This is the last of a three-part series about the San Diego Pain Summit. You can find the first post here which reviewed the video recordings of the previous years' summits and the second part is here, which described my experience at the 2023 Pre-Conference "Applied Neuroscience" Course with Dr. Morten Hoegh. This final installment, long overdue, and perhaps too verbose in content, was an opportunity for me to re-watch all the 2023 presentations, dive into the cited resources, and review my notes from the conference several months after the fact. I didn't read every paper that was referenced and some talks more closely relate to my patient care, so I dove into that content a bit more than others. A two-day course filled with so many incredible speakers left me with more questions about pain mechanisms and management, tons of new resources, a broader network that I'm so grateful for, and numerous tidbits of knowledge and paths to follow for further growth. Overall, I highly recommend watching the YouTube videos that San Diego Pain Summit Founder/Owner Rajam Roose has generously posted online for everyone (2023 Summit to be made available in November 2023).
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| Keynote Speaker: Dr. Kathleen Sluka |
Keynote Speaker Dr. Kathleen Sluka kicked off the weekend talking about "The Science of Exercise: Basic Mechanisms and Clinical Implications." She shared, “We have known about the value of exercise for over 100 years. This paper (Wainwright 1921) is said to be the first known paper published in Physical Therapy, and what you can see is that physical therapy showed 25% decrease in disability and saved the hospital $4000 a year which is a ton of money 100 years ago. Exercise is cost effective and reduces disability.” She continued, there are "numerous randomized controlled trial studies that show that exercise is effective for almost every pain condition."
It was entirely by accident that I started part one of this blog series describing animal studies used to explore pain, as I didn't realize Dr. Sluka was going to share research from her lab about pain in rodents. Pain does increases during activity in people and animals - but over time, exercise helps reduce pain. This is often a battle we face in the clinic - where patients are hesitant to exercise because the acute bout of activity is uncomfortable and needs to be repeated for the cumulative impact of pain reduction. Consistent participation in activity is the key for pain management, and it is not a simple task to convince those who have suffered to push through the early days to achieve that long-term outcome. Dr. Sluka described experiments where they compared pain responses in sedentary and exercising rodents to demonstrate underlying mechanisms for how pain reduction occurs. As a physical therapist with a degree in exercise physiology, I've read about exercise and pain before, but I considered a macroscopic level for why it works. Concepts like exercise facilitates blood flow and circulation of nutrients or waste in the body, increases GI motility, reduces brain fog and increases concentration, stimulates appetite and improves sleep, and enhances psychological and sociological well-being. Dr. Sluka commented on many of these macro mechanisms, but she studies the microscopic level, and explained how exercise reduces pain at this deeper level.
Exercise is multi-modal, preventing and improving pain through multiple mechanisms, It impacts the central and peripheral nervous systems as well as having an impact on immune function. Exercise can increase endogenous opioids in the central nervous system, increase serotonin availability which reduces pain, reduce central excitability, increase the presence of receptors and block others known to impact pain, and more! Dr. Sluka and her team researched these physiological processes and she shared how they studied each mechanism. Dr. Sluka described an experiment studying the impact of resistance training on pain in rats in which weights were attached to their tails while climbing ladders. Typically, aerobic exercise is more commonly studied for pain reduction, but this study found strength training to be beneficial as well. The image of rats climbing ladders with weights on their tails made me laugh... it puts the concept of a gym rat into a whole new context, right? So what exercise is most effective? Almost everything works, so the choice should depend on patient references, therapist training, and cost effectiveness. If the patient doesn't do it consistently, it won't work.
Who else spoke? The lineup included researchers and clinicians from different backgrounds and countries with unique perspectives. Bios for all the speakers.
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| Dr. Nathalia Costa |
Dr. Nathalia Cordeiro da Costa talked about “The
Ubiquity of Uncertainty: Learnings from the Low Back Pain Context.” Dr. Costa said, "Rather than resisting
uncertainty, navigate it alongside your patient as if you’re on a journey
together. Where clinicians do
embrace uncertainties, they provide care in a way in which they can
collaboratively and continually attempt to attune knowledge to complex lives, attending
to emotions that emerge and exploring ways of shaping a good life in a
non-linear manner." Dr. Costa cited one of her papers co-authored with fellow 2023 presenter Dr. Karime Mescouto, which I enjoyed reading because the paper shares how uncertainty in practice can contribute to clinician burnout. The paper described interviews with 22 clinicians of varied backgrounds, all of which worked with patients with low back pain, summarizing various ways that uncertainty appears in low back pain management. I sit with uncertainty in my patient care pretty frequently and it's a topic of discussion with coworkers particularly with more complex medical conditions. We typically discuss the selection of interventions for the patient, but we don't discuss how we deal with the uncertainty ourselves or if we address it with the patients. Since hearing this talk, I have found myself sharing my uncertainty more directly with some patients and I've noticed that in those cases, patients are more willing to help choose their treatment pathways and also to speak up if they want to make a change to their approach. "Uncertainty is a necessary stance that pushes clinicians to remain open
to other possibilities rather than to paralyze or ossify their practices."
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| Dr. Nathan Hutting |
Dr. Nathan Hutting was next with "Person-focused
self-management support in people with musculoskeletal pain conditions." Dr. Hutting discusses the importance of the biopsychosocial approach in patient-centered care in an effort to encourage patient self-management. He emphasized therapeutic alliance and an understanding of problem-solving skills and behavior change approaches in patient care, and then provides two definitions of self management:“The ability to manage
the symptoms, treatment, physical and psychosocial consequence and lifestyle
changes inherent in living with a chronic condition.” Barlow 2010.
“Interventions that aim
to equip patients with skills that allow them to actively participate in and
take responsibility for managing their persistent condition so they can
function optimally.” Jonkmen 2016.
Self-management is the idea that patients with chronic conditions need to take an active role in their treatment. This isn't easy to do and it certainly goes against a lot of the usual patient care that we provide - but I think it's an essential practice that we should be encouraging patients to partake in, particularly when they are likely to need ongoing self-care. How did I apply this to clinical practice? A few months ago, I sat down with a new patient experiencing chronic pain who could hardly tolerate getting out of bed. Her pain had taken over her life. Self management for this patient included the patient deciding that the pain couldn't be in charge anymore. She started by deciding what activities she wanted to do even when she had pain. This approach isn't possible for everyone - but it was possible for that patient. I don't think her progress would have been the same if we had just started with a home exercise program like our usual approach. She needed some motivational interviewing and behavior change and some autonomy over her day to day activities.
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| Dr. Morten Hoegh |
Next was the return of Dr. Morten Hoegh, this time focused on "Low Back Pain and
what to do about it in 2023." I already wrote about Morten in part two of this series, but this was a different talk, also very excellent, so I'll share one key take away from him here. "Just because you have pain, doesn't mean you need pain management." This directly aligns with two key papers and ideas he shared. First - the presence of pain is something that occurs because we're human. What if, instead of looking at low back pain as a problem, we looked at it as the normal occurrence that it is, since most people will have it at some point in their lives? Does it always need treatment if it's normal? And second - imaging for pain often takes us down the wrong path and can be quite harmful for patients. In fact, many patients who have MRIs taken have worse outcomes than those who do not. This paper discusses the negative impact of having imaging conducted too soon. He shared this clinical practice guideline for non-specific low back pain from 2018 which has three key recommendations: 1) triage patients with low back pain and group them into subtypes, only pursuing imaging if serious pathology is suspected. 2) "In acute low back pain, patient education, reassurance about a favorable prognosis, advice on returning to normal activity, avoiding bed rest, and use of NSAIDS and use weak opioids for a short time period" are recommended treatment. 3) "In chronic low back pain, patient education, exercise therapy, psychological interventions, NSAIDS, and anti-depressants when necessary are the recommended treatment." Morten is speaking again soon (Oregon Pain Summit October, 2023), and it's a huge bummer that I can't attend that conference
Dr. Mai Huong Ho-Tran talked about "Creating Patient Safety." This was a discussion including breath work and mindfulness strategies. She outlined the six core processes of ACT (Acceptance and Commitment Therapy, which uses mindfulness and acceptance along
with commitment and behavior change processes to increase psychological
flexibility.
She cited BJ Fogg who studies behavior change at Stanford and wrote Tiny Habits, which explores the premise that if you tie a behavior to something that already exists in your routine, it can act as a cue for the patient. The example she used was to have a patient do a heel raise every time they go to the bathroom. I personally do my heel raises while I'm pumping gas.
Next we come to Dr. Devra Joy Sheldon's “Intruding on the Intruder.” Dr. Sheldon has graciously mentored me with complex patient cases and is a brilliant human and neurology specialist PT. We're presenting a talk about Complex Regional Pain Syndrome along with Dr. Karen Litzy at the Boston APTA Combined Sections Meeting in February 2024 together! Want to have your mind blown? Watch this presentation when it comes up on YouTube. Neurology is an area in which my knowledge is immensely limited. I heard her talk in person in San Diego and watched it twice more since then, reading several of the papers she cited as my neurons slowly exploded from being overwhelmed. I had never heard many of the words in her talk prior to the San Diego Pain Summit, and I can't imagine I'm doing them justice here, but alas...
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| Dr. Devra Joy Sheldon |
Dr. Sheldon describes chronic pain as an intrusion on living life, an interruption of thought. Pain steals attention and impacts a human's ability to multi-task. People can train their ability to complete two tasks at the same time, unless pain is present. Distraction is a common approach in pain management for some patients, used in an effort to bring attention away from the pain. An opposite to the pain intrusion is a deeply absorbing mental state called the flow state. Flow is a state of complete focus. Think of a basketball player's ability to tune out the fans in the arena during a game while being acutely aware of what's happening on the court. That's a flow state. When in a flow state, there is high focus and concentration, driven towards a goal, concurrent with a loss of self-reflection and awareness of the environment. It brought me back to when I attended a course in 2017 where we talked about examples of an athlete breaking their leg on a final play of a big game - and if it would hurt the same depending on if their team won or lost.
Dr. Sheldon cited this paper, which describes three key networks in the brain which regulate the flow state. First, the default mode network (DMN), which prevails when a person isn't engaged in a cognitive task or working towards achieving a goal. It is an internal-directed network, active when a person is thinking about themself or the impact of their own words or actions, active in social scenarios or in reflection. Next is the central executive network (CEN), an external-directed network that facilitates concentration and focus. With limited resources to process all the thoughts in our brain at one time, it appears that one network must dominate over the other at any given time, as we are unable to concentrate on an external task while simultaneously focusing on ourselves.
Finally, the salience network (SN) appears to serve as the switch between the other two networks (and more networks that exist), making the determination of where attention should be directed - internally to self or externally to a task. It is the brain location where we assess self awareness taking into consideration risk versus rewards, skill versus ability, parasympathetic versus sympathetic activity, and if we are willing to put forth the effort to pursue the goal in front of us.
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| me & Dr. Sarah Cruser |
As a fun flow state activity, Dr. Sheldon had us partner up and draw together. I sat with my friend and colleague, Dr. Sarah Cruser, at the conference, so we drew together. These brain networks for attention for flow are also involved in chronic pain. For this reason, we cannot use reduction in pain in order to help patients to feel better. We need to use opposing processes like joy, novelty, fun, play, and curiosity in order to reduce pain. This reduces prior expectation and anticipation of pain. Novel activities demand attention and facilitates reflection - which shifts us to the default mode network, which we want! Art and self expression can help improve resiliency, self-efficacy, activation of reward circuits, and improve novelty, and are another way to work towards flow state and away from chronic pain. Dr. Sheldon's talk was really incredible and definitely provided new subjects that I hope to spend more time learning.  |
| Dr. Ryan Shelton |
Dr. Shelton reminded everyone in attendance, particularly the American physical therapists, of the APTA Code of Ethics which includes social responsibility as a Core Value. It is our responsibility to help those in our community In general, my employer, Seattle Children's Hospital, provides options for payment for medical care so that no kid goes without it. I previously worked in a private practice clinic where patients were turned away if they had certain types of insurance or couldn't pay for their care. Medical care in the United States is a business, and it's a poorly run business, in my opinion. Insurance companies act as gate-keepers, limiting what services are covered, profiting at the expense of people who are sick. I think physical therapy is an important service, but at an even bigger level, I find immense appreciation for the fact that kids who need vital medical treatments can get them at my hospital. Unfortunately, they might not be able to get them elsewhere, just because their family can't pay. (It is the law, however, that US hospitals provide life-saving treatment to people in an emergency room regardless of ability to pay.)
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| me & Dr. Shelton |
Dr. Shelton's talk was full of great kindness. He said, "If you don't make a conscious decision to do something, you've already made a conscious decision to do nothing... I know that where I live, nobody else is going to take care of the people that I take care of. If I don't get up and do the work, nobody does the work. Every one of us has a community that we care deeply about, and have enough determination to work for. The least we can do is 'no harm.' That's the least we can do. The best we can do is advocate for justice."He advises that you think about the niche of your patients. As an example, there are physical therapists who treat patients following an ACL injury. They need to consider if they would treat the patient with an ACL injury if they couldn't pay for their services or if they didn't have insurance? This is the case for some of my patients. They can't get care elsewhere, so they come to my facility. This is the case for a lot of Dr. Shelton's patients. He has shown that he can own a profitable business without turning these patients away with creative payment methods, and he shares these methods with others to encourage the rest of us to find ways to help our communities so everyone can have access to medical care.
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| Dr. Jessica Isom |
The keynote speaker leading day two was Dr. Jessica Isom, a board-certified psychiatrist whose talk, "The Urgency of Now:
Disrupting Racism in Pain Management," guided us to reflect on our biases and unpack medical discrimination. She shared video clips from The Whiteness Project, a collection of short interview clips with white people sharing their understanding of white privilege or race accompanied by statistics. There were some really interesting beliefs expressed, some show understanding of the problem, others openly denying that being white comes with privilege. I highly recommend checking out a few of these clips and considering the potential implications of the beliefs that are demonstrated. If the person in the interview was your healthcare provider, would they provide optimal care to you, regardless of the color of your skin? They might not ever say the same words in a clinical visit, but how would these underlying beliefs impact the way they behave? I found these clips eye-opening.
Dr. Isom referred to research from this 2022 paper about racism in healthcare, "The majority of healthcare providers tend to dismiss racism as existing in healthcare interactions. Racism is seen as a matter of individual experiences rather than structural." She also cited this 2019 study that asked
subjects to identify pain on photographs of people's faces, which found that white participants more readily
recognized pain on white faces than on black faces, and that this facial recognition of pain also carried over to the treatment recommendations made for the patients. She also included this 2021 correspondence to the Lancet that she co-wrote with my college friend, Dr. Galina Portnoy, written as a response to Trump legislation that restricted diversity training in healthcare, later rescinded by the Biden administration, outlining the importance of DEI in medicine.
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| Dr. Karime Mescouto & Dr. Haag |
Dr. Karime Mescouto followed with "Let’s
talk about power in pain management? Thinking beyond the biopsychosocial model." This was a talk about shared decision making which requires an exchange of expertise, ultimately requiring negotiation of the balance of power. Power can play out in numerous ways in a clinical interaction. In January 2023, about two weeks before attending the San Diego Pain Summit, I met with a lawyer to finalize my estate plan, the legal paperwork for what happens to all my stuff if I die. The process was emotionally difficult for me, initiated solely because of the torture my siblings and I went through when our parents died suddently from COVID and their wills were not recognized in Florida. The lawyer had been incredibly kind, thoughtful, supportive, and well-organized. Her conference room was beautifully decorated in all my favorite shades of blue, but the chairs at the table did not fit my body. Not even close. The arm rests dug into my sides as I sat through our meeting, sad and distracted, struggling in a physically uncomfortable way. After all the signatures were completed, I went home, grateful I wouldn't ever need to return to that office unless I want to make changes to my paperwork.
As I was listening to Dr. Mescouto talking about power in clinical spaces, I could appreciate that the way a clinic looks or feels might not be comfortable for every patient, but I couldn't build the bridge to understand how it impacted power. She asked, "What color are the walls in the clinical space? Is there artwork or posters on the walls?" If there are pictures of anatomy on the wall, those might impact how the clinicians practice physical therapy - directing our treatment at anatomical structures. "Do the posters include people on them and are those representative of everyone who will be present in your space?" Are there diverse representations - or just white people in the posters? And then she said it. "Are the chairs different sizes, able to accommodate different bodies? A small change to the physical environment may seem minor, but they can have a big impact on who feels the power in an interaction."
Wait a second! I emailed that lawyer while I was still sitting at the Pain Summit, thanked her profusely for how she handled my particular estate-planning circumstances, and I shared that I needed to provide feedback that could make her company's services even better: the addition of more inclusive chair sizes in their conference room. The response I got was overwhelmingly positive - gratitude from someone who loves shopping and wants her clients to feel comfortable during their work together. I no longer need to dread an update to my will, and hopefully nobody else can now avoid an uncomfortable meeting. I looked around my clinical space when I returned from the conference to make sure there are chairs and treatment tables that can accommodate everyone - and was pleased with the options in both the PT gym and in the lobby.
Dr. Mescouto includes reference to this video clip, made with Dr. Costa, called Power and the Clinic. In this clip, a dinosaur is the patient and there are interactions discussed between a provider and their supervisor reviewing how the patient experience went. It's very cute, while also impactful.
Dr. Ericka Merriwether's talk, "Personalized Pain Management for EveryBODY,"
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| Dr. Ericka Merriwether |
presented a framework for conducting research for patients with chronic pain with consideration for the intersectionality of race and BMI. Weight and body type are assigned identities, constructs that were created by people. I've previously written about BMI, a construct I have a lot of issues with, here. One comment Dr. Merriwether made was that weight changes daily, but race does not. These labels may or may not be self-adopted, so while the world may view you as white or black, skinny or fat - you may not subscribe to those same labels. Some people are light-skinned, but have black ancestry, and thus identify as black. Just because others do not view them in that group, does not make it the case. They may benefit from the way others view them, but this goes in both directions. Identities and the interactions between them, along with who is perceiving them, all need to be considered in pain research. Dr. Merriwether shared Antiracism CoaliTION in Pain Research (ACTION): Guiding Principles for Equity in Reporting which described a group, formerly known as the Pain Justice League, and their work to identify racial disparities in pain research and combat them. They conducted pain research taking race into consideration, presented lectures and grand rounds to share their findings, and developed guidelines to improve EDI in publishing research specific to pain. The coalition also worked with the editorial staff of the Journal of Pain, including current Editor in Chief (and my colleague at Seattle Children's) Dr. Tonya Palermo, to implement new processes to increase EDI in research content, author and reviewer diversity, and methods for tracking EDI metrics.
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| Dr. Jonathan Alexander |
Dr. Jonathan Alexander spoke next in a talk titled "Queer & in Pain: the Challenges of being an LGBT Patient in the Contemporary Medical Establishment." He described The Cancer Journals, written by Audre Lorde, which describe her experience with breast cancer as a lesbian and feminist and how this work impacted his own writing journey after experiencing a mild stroke. Another resource Dr. Alexander shared was an article from The Medium that summarized US legislation emerging to restrict trans rights, including severe penalties for providing gender-affirming care in many states. Then he provides four suggestions for how we can best serve those who are LGBT: 1) Use the name they provide and honor the pronouns they identify with. 2) Inquire kindly about your patients' sexual health needs and concerns. 3) Many LGBT patients have had family experiences that have been harmful to their physical and/or mental health. Their family may be chosen family instead of born family. 4) Keep in mind that most LGBT patients have been traumatized by past experiences with the medical establishment. My LGBT patients have certainly been suffering from the legislation and family traumas. This was a timely lecture and opened up conversation between attendees outside the conference hall."Persuading Change: Pointers from Conversational Cognitive Hypnotherapy" was the penultimate talk, presented by Sheren Gaulbert. Sheren's bio tells of her history with debilitating chronic pain for which she used cognitive hypnotherapy (in the US, this is called hypnosis), building a career on her lived experience. She described SnowWorld, an immersive video game during which participants throw snow balls at penguins, used with patients who have suffered from burns while they underwent bandage changes, and how this immersive experience decreased their pain experience by 35-50%. That pain reduction is comparable to the use of opiate medications! Whren I attended the 2022 NOI Group's Mastersessions, Dr. Daniel Harvey also presented data about the use of virtual reality systems in pain management, so I think we may be seeing more of this down the road in clinical practice.  |
| Sheren Gaulbert |
A word I had never heard before came from Sheren's talk: aphantasia: the inability to create mental imagery, described in this paper. Aphantasia is a condition which impacts memory and perception, found in a very small percentage of people. About half of these people cannot dream. I don't dream and I also have no ability to imagine a map in my head, which has always frustrated me, so I found this new concept fascinating to read about. I'm stuck with two questions related to aphantasia and how it might impact pain. The first specifically relates to Graded Motor Imagery (GMI), a treatment approach where a patient visualizes their body doing an activity that they're currently having pain with. Some athletes visualize themselves performing their sport before doing it - that would be a similar comparison. A person with chronic pain of their foot who may not be able to tolerate walking might be able to tolerate visualizing themself walking as an exposure for the brain to the task. I've previously written about GMI here. Do humans use something analogous to GMI automatically for self-care? Are the neurological processes of a meditative body scan the same as those in GMI? The second question relates "The Gift of Pain," a book about patients who do not feel pain and how dangerous it was for them. Fantastic book, but in my mind, a patient who cannot feel pain is not the same as someone who cannot create mental imagery, but can these patients who don't feel pain mentally image their own body? I'm trying to discern the implications for a patient with aphantasia related to pain. Unfortunately, in my mind they're all bad, but since pain is an experience and includes memory components, I'm hopeful that perhaps there is some good that I just can't (yet) comprehend.
Sheren talked about self efficacy and locus of control. An external locus of control is a person outside ourselves, an expert to guide us. An internal locus of control is guidance from within, such as with self efficacy. One of the keys I took from Sheren's talk was the concept of ironic process: when you try to avoid thinking about something, you're inevitably going to think about that thing you're trying to avoid. She advises the room "If I asked you NOT to think of a blue elephant, what happens? You're going to think of a blue elephant!" If the patient's goal is to be pain-free, but they're thinking about pain all the time, the attention to pain is prioritized. By "starting with the end in mind," you can restructure pain care by determining what is important to the patient, re-directing the focus away from the pain and towards the functions the patient wants to be participating in. This is the common approach we use at the Seattle Children's Pain Clinic, where we focus on function rather than trying to remove pain first. It's difficult to achieve, but for many patients, this approach has proven to be optimal.
Since the San Diego Pain Summit, Sheren is one of the few presenters whose work I've actively followed online and who I've also had some continued engagement with. Her company, The Ultimate You, is where she provides patient care as well as services to educate clinicians. I recently reviewed her Burnout resource for healthcare providers and it guided me to make some positive changes in my daily routine. Physios - we need more mental health providers in our arsenal when working with patients with chronic pain. Her website has some great resources on it.
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| Laura Rathbone |
Which leads me to the last presenter from the 2023 San Diego Pain Summit, Laura Rathbone, who I've spent the most time interacting with since February because I joined her International Reading Community, Pain Geeks. Laura's talk, "Phenomenology: the body as a place of knowing," was a fantastic conclusion to the conference. Phenomenology is the philosophical study of objectivity. I generally find philosophy to be deeply maddening as my brain seems to malfunction at such deep levels of thought, filled with big words, but Laura managed to explain these pieces in a way that both light-hearted and accessible. It certainly helped that I was able to re-watch her talk several times, looking up terms I wasn't as familiar with as I went along, reading cited articles, and thinking about what she's demonstrating.
I'd imagine that any talk about philosophy would include many terms with definitions in order to apply to the concepts. Laura started her talk with the concept of experience, which is subjective in nature. Since pain is an experience that can only be described by the person having it, it is also subjective. But remember, Laura is talking about phenomenology, which is objective, acknowleding that objectivity is difficult to achieve, influenced by bias, experience, knowledge, and assumptions. Phenomenology, defined another way, is a philosophical movement that explores human experience without preconceptions or theories. We can measure changes in pain, so to some degree there is an objective component available to us. Basically the key is that we need both phenomenology and science to best understand pain.
This talk was so good, and goes even deeper. The Hard Problem of consciousness is "How do you explain unconscious matter giving rise to conscious experience?" Humans are made of neurons and cells and hormones - and these thigns all interact with each other in order for consciousness to occur. The Easy Problem is explaining mechanisms using science, but the hard problem persists and we don't have the answer to it. We use a phenomenological approach to acknowledge that we can't answer the Hard Problem and to understand that we don't know how consciousness happens, despite knowing that the brain is made of of components that work together in order for consciousness to occur. I'm pretty sure there was an underlying suggestion of being comfortable with uncertainty, but I don't want to put words into Laura's mouth.
Laura defines homeostasis: the state of internal steady state maintained in a living system and allostasis: the processes which occur in the living creature in order to maintain homeostasis. She continues to describe embodied cognition,
a phenomenological approach to studying the human experience that looks at the whole human: mind and body together.
She asks the group to look at a chair and decide - "What makes it a chair?" The realization that the item becomes a chair because a person can sit on top of it demonstrates the importance of understanding the relationships between things. As clinicians, we come from a position of belief. We believe the item is a chair because it can be sat upon. Would it be a chair if you could not sit upon it?
There is a need to understand our own beliefs and the beliefs of our patients. If they see the item as a chair, but you do not, how will this impact your relationship? They see their pain, but we do not - so how will this impact our relationship? Only you know the truth about yourself, and only the patient knows the truth for themself, so we must believe the accounts that are shared with us. Laura shared the article, "An Embodied Predictive Processing Theory of Pain Experience," which goes into far more detail about embodied congition, phenomenology, and maintaining homeostasis. If this wasn't Laura's attempt to make sure my brain completely exploded by the conclusion of the conference, she was successful at it anyways. A great read that I'm glad I spent my time on and I'm very grateful to have made a new friend. And so I've reached the conclusion of this far-too-long, many-months-delayed summary. Re-watching all the talks was worth every minute and reviewing all the papers I've linked to throughout this post maximized my learning from the conference. All this knowledge has impacted my patient care already. I would be wrong to leave out that the best part of this conference was meeting so many people who care about helping those who are experiencing pain. These speakers are brilliant and caring for patients or researching so that clinicians can do better. Many of them have served as gracious mentors, opening my eyes to the vast world that pain inhabits. So - who wants to join me at the 2024 San Diego Pain Summit? Registration is already open. I'll be there. It's sure to be a great time and the speaker list is fantastic.
Special thanks to Dr. Sluka who agreed to let me include some of her artwork in this post. It's really incredible. Here's the link to her website to see more of her art - which is for sale. I can't decide which is my favorite. It's really cool to see that journals have used her art on their covers, too!
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