YTread Logo
YTread Logo

Pain, Is it all in your mind?: Silje Endersen Reme at TEDxNHH

Jun 09, 2021
In 1869 Dr. George Beard wrote an article in a distinguished scientific journal describing a new condition of which she has become aware that the symptoms of the disease include back

pain

, neck

pain

, headache, general fatigue , mental fatigue in Sonya and stomach problems as a cause that he blames on modern life and as a cure he suggests everything from air, sunlight, fun entertainment and physical activity to a very special method that he himself has come to favor, which consists of putting patients in a bathtub with water and apply general electricity from the head to the spine, he writes in his articles that it works every time none of his patients returned for more treatment after receiving the shock in the bathtub, in addition to this somewhat treatment Untraditional, the similarities of the condition you describe to the conditions we struggle with today surprise most sufferers.
pain is it all in your mind silje endersen reme at tedxnhh
The leave is due to complaints exactly like this. My starting point was to take a closer look at one of the largest groups that affects the most people and accounts for the majority of sick leave costs in Norway today, which is the large group fighting chronic back pain. It is actually ext

reme

ly common, in fact, it is more common to have back pain than not to have back pain. As much as 80% of the population will experience an episode of back pain at some point in their lives, so you are still young, but you have. You still can't be quite sure that you will have some back pain at some point in

your

life, and when I say back pain I don't mean a slight itch or a little discomfort. real back pain, that's the bad news, the good news is that for most the prognosis is very good with improvements within a few days or weeks, the pain can be severe and the disability can be horrible if you just take it with calm for a few days. and try to return to normal activity as soon as possible, for some people it will be fine;
pain is it all in your mind silje endersen reme at tedxnhh

More Interesting Facts About,

pain is it all in your mind silje endersen reme at tedxnhh...

However, the pain does not go away so easily, but rather develops into disabling conditions that dramatically reduce

your

ability to function at work and at home. Their pain is intense and their disability is severe, but there are still no organic findings that can explain the amount of pain we see in this group; There is actually a very low correlation between what we see on a back MRI and the intensity of pain experienced by the patient and the biomechanical and anatomical findings cannot explain the amount of disability we see. We call them non-specific back pain simply because we don't really know what is happening.
pain is it all in your mind silje endersen reme at tedxnhh
In very few cases, between 10 and 15 percent of cases, there is a specific cause. It could be a fracture, an infection or cancer, but in the vast majority we are not able to find a physical cause that explains the pain and disability, so what happens is in the

mind

and how we handle it if we put them all in the same place. bathe and apply electricity as George Barry suggests, although it is a bit tempting. I have used a slightly different approach in my PhD. I want to know who these people are, what the complaints are, and what the important factors are in the transition from acute to chronic. back pain To do that, I did a study on 600 Norwegian workers sick due to back pain and one of my main findings was that, in reality, for most of these people, back pain was only part of the problem, what we call comorbidity.
pain is it all in your mind silje endersen reme at tedxnhh
The number of additional complaints was very high, with 99 percent reporting other health complaints in addition to their back pain with an average of 10 complaints, which is much higher than what we see in the general population. When we analyze the severity of the complaints, we see that they report much more. more serious complaints than the general population, for example in terms of gastrointestinal complaints, which are stomach problems, or external neurology, which is fatigue, anxiety and depression. Now this gives a slightly different picture than just a back problem, but very similar to the conditions that George Bier described.
Almost 150 years ago, but I wanted to dig deeper, so I did a smaller study with a subset of these patients where I asked them what they considered to be their main complaint or main problem in life, and then I found that more than 1/ 3 of these patients said pain was no longer a problem now all of these are listed patients sick due to pain still pain was not their main problem when I asked them what the problem was they reported a wide range of spectral complaints from problems in the job. and at home to emotional stress and other bodily complaints and disorders and here are some of their responses work stress conflicts at work social anxiety chronic fatigue depression little work hope sleep problems loneliness activity limitations migraine and mother-in-law this is not a joke and Yes If you knew about this guy's mother-in-law's situation, you would understand that she actually told me that you know at least my back pain is somewhat predictable.
There you have it, after my PhD. I moved to Boston to continue this work. The PhD research findings correspond to international research and have led to the idea that there could be different subgroups of back pain patients with different characteristics and different treatment needs. Anna, who has back pain and also struggles with anxiety and depression, might, for example, have a slightly different need for treatment than Christian, who has back pain and also has a major conflict at work with his boss or Bob, who in addition to back pain has a horrible mother-in-law. With my colleagues in Boston, we begin where researchers usually begin.
Never do a systematic review of the literature to see what previous research has found to be the most important predictors of chronic pain and work disability or sick leave; In other words, what factors are best able to explain why some people develop chronic pain and become ill. leave while others don't, the answer may not be what you would expect because the strongest predictors were not the anatomical or biomechanical ones but the psychosocial ones; It's not how physically demanding your job is or what your back looks like on an MRI that is most influential in explaining whether you will develop chronic pain or not, it's how you do emotionally and socially at work and at home.
A few months ago we did a study on the construction industry in Boston and one of the construction workers I spoke to. There, someone who struggles with back pain told me that insecurity in the job market, instability caused him a constant fear of losing his job. He told me that his back bothered him but it was that anxiety that kept him awake all night and took away his sleep Now, this man had a heavy job that probably didn't improve his back, but it is this anxiety that will put him at risk of developing vicious cycles that in the long term could reduce his ability to function at work and at home.
What we did was we put all of these major psychosocial predictors into a screening tool and gave them to 500 acute back pain patients who had just had back pain and the measures included, as you can see here, pain, depression, problems in the work and hopes for recovery. impact on life pain activity avoidance catastrophic pain and activity limitations After giving all these questions to 500 patients with acute pain, we followed them up after three months to see how they did and the results led us to a algorithm that divided these patients into four different groups and as you will see here I will show you the groups and the closer to the center they are the less complaints the further from the center they are the more complaints the first group had some back pain but no additional problems these are the ones I as mentioned above, with a good prognosis, have some back pain, but know just take it easy for a few days and it will pass.
The next group had more back pain, but as a main concern they had problems at work, it was some problems and problems. at work, which would bother them more. The next group had more back pain. There were no problems at work, but it was a physical limitation that really bothered them. Their ability to function at work and carry out their daily activities bothered them the most, and the latter group shows the same amount. of pain but also a variety of different emotional problems including depression anxiety no hope for the future and avoidance of activity now these four groups were very capable with a high accuracy we were able to predict the results after three months the first group as I told you you had a very good prognosis all of them returned to work without further problems with pain or disability the second or third group showed a medium risk of having some pain problems and being sick listed after three months was the last group this yellow group showed a very poor prognosis , almost everyone was on sick leave and struggling with chronic pain after three months.
Therefore, we can predict with very high accuracy, already a few days after the pain started, who will develop chronic pain and who will win. And more than that, we can also say something about what characterizes them, whether it is work, activity limitations or emotional problems, which is worse. That way we can tailor treatments and give them to them before they develop these vicious cycles that we know they're stuck in and hopefully be able to prevent disability from occurring before it starts, so let's gain a little perspective and see how You will see this in real life: a worker goes from being healthy and relatively handsome to disabled due to back pain, what do we do right?
The first thing we need to do is look at the injured area and for this guy, it appears to be the back from a medical perspective to do a thorough clinical examination to see if there are any. specific pathology that needs a specific treatment but, as I said, in most cases we cannot locate any specific finding because there is no specific treatment, so we move away from the pain or the back and we go into the brain and the big million . The dollar question is the pain in the

mind

, yes of course, where else would it be if I cut your head off?
You can be pretty sure you won't feel any pain. I say that mostly figuratively, of course, but that's what it is. This does not mean that the pain is not real or that it is only imagined. You might think we've moved away from all this dualism with the separation of head and body, but we still see it, so let me give you a simple example of how our mind influences our experience of pain. Are you ready? okay, let's say you wake up one morning, you're on vacation in Australia and you wake up with a bat ready to go out to experience the city and you look at the koala bears you put on your shoe and suddenly you feel a sting, you quickly take off your shoe, You turn it over and a spider falls out.
Now this Martin loves you. Remember that we are in Australia, where there are poisonous spiders. How do you feel? What does pain feel like? press how it moves up your leg you can feel it good then come with me to a different scenario you're back in the bag you get up take off your shoe put it on put on the shoe feel a pinch take it off and a pin comes out, you know what a pin is a pin small with a needle at the end, how does it feel different? How does pain feel differently in different scenarios?
You see my point, our experience of pain is heavily influenced by our interpretation of the pain there. There are numerous examples of this and we have seen it in numerous laboratory studies: our pain is experienced and the intensity is strongly influenced by our interpretation of pain and our expectations of how much something will hurt. Does that mean happy thinking will eliminate all pain? Does this mean that cognitive techniques can help you cope better with pain? Yes, if you focus all your attention on the pain, it's like plugging your brain into a guitar amp where everything is experienced louder and louder.
A continued focus on pain, often related to it. A catastrophic interpretation like that of the spider will result in an overwhelming experience of pain, while cognitive techniques can help you redirect your attention and change your interpretation of pain so that the pain is less ext

reme

and/or easier to cope with. A common catastrophic interpretation of back pain. In reality pain is equivalent to damage and that movement and activity is dangerous and harmful to the back while in reality it is the opposite, our entire instinct tells us that if something hurts if something hurts it means that something is damaged or something is wrong and we need protect our back we need to avoid the activity but in this particular case our instincts are wrong and we need to reprogram a brain to understand that so we can do what is best for us and this is a technique that can be learnedadditionally.
As we saw in my subgroups, some of these patients struggle with anxiety and depression, in addition to pain, which makes the entire situation more difficult to deal with and this particular case is where psychological techniques and interventions can be extremely useful. , so that was the brain. and as much as I would love to stay here, as you saw in my research, there are more factors that influence pain and disability than what happens in the brain and one of them is the person with their social environment, this is where we find the mother-in-law and this is where many factors lie that we know influence the individual experience of pain and disability, for example, financial problems, marital problems, lack of social support, the next system is the work system, one of the suburbs reported this. be your biggest concern and problem and you may have all the power in the world to deal with your salary and a disability, but if you have a horrible boss or if you have extremely difficult work situations, you need to make some changes here before you can go back.
To work through pain, the next system is the healthcare system and access to evidence-based treatments. Now, what evidence-based treatment is is a topic for another talk, but what I want to say here is that one of the biggest problems we have today in this field is actually overtreatment and medicalization, too many people receiving surgeries. spine problems, pain prescriptions, and unnecessary tests and procedures that actually make them worse. We have good research showing that unnecessary testing procedures up front actually worsen the prognosis of the disease. patient, so we have to stop doing that. The next and last system is the legislative and insurance system, which has a great impact, especially on pain-related work disability.
I think that in order to really see a change in the cost of sick leave in Norway today, we need to need changes in the system, we need to incentivize the individual worker to return to work to a greater degree than our system allows today. , so all of these systems, all of these factors are involved in individual workers' experience of pain and how they cope with work. pain versus ability, so we need to work together. I realize this problem is more like Olympic circles than anything else, but the point was simply to show that we need different disciplines to work together.
I have made the argument for psychology today. and the importance was a university of chronic pain, but psychology is not the only solution. There are some interesting studies of genetic studies looking at chronic pain and gene-environment interactions, and the most impressive studies I've seen in healthcare are actually several. disciplines that work together, including physical therapy or occupational health psychology and medicine, I still think we need to go a step further and include non-traditional disciplines that we haven't done before, like some of the ones I've listed here, sociology, science policies, law, economics, people who "We are experts in other systems that we don't know much about because I think that if we access them, we look at this problem from a single disciplinary perspective and we run the risk of doing exactly the same as the blind, many of the elephants and me.
I guess you know this analogy. They're okay, everyone is looking at a little piece of the elephant, but they don't see the whole picture, they don't see the elephant and I think if we're really going to see the whole elephant. To pay for disability, we need to work together and we need to look at this from multiple perspectives and we need to cross our disciplinary boundaries and collaborate because pain is not just pain, it's more complex, so do we have new answers to the old questions? George Spears stated almost one hundred and fifty years ago, well, we don't really know much more about the physical causes of pain, but we do know what else about the psychological factors that maintain pain and the different ways we can help people cope with it. , and we know that putting these patients in a bathtub with electricity is probably not a good idea thank you very much

If you have any copyright issue, please Contact