Being part "nerd", I'm totally fascinated by science & especially scientific trends. I recently read this paper looking to unite two major scientific disciplines: "stress biology" with the "cognitive neurosciences", by three of the biggest authors in these disciplines! It's a doozy to read, but the overall take home isn't that complex. Here is my synopsis:
We don't actually experience or see world directly. What we experience is our brains best guess at any moment! From an evolutionary perspective this best guess has been more than adequate, however it appears "absolutely" & "utterly" real to us in every way, so is perfectly understandable why some are "incensed" when told their perceptions of the world are not entirely accurate! This represents some of the current thinking within the cognitive neurosciences. Attempting to integrate this research into manual therapy is at the cutting-edge of a understanding many ongoing or chronic pain states.
This "best guess" represents something like a "map of the world", we use to make predictions about what to expect when we do certain things or interact with certain people for example. This map is continuously updated throughout the day by input from our 5 senses and our mental processing. When we achieve our daily goals and things go as expected, everything is hunky-dory, or said another way, our "predictions" are accurate!
When our predictions fail or things don't turn as we expected, it generates doubt & uncertainty in the accuracy of our map. This becomes relevant in some ongoing pain states, especially when it isn't 100% clear what the underlying cause is, & also when we try different things but remain unsatisfied in the result. If biomedicine had this stuff 100% sorted, we would be able guarantee all treatments used in targeting pain, however you know this is not the case! So no matter how confident a medical or any health professional appears to be in what ever they are selling you, "caveat emptor", or buyer beware!
When the accuracy of our map is called into question it creates uncertainty about the future. In a state of high uncertainty, the brain potentially goes into overdrive. Basically the brain enters a state where it attempts to process all the actions & options that could potentially be taken to minimise this "uncertainty", or said another way creates more "certainty". In other words, what is my best option at the moment?
If the brain can't find a "best option" or is conflicted in same way about which option to take, it can remain in some sort of "overdrive" state. This is the point the paper links up with the stress biology, or what energy systems tend to get used when the brain needs the energy or hence the extra "processing power" to compute all these action & options, & the likely scenarios from each.
The level of complexity is intense, but one can easily appreciate how screwed up things can get if certain "cognitive or perceptual strategies" start utilising particular "energy systems" over the long term; or said another way, are affected by long term stress. It eventually affects the brains neural architecture, potentially creating a positive feedback loop that can spiral out of control, if certain lifestyle choices aren't made. What choices? It depends on the individual, there is no hard and fast rule here; exercise, nutrition, sleep, learning to relax, even the right kind of musculoskeletal rehabilitation etc.
So what does it all mean? In a previous blog I mentioned the difference between biomedical and biopsychosocial approaches to healthcare. Biomedicine works famously well when it has an obvious biological target to treat, however many ailments today have no "stand out" or obvious target! In today's fast pace world, many of our ailments are said to be chronic or related more to "lifestyle factors" than any obvious medical disorder. When I treat in clinic I always attempt to identify a therapeutic target but I still put myself in the biopsychosocial camp, which is just a fancy way of saying that I attempt to treat the person, not the condition they happen to present with on the day. In the context of the article I've been discussing, I aim to help a person develop mastery over themselves.
Reference:
"Uncertainty and stress: Why it causes diseases and how it is mastered by the brain." (2017) https://www.ncbi.nlm.nih.gov/pubmed/28576664
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