I was in New Zealand on the west coast two years back and a friend took me to see a rugby match between two Maori teams. What a rough match! It made me think “no wonder New Zealand has the best rugby union team in the world”. Anyway, I somehow ended up in the dressing room of one of teams before the match and was called upon to help strap ankles. I hadn’t strapped ankles for some years but the old skills quickly returned. A young shy limping lad came up to me and said “my ankle makes a funny crackling noise, is it OK?” I took a quick look, did some routine ankle stability tests, put some strapping on, “one extra piece for you” I told him, and then said “it’s safe” and“off you go”. The whole thing just took a few minutes and it was onto the next ankle.
I watched the game and noticed the youngster, playing on the wing. He ran, tackled and performed beautifully. I caught up with him after the match and said “How was your ankle?” He looked at me quizzically as if to say why are you asking and said, “it was safe” and just wandered off.
“Safe” – the incredible transformative power of one word, I thought. Readers will have many examples of course and we would love to hear them. And it can go the other way of course – just one word – “be safe with your bulging discs”.
From a neuroscience perspective, the word “safe” had quickly become ‘sticky’ in the young footballer’s brain. ‘Sticky’, meaning brain activity that is sensible, welcome, easily elaborated throughout the brain and accommodating and anchoring to other brain neurosignatures, in other words the word was neuro-modulatory. It makes me think – why can’t we achieve this in everyone and the processes that allowed this stickiness should be explored more.
Theta waves for best stickiness?
I am looking forward to a three day explain pain course with Lorimer Moseley and Mark Jensen in Melbourne next month. Mark is a psychologist, a professor at the University of Washington and among other things, the editor of the Journal of Pain.
Explain Pain courses are evolving quickly and one direction is the translation of words/information/story to peoples’ brains in ways that are sticky, useful and lead to more appropriate behaviours. Mark Jensen is involved in some intriguing research that may shed some more light on this. Brain activity assessed by electroencephalogram (EEG) shows brain waves in various frequencies – alpha, beta, theta and others – all much beloved by alternative health movements, but clearly needing more research. There are some correlations with rhythm activity and pain – for example with intense pain, beta frequencies increase more than other bandwidths and less pain is associated with a lessening of beta activity and increases in slow wave activity (eg. delta, theta). For a review see (Jensen, Hakimian et al. 2008). One basic hypothesis is that theta brain oscillations reflect a physiology of brain state that is ready to accept and process new ideas as opposed to the zoning out of alpha waves and information processing of beta waves. States of relaxation, mindfulness, and safety are likely to lead to theta brain waves and thus more stickiness and acceptance. This opens up a new world of clinical research that is instantly clinically relevant – neurobiofeedback, new research measures, allied therapies for explain pain, and contexts to improve explain pain outcomes.
Meanwhile, I do wonder what radical reconceptualisation and change of brain waves may have occurred in the footballer who now reasoned his ankle was safe.
Jensen, M. P., S. Hakimian, et al. (2008). “New insights into neuromodulatory approaches for the treatment of pain” The Journal of Pain 9: 193-9.
Noi Notes is a blog written by David Butler and friends to inspire thinking and discussion for clinicians pain sufferers.
I like to try to utilize what the patient gives me when looking for sticky words. A patient who describes burning pain might be told that the treatment is very cooling and soothing for the nerves. A patient who is stuck on an idea that the spine is “weak” might be told of how strong and healthy everything feels when it’s palpated (and that I understand why he used to think it was weak). A patient who has been told by others that the issue will take years to mend will be told instead: “yes, it might take years for a worst case scenario, but you’re not in that category”. It’s possible to alter the whole (possible) prognosis without introducing unnecessary confusion. The absolutely critical element is believing your own words. If you can’t do that, the whole thing is pointless.
Does Jensen have any example videos of his hypnosis work on Youtube or elsewhere?