Embodied pain - What is it and what does it mean for rehabilitation?
Article review of Tabor et al., (2017)
Paper title and link to paper:
Embodied pain—negotiating the boundaries of possible action (Tabor et al., 2017)
Overview of the paper:
This blog hopes to simplify a recent paper I heard Jo Gibson talk about on Emodied pain. I found it quite a hard read (even though it is a relative short piece) so I’ve tried to summarise the paper below and some of the ideas presented by Jo in the webinar.
Let’s look at this quote to start with about their ideas about how we should view pain.
“Our focus should shift from pain as a passive, sensory experience to pain as a dynamic, motor experience, Pain is always about action” pp. 1009
The authors then suggests that perception, and pain as a perception, is both emobodied and embedded.
They defined the two terms as follows:
Emobidied is the idea that cognition extends beyond the brain and that our body has a key role in how our experiences are shaped
Embedded is the interaction between the embodied being and the external environment in place and time
The authors draw from three principles on this embodied experiences that are:
Inference
Liminality
Defence
Inference
Inference, the noun for infer, is defined as “Something that you can find out indirectly from what you already know”
We selectively attend to information
We prioritise efficiency over accuracy
We fill in the gaps
We attempt to accomodate information that has deviated from our predictions
We experience the world through our sensorimotor interactions in a hierarchical fashion
We alter our experience to the environment around us and in turn this changes what the environment gives back to us
“The reciprocal relationship between action and prediction continually reshapes our experiences of pain” pp. 1007
Liminality
For the case of perception, this paper suggests liminality is the boundaries or threshold for possible action.
Experiences which intrude awareness indicate that boundaries have been reached and action must be taken
Homeostatic coherence drives experience
The authors related pain to other bodily experiences such as temperature and an itch. In the former example, if a certain boundary is reached for you being too cold, you may reach for that extra jumper to warm yourself up.
Defence
“Like a stream following a well-worn channel defined by natural banks that guide and constrain, so felt experience flows largely uninterrupted, embodied by physical constraints and embedded within social contraints. To stray outside of these bounds produces specific alerts that function to modify our actions or alter our predictions” pp. 1008
Every physical sense has specific threats which are tied to specific defence actions
Attempts are maintained to return to homeostatic coherence
Actions may be experienced as disturbing
Failed defensive actions can lead to repression, derealization and dissociation from ones self, thoughts and feelings
Summary
This idea of emobodied pain has helped me to recognise the important effects the environment plays on pain and inter-relationship between the two. Changing the context our environment may help to alter our perceptions thus enabling us to lower this threshold of a defensive mechanism.
This can be used in rehabilitation to manipulate our environment to challenge their perceptions. For example, if the patient is struggling with active shoulder flexion examples we may look and different ways modify this perception of this movement including:
Goal and task orientated focus (e.g. Reaching up for a cup of a shelf)
Distraction (e.g. Listening to music or singing at the same time)
Location (e.g. Somewhere in a place of comfort)
Technology (e.g. Virtual reality)
Adjuncts (e.g. Taping or compression garments)
Assisted movements (e.g. Therapist assisted)
Equipment (e.g. Band/Weights/Pulleys/Towel/Swiss ball)
Symptom modification techniques (e.g. Changing lever arm)
External cueing (e.g. Metronome)
I hope this blog hasn’t be too hard to read. To finish this blog off, I’ll leave you with this quote.
“The body, not separate from the brain nor the world, but part of the facility that actively shapes our experience of pain” pp. 1007
As always, if anyone has any comments, further reading or suggestions on this topic please feel free to fire them at me on here or on my Twitter. I am always learning and any discrepancies on what I have written is thoroughly encouraged.