The past three weeks have been a swirl of joyous, passionate neuro-nerdy stuff! And yes, it’s absolutely possible to call neuroscience joyous and passionate (just ask David Butler and the NOI crew).
What have I learned?
Let’s begin with the obvious: pain is an output of the brain. What does that mean? It means that unless the parts of the brain involved in deciding what we need to know about decide we need to know about a threat – we won’t experience that unpleasant sensory and emotional experience we call pain. Pain is a complete biopsychosocial phenomenon. Our experience of OUCH! or YEEEOWW! is absolutely determined by a judgement call made by our brain, and the basis for that judgement call is on the degree of threat we are facing. If we’re purposively allowing someone to etch a design into our body, we’ll experience a sensation, but most people who have a tattoo say that it’s not painful. It might be different if we were being held down against our will, and someone is etching an abusive word onto our flesh – the context would be different and we’d view it as a real threat to who we are.
Neuroscience, and especially studies using fMRI, has been able to unravel some of that fringe stuff that lies between “psychosocial” and “biological”. It’s a research paradigm that has much to offer because it’s uncovering how the structures in our brains respond to both internal and external events. Yes, thinking can make something happen.
There are limitations, though, and it was refreshing to hear this often throughout the two conferences I’ve attended.
An MRI is a big, noisy machine. People have to lie down and be still during imaging. There is not a lot of room in the machine. Images only show how blood flows to various regions of the brain. It’s not available to many people. They’re expensive! The results require interpretation (but what testing doesn’t require interpretation?!).
What this means to me is to interpret findings somewhat cautiously. These studies don’t examine the situations and contexts of the people I work with. Many of the studies use acute pain research protocols – things like thermal stimulation, cold pressor, capsaicin. The people being studied are often young, healthy volunteers – often undergraduate students. The experiments are short-lived, and they have an end in sight for the volunteers. People can’t move about, or do the activities over time. The context is different from everyday living.
At the same time, the experiments begin to uncover information about how our brains function – and maybe we can take the findings and begin to study correlates in the real world. I think this is much of what the Body in Mind group do.
One of the problems, and criticisms, of translating neuroscientific research into the clinic (and probably one of the reasons occupational therapy suffers from a low profile in health) is that the real world is a messy, joyous, passionate, grim, untidy place.
People are made up of their biology but modified by experience and context and opportunity and restriction. People bring this context into their treatment environment. And the treatment environment is also a context, and so are we as clinicians. It’s unsurprising that some of what can be demonstrated in neat, controlled, rigorous clinical trials just can’t be replicated with the people we see, in the world we live in, and in the activities and communities people are in.
This is where joining the dots between scientific methodologies is needed. Bringing together the artificial research methodologies used in fMRI and randomised controlled trials (double-blind, placebo) where standardisation and unformity are underlying assumptions – and the qualitative, individual, quirky and idiosyncratic methodologies that assume that my reality is mine alone, and that it’s impossible to ever really experience it the way I do.
Both methodologies have application. Both contribute to our understanding of how people and our world work. And somehow, our theory-building (which is simply a way to provide a metaphor so we can share understanding) needs to pull the multiple strands of knowledge together so that I, as a clinician, can work out how to help my fellow human.
What am I saying here?
Nerdy, sciency stuff is probably what I, as a clinician and researcher and teacher, need to immerse myself in. My passion is to help clinicians who maybe don’t enjoy this stuff, maybe don’t have the time to learn this stuff, maybe don’t think this stuff has direct relevance to what they do, gain access to the implications of research. Not a theory of everything (or this)- but a practical translation of nerdy, sciency stuff into what a clinician might do.
There. I think I’ve summarised my current reflections on all that neuroscientific goodness that has nourished my neurones. I’d love your comments! And don’t forget, you can subscribe, join me on Facebook, or introduce yourself.