In my anatomy courses, pain is most commonly attributed to compression of a certain nerve resulting in the pain of an area. I really enjoy the content you guys put out as far as pain goes and the literature seems to firmly support the biopsychosocial model, but does something like nerve compression hold any sort of viability in the explanation and treatment of pain stimulus? For example, something like carpal tunnel syndrome. The median nerve is compressed and therefore theres pain in the hand, it would make sense no? My professor tells me that cutting the flexor retinaculum is a way surgeons alleviate this compression, but my ignorant opinion tells me that this wouldn’t be a very good way to get rid of the painful stimulus however.
So as for my question, how much of the “bio” is actually involved in the biopsychosocial model and what would be a method to alleviate something like carpal tunnel syndrome considering both the psychological and social aspects? Also, as a side question, are there any good resources that you know of for students to learn more about pain and rehab, besides the content of BBM and several of the popular pain science podcasts?
Thank you very much for all the information you guys put out by the way!
So in something like a nerve injury where the innervation to the muscle is compromised and significant muscle weakness is observed would this be handled differently than if there was just the perception of pain alone? So for example if an individual has less muscular endurance in the plantar flexion of one leg versus the other would this affect the way the patient is treated? Would surgery in this case, or ones more severe to this, be viable?
I feel a bit hesitant posting just a general information question in a forum dedicated to specific rehab but It’s hard to find information in my university that only uses the biomedical approach to injury so I find the information you guys put out to help me broaden my perspective a bit.
There is a difference between injury and pain. While the two can co-exist, you can experience pain without injury and can sustain an injury without necessarily experiencing pain. In short, the “bio” is still important but its importance is dependent on the context at hand.
In the context of your nerve injury example, it depends on the severity of the injury. If the nerve is cut, then surgical intervention is required to restore innervation to the target muscle and in turn, function. If the injured nerve is still intact, healing is typically observed to determine the adequacy of recovery and guide the clinician with respect to the treatment plan.
The learning process is ongoing. Fortunately for you, you are being exposed to the formal curriculum at school and the hidden curriculum on here.
The first point by JHG is spot on. The bio does often matter, but as much related to healing timelines as anything else. To your nerve example, we know approximately the rate of healing for nerves so we can approximate how long it will take physiological healing to transpire. But this still has to account for the stress applied to that tissue during the healing phase as there is a Bayesian window for optimal healing. The easiest example of the “bio” mattering would be ACL reconstruction. Typically, patients feel better and “normal” with ADLs within 3-4 weeks (if in a proper rehab program) but we hold return to sport to 9 months because of the religamentization process. Here, the bio absolutely matters in managing risk of retear with return to sport but it also gets at the psychosocial component. Even though we cannot compete, we can sure as hell train and work to maximize the athlete’s potential for return to sport. If we just let the bio portion happen and the athlete is not active and just waiting, there is a good possibility that even though the athlete has “healed” they are not ready for return to sport.
The second portion to be aware of is “how much can we change the bio?” I’ve never seen a study that shows a modality expedites healing (sorry for those reading this, 24-48 hour outcomes where one arbitrary variable changes don’t tell me shit about healing). I’m not going to fix a cam morphology with exercise, tendons are called “mostly dead during life,” if I know this, what am I to do with interventions. To quote the epic philosopher Feigenbaum “what are you gonna do, not train?” We have the option of working around or through the bio component (truly a combination of both most often). Having an understanding of the healing times related to the bio part, and what we can actually change informs that decision.
There are two ways of framing the bio question “what can I not do because of this injury” and “what can I do in spite of this injury.” While we do have to mind contraindications of the first question, there are limitless possibilities for how we answer the second question.