Stepping Back Part I

When it comes to the science of pain, I would say that I remain agnostic about many of the interventions employed in rehab. Social media often displays a dichotomous view where people are either for or against certain interventions, however, when I post content, I only challenge the thought processes we have behind those interventions rather than the intervention itself.

Many researchers and publications have been saying for years that the context and complexity involved with what we call the human experience is far too ambiguous to be able to predict with high precision that we know the solution to one’s problem. This definitely creates uncertainty.

To become comfortable with uncertainty means embracing the fact that you will never be fully capable of comprehending the totality of evidence that has been compiling over the past millennia. This feat is so far outside of our current scope of knowledge that we can’t even begin to imagine the type of information we don’t know we don’t know.

In turn, there appears to be this pervasive nature of individuals opting for reductionist models and lines of thinking to help make sense of their thoughts. To find comfort with our reasoning, we then cling to others who share similar views seeking confirmation that our theories are most certainly true.

Problems exist in this mode of knowledge because when it comes to complexity, it’s hard to reconcile what is actually true. Circling back to the interventions we perform, one thing that seems to be ubiquitous is that most people get somewhat better or will regress back to their average over time. What is difficult to understand and is why some people are able to improve far more significantly than others despite similar courses of treatment.

Again, we can theorize all we want, but for there to be any validation to the theories we create, it must have adequate scope, depth, and precision remaining consistent over time. For example, if we use the theory that the body is like a machine, this is based on a mechanistic worldview. For this to be true, we will have to see a linear progression of tissue degeneration with more active people showing significantly more degeneration. However, that doesn’t appear to be the case. As our knowledge improves and we find that active people have better looking joints than their sedentary counterparts, it pokes holes in the original theory, and one cannot adequately explain why that may occur. This becomes an incoherent way of thinking as the theory says one thing, yet what is observed appears to be different.

Since medicine has been derived from a mechanistic worldview stemming from Descartes theories of dualism, most theories formulated today hold similar mechanistic perspectives. This draws us back to the belief that our bodies are like a machine creating the idiom commonly referred to as ‘wear and tear’. Mechanistically speaking, it makes no sense to describe our bodies like a machine that will only break down when there is solid evidence of one’s ability to adapt based on the context surrounding their unique history. Without context, it’s hard to understand whether someone’s tissues will degenerate to the point they become problematic.

As research continually evolves, pain science enthusiasts have recognized the many flaws in these theories, so they decided to create new ones. Although this sounds good in theory (pun intended), the new theories that are replacing the old theories are still viewed in a mechanistic worldview. Instead of thinking of our bodies like a machine, we moved into the neurocentric idealism that our brains are the machines that can be controlled. Replacing one reductionist model based on a mechanistic perspective with another reductionist model based on another mechanistic perspective is like the definition of insanity. We keep doing the same things repeatedly thinking we are going to get different results. Our failure to become aware of and understand where our beliefs are rooted only hurt the forward progression of where medicine needs to transition.

So where do we go from here? Existing models have been proposed over the past few decades calling for such change, but many people become lost in translation with how they interpret those models. Opinion pieces and different perspectives continue to get published criticizing the nature of how we interpret these models with suggestions to move forward towards newer philosophies that give clinicians a different model to understand the complexities of dealing with pain. But we don’t need another model. We don’t even need another philosophy to show us a better way to understand and explain pain.

What we need is to take a HUGE step backwards. So far back that we explore what worldview we are living in and where our beliefs are rooted. As mentioned earlier, medicine was founded within a mechanistic worldview believing the body was a machine. We have made some progress in the 21st century recognizing and acknowledging the limitations that exist with mind-body dualistic perspectives, yet we replaced all these old theories with the neurocentric belief that the brain is a machine that can control everything. We didn’t actually change our root worldview, we just shifted from one perspective to another with a very similar reductionist thought process.

Now before I go on criticizing the mechanistic worldview, I would be remiss to acknowledge all the benefits that have occurred because of it. It was because of this worldview and its associated beliefs that the field of medicine now has the capabilities to prescribe certain pharmaceuticals and perform surgeries that are lifesaving. If you are a surgeon removing a cancerous tumor from the spinal cord or a physician prescribing the appropriate life-altering medication, you may not care as much about the context involved in the situation and instead do what is necessary to fix the mechanistic problem the individual is dealing with. But that doesn’t mean this worldview applies to everything in medicine. When it comes to pain, it is time we recognize that we can’t live in a mechanistic worldview and adequately treat it.

Stay tuned for Part II where we discuss the importance of shifting worldviews to better understand and apply interventions associated with pain.