A conversation about pain

A conversation about pain

Lee Schneider is a PhD candidate studying pain and predictive processing at the University of Notre Dame in Perth, Australia.

In this discussion, we talk about Lee’s agreements and disagreements with Asaf’s perspective, the debate about whether pain is a sensation or a perception, the predictive processing model, and many other topics.

The conversation was a lot of fun and we rambled all over the place, so there are some jarring cuts/edits in some places.

Many thanks Lee.

Also available as a podcast https://anchor.fm/physiosonline/episodes/A-conversation-about-pain-with-Lee-Schneider-e1h2u87 

You can follow Lee at https://twitter.com/LSchneiderPT

This conversation was inspired by my earlier chat with Asaf Weisman, available here https://youtu.be/j_0di-4Vaw4 and podcast here https://anchor.fm/physiosonline/episodes/Pain-is-not-a-thing-with-Asaf-Weisman-e1ghu0s

Notes:

01.15 Intellectual bubbles
Lee: “I’ve been enjoying this last couple of weeks, the back-and-forth with Asaf, he’s gotten me to think about pain in a different way.”

03.21 Addressing the idea that “neurons don’t make predictions”, and
the meaning of “predictions” in a predictive processing framework

Lee: “that individual neuron has the properties that will be predicting a certain environment”.

05.00 Thoughts about the statement “nociception is negatively valenced”

Lee: “I used to be sympathetic to the view that sensory info is meaningless until it’s imbued with meaning by these “higher centres”. I don’t really subscribe to that view any more”.

08.45 “When I talk about *valence* I think more about the feel of something. Less about what is objectively happening, and more about how that feels to you. So I’m less confident in making an argument that nociception is negatively valenced”.

12.00 Predictive Processing, relevance for physios

13.30 Lee: “you’ve got this stuck representation or expectation and that feeds into the experience of that movement, you’re more likely to experience pain because what we predict forms our experience.

17.45 Sine-wave speech as en example of making sense of sensory information

21.30 Visual illusions

24.18 Evie trying to explain why she doesn’t think visual illusions are a good analogy for pain, or why she disagrees with “checkerboard illusion picture is to vision as nociception is to pain”

Evie: “If there can be pain without nociception, that’s like saying you see different shades of grey even if it’s dark and there’s no light going into your retinas.”

30.12 Lee: “A prediction of threat in the tissues might start to change the local tissue environment itself, to confirm that prediction”

Lee: “The idea of pain in the absence of nociception doesn’t make sense in the context of chronic pain, because we know there are all these neuroinflammatory processes going on. But you might say people are having very vivid & strong experiences of pain when there isn’t a LOT of nociception going on”

31.20 Evie’s confusion and doubt about the idea that “we can have pain in the absence of nociception”. Evie’s opinion that the evidence for pain without nociception is a bit “thin on the ground. We must have more examples than one fella with a nail in his boot from years and years ago… do we not have way more solid evidence?”

34.37 Lee “I’m not ready to throw out the idea (of pain without nociception), because to me, PP predicts that we could have pain in the absence of nociception. But I think the environment around that experience needs to be noisy”.

Then we proceed to discuss nail-in-boot guy 🙂

38.20 Is predictive processing a framework of consciousness Anil Seth’s book Being You where he speaks of “Dissolving” the “hard problem” as opposed to solving it.

39.50 Lee: “Even if it’s not true, it feels like this still has to be the approach… even if this is all a waste of time and consciousness is an epiphenomenon and we can’t explain it”… PP is still a good approach to further our knowledge and understanding

41.40 By now, Evie has managed to talk us both into a rather sad, hopeless and dejected state. Moving swiftly on….

42.20 Lee: The problem of chronic pain has gotten worse in the past few years. Lee: “i see it as an information and a social problem, a public health problem. When someone injures themselves they are immersed in a system that can’t help but reinforce these models of brokenness”

45.38 Precision medicine and chronic pain
Lee: “When you have an entire person who has credible reason to be under threat and not have trust in their bodies, changing a single pathway… I don’t think that will change their experience.” “Looking at the history of precision medicine for pain, it hasn’t got a good history, and the problem of chronic pain seems to be getting worse”.

48.00 – 56ish, a rambling chat about honesty in clinic, should we tell patients what we think is true, or what we think they should believe? And what is true?

Evie worrying about whether what she says to patients is true or helpful

Lee: “going through Explain Pain, you get the sense that if the people that you’re saying just had the same beliefs that I have, then they would be fine. And I don’t know if that’s true.”

Lee: wondering about whether to give a patient information if you think that information will make them feel bad

Evie: Being honest “means that you can’t make your patient think you know something that you don’t actually know”. (Sidenote: Evie won’t tell her kids there’s a Santa Claus)

Lee: with patients, instead of focusing on explaining pain, he now tends to focus most on what the patients can do

Evie: I used to be confident and convinced that PNE was helpful and
useful. Now less so.

1.00 hr “As time goes on and you start to think hang on, is this definitely the truth, or is this a story that I got enamoured with cos a very charismatic lovely guy was very convincing on a course”

01.01 talking about Asaf’s comments about “gastlighting”

01.02 * NOTE: I cut out a big chunk of Evie & Lee chatting about yoga
and forward-bending. Sorry for the jarring edit.

At the end: a chat about the problems with thrashing things out on
twitter, and how real conversations are usually more helpful.

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Our podcast is available at: anchor.fm/physiosonline/