Massage & Bodywork

MAY | JUNE 2019

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technique THE SOMATIC EDGE Notes from the 2019 San Diego Pain Summit By Til Luchau I'm just back from this year's San Diego Pain Summit (SDPS), and thought I'd share some of my notes and impressions while they're still fresh. About a dozen presenters spoke about pain- science, ranging from the neurology of body/brain interactions, therapeutic relationships, and compassion to brain imaging, the role of patient/client expectations, and more. Here are some notes on my personal favorites. • Neuroscientist Antonio Damasio, PhD (Image 1), has written extensively on the ways the body informs the mind. To help explain this interaction, Damasio makes a neurological distinction between feelings and emotions. Emotions, in this model, are bodily reactions that serve to maintain homeostasis: physical reaction, retraction, and movement. For example, Damasio says, "When we are afraid of something, our hearts begin to race, our mouths become dry, our skin turns pale, and our muscles contract. This emotional reaction occurs automatically and unconsciously." The brain shapes this bodily emotion into mental feelings by assigning valence: the mental valuing that determines meaning and preference. "Feelings," Damasio says, "occur after we become aware in our brain of [emotion's] physical changes; only then do we experience the feeling of fear." 1 "And pain," he says, "needs to be treated as a feeling," implying a deep role for the mind in the pain experience. (For more, see Damasio's book Descartes' Error (Penguin, 2005), or his TED talk at • When Maxi Miciak, PT, PhD, was writing her doctoral thesis about how the practitioner/patient relationship influences the effectiveness of physical therapy, she found almost no existing research and very little formal study into the therapeutic relationship in any field. 2 What research she found, she says, showed (unsurprisingly) that the quality of the practitioner/patient relationship is linked to better patient satisfaction, and to better therapeutic outcomes. Her own research into the question (using an interpretive description qualitative method, followed by quantitative analysis) led to her model of the conditions of engagement necessary for therapeutic effectiveness (Image 2). One of her practical suggestions: since listening can be a powerful therapeutic intervention itself, practice making room for your client's story and try waiting for eight seconds after the patient speaks before responding. • Australian physical therapist Mark Bishop, PhD, shared his thought- provoking research into how patient/ From neuroscientist Antonio Damasio's keynote address: "Our minds are constructed in partnership between the brain and the body: the brain reports on the outside world, the body reports on the inside world, and the nervous system is the broker between these two." Image courtesy San Diego Pain Summit, used by permission. In Maxi Miciak's Safe Therapeutic Container model, her five conditions of engagement are visualized as a box, with the floor and walls representing two cornerstone conditions, "present" and "receptive." "Committed" and "genuine" are more variable, and so are represented by the mobile lids of the container. Image courtesy Dr. Miciak, used by permission. 1 2 Ta k e 5 a n d t r y A B M P F i v e - M i n u t e M u s c l e s a t w w w. a b m p . c o m / f i v e - m i n u t e - m u s c l e s . 101

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