A Message from Dr. Lasich
Being a doctor is really a commitment to life-long learning. As new technology and research becomes available, the world of healthcare is constantly changing. If conceptual shifts do not keep up with the science, then widely held misconceptions threaten to undermine our quest to improve the health of others. Thus, the role of the doctor should first and foremost be that of an educator.
In this newsletter, I wish to bring to the forefront two areas that have been drastically changing over the past ten years. First, the science of pain is rapidly evolving with the advent of functional MRI technology. Second, the area of hormone replacement therapy for women is changing with new scientific studies reshaping our opinions.
Please take a moment to educate yourself and challenge your beliefs. Adaptation and change is a necessary constant to maintain optimal health.
On the Journal Frontline: Misconceptions about Pain
by Christina Lasich, M.D.
What is the most common misconception about pain? Many people believe that pain is an accurate indicator of tissue damage. This notion is a common misconception about pain that arises from the belief system of many doctors and patients who base their conception about pain on the antiquated bio-medical model. This old operating system relies on the belief that if something is broke, like the body, you fix it with a treatment like a pill. The black-and-white terms of the bio-medical mindset also leads to the belief that if something is injured, it hurts. Now, it is time for a conceptual shift because pain is not an accurate indicator of tissue damage. For example, phantom limb pain is pain that occurs in a limb following an amputation. The limb is gone and yet there is still pain in that "phantom" limb. Or is the pain really in the limb? What limb? Yikes, this proves that pain is not a very accurate gauge about the condition of the tissues. Another example of the dichotomy between pain and tissues is that of spinal MRI’s. Sometimes an MRI might look terrible and yet a person feels no pain. When the imaging study does not match the experience of symptoms, doctors and patients get very confused. Being stuck in an old operating system must be very frustrating.
So, what exactly is pain? The scientists at the Neuro Orthopaedic Institute have proposed a new definition of pain.
Pain is a multiple system output constructed by an individual specific pain neurosignature. This neurosignature is constructed whenever the brain concludes that the body tissues are in danger and action is required. Pain is allocated an anatomical reference in the virtual body.
Alright, let’s break this new concept down into digestible chunks. Pain is an output, a signal that develops as a result of a perceived threat. The signal is meant to motivate the individual to do something. It is useful to think of this pain signal as being similar to the other signals in the body like thirst and hunger. The reference point for this signal lies in the "virtual body", the body map in the brain. Thus, even if the leg is gone, there can be pain in the "phantom" because the reference point for pain is in the brain map. This major conceptual shift is worth repeating: pain is an output from the brain, not an input from the tissues.
With this new definition, treatment of pain becomes twofold: first, eliminate the threat; second, do something. When you are thirsty, you drink. When you are hungry, you eat. When you are in pain, you _______________ (fill in the blank). For most people, I think filling in the blank with "improve your health" is most appropriate because the unhealthy, strained-by-stress state is the ultimate threatening "lion" in this world. Threat can come from any direction: the tissues, the thoughts, the belief system, the suffering, the social environment, and the behavior. To understand pain, one must move beyond the fix-it attitude of the bio-medical model. One must take on the brain.
The concept that pain equals damage is a misconception that has misled the public into this pain epidemic. Now is the time to clear-up misconceptions and educate the masses out of the epidemic. Now is time to embrace the bio-psycho-social model and learn the real meaning of pain.
“There's wisdom in adaptation”
– Dr. Andrew Weil
In the News
Is Hormone Replacement Therapy Right for You?
Legions of women across America are going about their daily lives feeling out of sorts. "You feel flat and you feel tired, you haven't had a good night's sleep in two years [and you're] just going through the motions, trying to get through the day," Oprah says. "You feel like your life force is being sucked out of you."
Long term use of opioid medications can lead to drastically low testosterone levels. Check the testosterone level if one is complaining of low libido and energy.