Figure 3 - uploaded by Mick Thacker
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There is much that I could say about Louis and I am fortunate to have had the opportunity elsewhere (see http:// giffordsachesandpains.com/2014/02/ and www.csp.org.uk/ news/2014/10/13/physio-14-speakers-praise-work-louis-gifford- pain-management-pioneer). I want this account to be about Louis’ ongoing contribution to our understanding of pain and t...
Context in source publication
Context 1
... and proposed to Louis that much of what Noë was saying was essentially incorporated in the MOM. Alva Noë is a world-renowned American philosopher who has proposed a sensorimotor understanding of perception and consciousness within an embodied construct. Put simply, he believes that consciousness is “something we do” rather than something that happens inside us. As ever Louis requested more reading material, yet sadly he was unable to get round to reading it. What I was suggesting to Louis was that the MOM is inherently a model of the embodied cognition of pain (figure 3). Embodied Cognition (EC) is a rapidly advancing theory (in reality a group of theories) that has become the focus of some of the world’s leading neuroscientists (Friston, Edelman, Damasio), cognitive scientists (Lakoff, Johnson, Nunez), philosophers (Clark, Noë, Thompson, Gallagher, Zahavi, Hohwy) and those from the robotics and artificial intelligence communities (Brooks, Hinton, Pfeifer). Embodied Cognition holds that an agent’s (person’s) cognition (incorporating thoughts and feelings) is deeply dependent upon features of their physical body; that is, when aspects of the agent’s body beyond the brain play a significant causal or physically constitutive role in cognitive processing. I suggest that EC offers a better understanding of pain than other concepts as it sees the person as a whole without separation of the body from the brain/mind and acknowledges that people enact with, and shape their environments. Look again at figures 1-3 and now read the following quote from Varela et al ...
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Citations
... Pain, in a chronic stage of a disease, is plausibly generated by the complex phenomenon of central sensitization, where there is not a direct correlation between pain and structural alterations, detectable through clinical examination, diagnostic tests or structural diagnostic tests (Gill et al., 2014;Quartana et al., 2009). Pain modulation processes are characterized by different and complex stages, as suggested by Louis Gifford in his theory of the adult organism model and with the introduction of the concept of neuromatrix (Thacker 2015;Melzack 2005). ...
Background
and purpose: Shoulder pain is one of the most common musculoskeletal problems of the world's population. In particular, in water polo athletes, the frequency of injuries or pain to this joint is very high. The incidence of psychosocial factors in musculoskeletal pain is well recognized, even if they seem to be more present in chronic pain, rather than in acute pain.
Case description
The patient was a semi-professional water polo player with acute shoulder pain which occurred during a game. At first, the pain was very mild, but it progressively got worse after the visit to the casualty department where, even in the absence of any confirmed structural lesions, the patient is ordered to refrain from any active movements. The patient became worried, so his anxiety levels increased which worsened his symptoms. The physiotherapist opted for a “hands-off/hands-on approach”.
Outcomes
Significative improvements were observed in all the considered outcome measures the patient obtained complete recovery in a very short period of time and then he was able to return to his sport.
Discussions
Psychosocial factors such as anxiety, fear and catastrophizing can modulate pain responses in a subject without structural problems. Thus, counseling and education in pain science can be an effective therapeutic method, especially with conditions of acute, as well as chronic, pain.
Level of evidence
4.
... Pain mechanisms can be categorized into input mechanisms, including nociceptive pain and peripheral neurogenic pain; processing or central mechanisms, comprising central pain, central sensitization and cognitive-affective mechanisms of pain; and output mechanisms, including autonomic, motor, neuroendocrine, and immune systems (Thacker, 2015;Gifford, 1998). All these mechanisms occur at the same time; however, one mechanism might be clinically dominant over the others. ...
Background:
Nonspecific low back pain (NSLBP) is a common problem. Attempts have been made to classify NSLBP patients into homogenous subgroups. Classification systems based on identifying the underlying mechanism(s) driving the disorder are clinically useful to guide specific interventions.
Objective:
To establish consensus among experts regarding clinical criteria suggestive of a dominance of 'articular', 'myofascial', 'neural', 'central', and 'sensorimotor control' dysfunction patterns (DPs) in NSLBP patients.
Study design:
A 2-phase sequential design of a focus group and Delphi-study.
Methods:
A focus group with 10 academic experts was organized to elaborate on the different DPs discernible in LBP patients. Consecutively, a 3-round online Delphi-survey was designed to obtain consensual symptoms and physical examination findings for the 5 DPs resulting from the focus group.
Results:
Fifteen musculoskeletal physical therapists from Belgium and the Netherlands experienced in assessing and treating LBP patients completed the Delphi-survey. Respectively, 34 (response rate, 100.0%), 20 (58.8%) and 15 (44.12%) respondents replied to rounds 1, 2 and 3. Twenty-two 'articular', 20 'myofascial', 21 'neural', 18 'central' and 11 'sensorimotor control' criteria reached a predefined ≥80% consensus level. For example, after round 2, 85.0% of the Delphi-experts agreed to identify 'referred pain below the knee' as a subjective examination criterion suggestive for a predominant 'neural DP'.
Conclusion:
These indicators suggestive of a clinical dominance of the proposed DPs could help clinicians to assess and diagnose NSLBP patients. Future reliability and validity testing is needed to determine how these criteria may help to improve physical therapy outcome for NSLBP patients.
... The Mature Organism Model (MOM) (Gifford, 1998) integrates several ideas and suggests that pain can be considered an integrative experience forged upon sampling, appraisal, scrutinizing, and response processes from a top-down perspective. The MOM proposed an embodied cognition of pain (Thacker, 2015) that sees pain as a perception derivate from a constant sampling and elaboration of the inner and outer environment in a predictive coding comparator, in close accordance to the free energy principle. ...
Pain is a complex and multidimensional perception, embodied in our daily experiences through interoceptive appraisal processes. The article reviews the recent literature about interoception along with predictive coding theories and tries to explain a missing link between the sense of the physiological condition of the entire body and the perception of pain in chronic conditions, which are characterized by interoceptive deficits. Understanding chronic pain from an interoceptive point of view allows us to better comprehend the multidimensional nature of this specific organic information, integrating the input of several sources from Gifford's Mature Organism Model to Melzack's neuromatrix. The article proposes the concept of residual interoceptive images (ghosts), to explain the diffuse multilevel nature of chronic pain perceptions. Lastly, we introduce a treatment concept, forged upon the possibility to modify the interoceptive chronic representation of pain through external input in a process that we call interoceptive modeling, with the ultimate goal of reducing pain in chronic subjects.
