This is where a Le Pub Scientifique can lead to. Professor Mick Thacker and Dr. Julian Kieverstein just published this paper. A must read!
This paper aims to provide an account of the subjective character of pain experience in terms of predictive processing. The PP theory is often taken to support a view of perceptual experience as a controlled hallucination of the external world. Transposed to pain this would have the consequence that pain is a controlled hallucination of the body. The PP theory would have the consequence that the body that is in pain is just another hidden cause of sensory input that stands in need of inference and control by the brain. We argue that pain experience cannot be a controlled hallucination of the body since the predictive machinery that constitutes pain experience is not brain bound. The subject’s pain experience is physically realised in a system that is spread
across the body as a whole. This system comprises the immune system, the endocrine system, and the autonomic system in continuous causal interaction with pathways spread across the whole neural axis. We will argue that these systems function in a coordinated and coherent manner as a single complex adaptive system to maintain homeostasis. This system, which we refer to as the neural-endocrine-immune (NEI) system maintains homeostasis through the process of prediction error minimisation. We go on to propose a view of the NEI system as a multiscale nesting of Markov blankets that integrates the smallest scale of the cell to the largest scale of the embodied person in pain. The NEI system is the embodied subject’s first-person perspective on the world. The PP theory, we will argue, can therefore make sense of how a living body that acts to minimise prediction error can also be a lived body, the subject’s embodied point of view on their surrounding world.
We have shown how the predictive processing theory of pain is best understood against a backdrop of a view of the whole NEI ensemble as working predictively. Pain experience cannot be reduced to nociception or decomposed into sensory-discriminatory, affective-motivational and cognitive-evaluative elements. Instead we have argued pain is the outcome of predictive processing that takes place in the whole neural axis in continuous reciprocal interaction with the immune system, the neuroendocrine and the autonomic system. All of these systems are working together as an integrated whole. Pain occurs when all of these systems together conclude that the prediction of body integrity is likely to be disconfirmed. Body integrity here means the states of the body the organism should return to under a wide variety of different conditions that are necessary if it is to continue to exist. Pain is an allostatic process that aims to maintain the body in these states under conditions of constant change, providing the organism with feedback that it is diverging in potentially dangerous ways from these (adjustable) setpoints.
We have argued that the predictive processing theory of pain does not support a conception of pain as controlled hallucination of the body. Proponents of the PP theory often present the body as just another hidden cause of sensory input no different from anything else in the environment external to the body. We have argued this is a mistake. Predictive processing takes place in all of the systems that maintain the homeostasis of the body. What travels up the neural axis to the brain is prediction error from these systems, not a sensory signal originating from an external hidden cause.
In place of a view of the brain separated from the body by an evidentiary boundary we have proposed to think of the predictive processing that takes place within each of the systems that makes up the nervous system as producing and maintaining a nesting of Markov blankets. At the smallest scale to the largest scale processes of prediction error minimisation play out that separates but also connects and integrates these systems. This nesting of Markov blankets makes sense of how the body is presented in pain not as an object but as the subject’s point of view on the world. Pain is not only in the brain. Pain is a state of the whole body that prioritises the actions the organism needs to undertake to return the body to the state of healthy flourishing that is expected.
Why is Pain Painful
Shut up and listen! A patient takeover
About this event
Well this is a first for Le Pub, a patient takeover!
This Le Pub is being taken over by Joletta Belton and Keith Meldrum, both well known patient voices in the pain world.
One of our goals at Le Pub is to bring together researchers, clinicians, AND people who live with pain. We strive to give people experiencing pain direct access to the science that informs their treatment. This time we’re flipping it on its head and bringing scientists and clinicians to hear the patients’ perspective.
You’ve shut up and listened, now what?
Join Keith and Jo for a conversation about where we go from here in the evolution of pain care, with perspectives from those living with pain and the clinicians who are leading the way in meaningful patient partnerships.
Joletta and Keith will share their experiences and discuss how this has informed their knowledge, thoughts, opinions, and recommendations on the future of care for people experiencing pain.
Joletta and Keith will be joined by regular Le Pub panellist, Kat (@tmopain)another strong patient voice and Diarmuid Denneny, who will be known to many of you through his role as chair off the Physiotherapy Pain Association
This promises to be a really lively discussion and debate and we’re super excited to see where Joletta, Keith, Kat and Diarmuid take us.
World Event Times
London – Friday, 27 November 2020, 20:00:00 GMT
Amsterdam – Friday, 27 November 2020, 21:00:00 CET
New York – Friday, 27 November 2020, 15:00:00 EST
Adelaide – Saturday, 28 November 2020, 06:30:00 ACDT
Jo makes sense of pain through science and stories on her blog, MyCuppaJo.com, and is an advocate for integrating the lived experience of pain into the study, education, and treatment of pain. She is co-chair of the IASP Global Alliance of Pain Patient Advocates presidential task force and the first Patient & Public Partnerships Editor at JOSPT.
Kat is learning to live well with persistent neuropathic pain. After her first diagnosis of a “chronic, progressive” pain disorder, she learned to meditate and somewhat navigate the healthcare system. After receiving her second, she began discovering pain science and is finding strength in (mostly gentle) movement. She has a special interest in the ways we communicate about pain. A thoughtful presenter and engaging public speaker, Kat interprets the lived experience of persistent pain for clinicians and researchers world-wide.”
Diarmuid is professional lead physiotherapist at the Pain Management Centre (PMC), University College London Hospitals NHS Foundation Trust in the UK. Clinically he is an advanced practitioner physiotherapist and independent prescriber.
He is chair of the Physiotherapy Pain Association, a Professional Network linked to the Chartered Society of Physiotherapy.
Diarmuid has a particular interest in psychologically informed practice, co-production methods, and the role for health care professionals in supporting people who have pain and medication related issues. He has published peer reviewed articles relating to pain and physiotherapy practice.
Diarmuid is a member of the guideline development committee for the NICE chronic pain guidelines. He is a module lead (Strategies for the Self-Management of Pain) for the new UCL MSC in Pain Management. He also has interests in the non-medical management of CRPS and is a committee member of CRPS UK.
Check out more upcoming events – http://www.lepubscientifique.com
Places can be cancelled and refunded up to 48 hours before the start of the event. Within 48 hours of start time no refund.
Please note that Le Pub Home Brew is a LIVE EVENT. We are looking at options for giving access to recordings in the future, but right now, we are doing what we are best at – bringing you awesome live and interactive learning events!
Brilliant essay on uncertainty – co-authored by a previous Le Pub panellist Mark Miller.
– We can deal with a bit of uncertainty in our lives, in fact it is healthy
– However, uncertainty takes many forms and when our worlds are turned upside down (with no predictable end) this can be unhealthy
– Engaging in activities that question or tease our expectations may be helpful, particularly when they’ve become entrenched (predictable). For the inner geek relating to chronic pain and volatility:”Sustained exposure to such volatile situations and environments [i.e. ongoing pain]
– where the outcomes of actions appear inherently unpredictable
– leads to an inevitable decrease in confidence in one’s ability to bring about the outcomes they expect. At that point, our predictive brains begin to infer an inability to exert successful control, and this then forms a damaging part of the model that guides our future actions.”
– perhaps leading to a state of learned helplessness?!
Check it out – read and re-read – there’s an incredible depth of insight and knowledge.