) has shown that the same areas of an individual’s brain can be active when you provide very different stimuli – both nociceptive and non-nociceptive, and the individual reports very different subjective experiences.

Insula, Amygdala and Anterior Cingulate not necessary for pain

In a recent piece on Gizmodo, this idea is echoed by Tim Salomons – the lead author of a recent case study (open access). From the Gizmodo piece:

“I wouldn’t say that’s it’s wrong to say that the ‘pain matrix’ is involved in processing pain,” lead author Tim Salomons (University of Reading) told Gizmodo. “What’s wrong is the idea that it is specific to pain—in other words, that when you observe this pattern, you can’t just assume that person is in pain.”

From the paper:

“These results challenge the notion of a “pain matrix” and provide direct evidence that the insula, anterior cingulate, and amygdala are not necessary for feeling the suffering inherent to pain”

A cautionary note

The excellent work done by people like Giando and Tim Salomons (and their teams) should be a cautionary note for anyone in the business of Explaining Pain to avoid simplistic and inaccurate metaphors. Further, these findings sound a challenge to keep up to date with the foundational neurosciences, while at the same time exercising some healthy skepticism and critical thinking – no trivial task indeed.

 

-Tim Cocks

 

 

protectometer-banner-advert

australian-tour 

We’re hitting the road and taking our NOI courses right across this great southern land:

Canberra 3 – 4 May Mobilisation of the Neuroimmune System (only Australian MONIS course for 2016)

Canberra 6 – 8 May Explain Pain and Graded Motor Imagery

Adelaide 14-15 May Pain, Plasticity and Rehabilitation (only Australian PPR course for 2016)

Noosa 17 – 19 June Explain Pain and Graded Motor Imagery (GMI is now FULL)

Perth 15 – 17 October Explain Pain and Graded Motor Imagery

noi_ep3_usa2016_banner1_600x95px

EP3 events have sold out three years running in Australia, and we are super excited to be bringing this unique format to the United States in late 2016 with Lorimer Moseley, Mark Jensen, David Butler, and few NOI surprises.

EP3 EAST Philadelphia, December 2, 3, 4 2016

EP3 WEST Seattle, December 9, 10, 11 2016

To register your interest, contact NOI USA:

p (610) 664-4465

e noius@noigroup.com

w noigroup.com/courses

7 Responses to “Not necessary for pain”

  1. Graham Yates-Osteopath

    Having just read Mary O’Keefe’s research showing nothing much works for chronic pain, it would seem that as therapists we have to start to wipe the slate clean and start thinking outside the (mirror) box. That FMRI might not be as good at providing data as we once thought and it is a little too naive to think that we can understand a brain that has 86 billion neurones and 10 trillion synapses.
    Neuroscience is content with its position as an area very much in its infancy, but therapists are at the coalface and want to make a difference to patients quality of life.
    I am really enjoying my intellectual journey in understanding pain, taking in neuroscience,philosophy and psychology along the way. But perhaps this is where it stops. It is my journey and not actually changing very much to the quality of patient care.

    Reply
  2. Barrett L. Dorko

    It has been “discovered” that “context” is the most important aspect of care. Ironically, this is at a time when therapists aren’t offered much an opportunity to control it.

    Reply
  3. bartvanbuchem0noi

    Hi Graham,
    I don’t think the journey ends here. It will become more complex but there is still much to learn about neuro immunology. Neuroscience pain and immunoly are not linear. The fact it is all emergent makes it hard to understand and to fit it in our addiction to linearity.

    Reply
  4. Graham Yates-Osteopath

    The problem is I am treating in my lifetime.I’m sure there will be better treatments available in the future ,but we are in the now.I still treat and (need to) feel i am making a difference,but often evidence suggests otherwise.
    When you enter the world of reading research you realize what a roller coaster ride it is.Currently for example,as this article suggests the “Pain Matrix” is looking a bit passe

    Reply
  5. Show me the pain | noijam

    […] a nice tour through some current thinking on brain imaging and pain. Tim Salomons’ (featured on NOIjam before) work that has cast doubt on the pain specificity of the so-called “pain matrix” gets […]

    Reply
  6. Hard to ignore | noijam

    […] The pain specific interpretation of such functional magnetic resonance imaging (fMRI) responses, although logically flawed remains pervasive. For example, a 2015 review states that “the most likely interpretation of […]

    Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Basic HTML is allowed. Your email address will not be published.

Subscribe to this comment feed via RSS

%d bloggers like this: