Introduction To Pain Neurocience Part 1
by Julie Beck, DC, MS. CSCS
“Dogma is the principle or set of principles laid down by an authority as incontrovertibly true. It serves as part of the primary basis of an ideology or belief system, and it cannot be changed or discarded without affecting the very system’s paradigm, or the ideology itself.” -wikipedia
The central dogma of orthodox biology was the belief that DNA controlled life, period.
The anti-climax of the Human Genome Project, the costly effort to sequence our genetic code, taught us that there is more to the story of our individual uniqueness than can be found in our 25,000 protein coding genes. The awakening gave birth to the field of epigenetics (i.e. how environmental, nutritional, lifestyle, stress, sleep and other variables effect how our genes are expressed), leaving the DNA emperor looking a tad chilly.
Pain similarly has its central dogma(s), and although they may not be expressed as explicitly as their biological DNA counterpart, they are implicitly entrenched in the education, language, management, perceptions and societal understandings of pain. Here are several pain dogmas.
1. Pain has patho-anatomical origins and patho-anatomical perpetuators – meaning that the origin of pain is in tissue(s), and the primary perpetuator of pain dogmas.
2. Pain generators can be elucidated via imaging (x-ray, CT, MRI) by identifying imperfections in tissue(s) (i.e., bone, joint, muscle, tendon, etc.) This behavioris strongly entrenched even though many evidence-based clinical guidelines strongly suggest that MRI and x-rays should not be the first-line approach in the assessment of musculo-skeletal pain.
3. Pain should be treated by surgical means, and if surgery is unsuccessful, should be managed with pharmaceuticals (primalirly ipiods, anti-inflamatories and/or anti-depressents. )
4. Last but not least, and potentially the most damaging of all: if no peripheral pain generator (i.e. damaged tissue, inflammatory mediator) can be found, the pain (and patient that has it) is dismissed as a malingerer (fabricating for secondary gain), or the pain is summarily dismissed as “less real” or somehow imagined (“all in your head”). This is medical scapegoating at its unsavory worst.
The scientific research clearly indicates a disconnect in the medical world – a disconnect between commonly-held beliefs about pain and the treatment of pain, and the evidence that refutes them.
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The interior ministry has announced plans to give five complementary therapies including homeopathy the same status as conventional medicine.
Homeopathy, holistic medicine, herbal medicine, acupuncture and traditional Chinese medicine will acquire the same status as conventional medicine by May 2017 when it comes to health insurance.
After being rejected in 2005 by the authorities for lack of scientific proof of their efficacy, complementary and alternative medicines made a comeback in 2009 when two-thirds of Swiss backed their inclusion on the constitutional list of paid health services.
As a result of the vote, these treatments are covered by basic compulsory insurance as part of six-year trial period from 2012-2017. However, they were all required to prove their “efficacy, cost-effectiveness and suitability” by 2017.
In a statement released on Tuesday, the interior ministry said it had come to the conclusion that it was “impossible to provide such proof for these disciplines in their entirety”.
They will thus be treated on a par with other medical disciplines, when it comes to health insurance.
The ministry plans to continue allowing reimbursements of treatment costs by compulsory health insurance, provided they are administered by certified medical doctors.
However, as is the practice for conventional medicine, certain controversial practices under these complementary therapies will be subjected to further scrutiny. The ministry has initiated a consultation process – open until June 30, 2016 – on the proposed modification of the regulations.