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manual [2024/04/27 07:32] – [4. Appendices] tommanual [2024/10/16 16:16] (current) – [Application of IEMT Techniques to Pain Management] andrewtaustin
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   * **Neuropathic Pain**: This type of pain is a result of damage to the nervous system itself, which can alter pain perception. It might be experienced as a burning, shooting, or stabbing sensation.   * **Neuropathic Pain**: This type of pain is a result of damage to the nervous system itself, which can alter pain perception. It might be experienced as a burning, shooting, or stabbing sensation.
  
 +{{ :pain-classification.png?900 |}}
 ===== Transmission of Pain Signals ===== ===== Transmission of Pain Signals =====
  
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   * **Modulation**: At the spinal cord, neurotransmitters can either amplify or dampen the pain signal.   * **Modulation**: At the spinal cord, neurotransmitters can either amplify or dampen the pain signal.
   * **Perception**: The brain interprets these signals as pain, influenced by both physical and psychological factors.   * **Perception**: The brain interprets these signals as pain, influenced by both physical and psychological factors.
 +{{ :napkin-selection_1_.png |}}
 ==== Types of Pain ==== ==== Types of Pain ====
  
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   * **Acute Pain**: Immediate pain resulting from injury, lasting less than six months. It serves as a warning mechanism.   * **Acute Pain**: Immediate pain resulting from injury, lasting less than six months. It serves as a warning mechanism.
   * **Chronic Pain**: Persistent pain that lasts longer than six months and can continue even after the injury has healed.   * **Chronic Pain**: Persistent pain that lasts longer than six months and can continue even after the injury has healed.
-  * **Burn Pain**: Typically acute and intensely painful due to nerve damage. Requires immediate pain relief and long-term management.+  * **Burn Pain**: Burn pain is typically acute and intensely painful due to nerve damage. It requires immediate pain relief and long-term management.
   * **Crush Injuries**: Can result in both nociceptive and neuropathic pain. Initial severe pain may transition to chronic pain syndromes if nerves are damaged.   * **Crush Injuries**: Can result in both nociceptive and neuropathic pain. Initial severe pain may transition to chronic pain syndromes if nerves are damaged.
   * **Visceral Pain**: Originates from internal organs; often difficult to localize. Typical in blunt force trauma to the abdomen.   * **Visceral Pain**: Originates from internal organs; often difficult to localize. Typical in blunt force trauma to the abdomen.
-  * **Somatic Pain**: Arises from skin, muscles, bones, and joints. More localized; caused by direct trauma. +  * **Somatic Pain**: It arises from skin, muscles, bones, and joints. It is more localized and caused by direct trauma. 
-  * **Referred Pain**: Pain felt in a part of the body other than its actual source, important for diagnosis. +  * **Referred Pain**: Pain felt in a part of the body other than its source, which is important for diagnosis. 
-  * **Phantom Limb Pain**: Occurs after amputation where pain is felt as though it comes from the amputated limb.+  * **Phantom Limb Pain**: This occurs after amputation, and the pain is felt as though it comes from the amputated limb.
   * **Psychological Pain**: Emotional distress that exacerbates physical pain symptoms, requiring holistic care.   * **Psychological Pain**: Emotional distress that exacerbates physical pain symptoms, requiring holistic care.
-  * **Inflammatory Pain**: Signifies tissue damage and inflammation, sustained by biochemical substances.+  * **Inflammatory Pain**: Signifies tissue damage and inflammation sustained by biochemical substances. 
 + 
 +===== Gate Control Theory of Pain ===== 
 +The gate control theory of pain, proposed by Ronald Melzack and Patrick Wall in 1965, is a revolutionary theory that provides a new framework for understanding the mechanisms of pain perception and modulation. This theory challenges the traditional view of pain as a simple sensory experience. It introduces the concept of a "gate control system" that regulates the flow of pain signals to the brain. 
 + 
 +===== Overview of the Theory ===== 
 +The gate control theory proposes that pain signals from the periphery (e.g., skin, muscles, organs) are modulated by a "gate" mechanism in the dorsal horn of the spinal cord. This gate can either facilitate or inhibit the transmission of pain signals to higher brain centres, depending on the interplay of various factors. 
 +The key components of the gate control theory are: 
 + 
 +The gate control system: A functional unit located in the spinal cord's dorsal horn that regulates pain signals' flow. 
 +Afferent fibres: Sensory nerve fibres carry pain signals from the periphery to the spinal cord. 
 + 
 +Small-diameter, slowly conducting fibres (C-fibers) transmit dull, burning, and chronic pain signals. 
 +Large-diameter, rapidly conducting fibres (A-beta fibres) transmit sharp, localized pain signals and non-noxious stimuli like touch and pressure. 
 + 
 + 
 +Descending fibres are nerve fibers that originate in the brain and descend to the spinal cord, modulating the gate control system. 
 + 
 +===== Mechanism of Gate Control ===== 
 + 
 +According to the theory, the gate control system functions as follows: 
 + 
 +Pain signals from the periphery travel through the afferent fibres (both C-fibers and A-beta fibres) to the dorsal horn of the spinal cord. 
 +The gate control system in the dorsal horn can either allow or block these pain signals from reaching the brain. 
 +The activity of the gate is modulated by the relative activity of the afferent fibres: 
 + 
 +Increased activity in the small-diameter C-fibers tends to open the gate, facilitating the transmission of pain signals to the brain. 
 +Increased activity in the large-diameter A-beta fibres tends to close the gate, inhibiting the transmission of pain signals to the brain. 
 + 
 + 
 +The descending fibres from the brain can also influence the gate control system, either facilitating or inhibiting the transmission of pain signals. 
 + 
 +===== Implications and Applications ===== 
 + 
 +The gate control theory provided a new understanding of pain modulation and had several important implications: 
 + 
 +It explained how psychological factors, such as attention, emotion, and past experiences, can influence pain perception by modulating the descending fibres that control the gate. 
 +It provided a theoretical basis for non-pharmacological pain management techniques, such as transcutaneous electrical nerve stimulation (TENS), which activates the large-diameter A-beta fibres and can close the gate, reducing pain perception. 
 +It highlighted the importance of considering both the sensory and emotional components of pain, leading to the development of multidisciplinary pain management approaches. 
 + 
 +While the gate control theory has been refined and expanded upon over the years, it remains a fundamental theory in pain research. It has contributed significantly to understanding pain mechanisms and developing effective pain management strategies.
  
 ==== Management Implications ==== ==== Management Implications ====
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   - The pain that is current   - The pain that is current
   - The pain that is anticipated   - The pain that is anticipated
 +
 +{{ :napkin-selection_2_.png |}}
  
 In addition, the practitioner needs to consider the response to the pain, which may be adaptive or maladaptive. Pain leads to suffering, and in some instances, alleviating the pain does not necessarily change the experience of suffering, depending on how the person has adapted to it. Alcohol and drug use, self-harm, social withdrawal, self-pity, etc, may continue long after pain has been alleviated. In addition, the practitioner needs to consider the response to the pain, which may be adaptive or maladaptive. Pain leads to suffering, and in some instances, alleviating the pain does not necessarily change the experience of suffering, depending on how the person has adapted to it. Alcohol and drug use, self-harm, social withdrawal, self-pity, etc, may continue long after pain has been alleviated.
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 **Stage 1. Patient expectations and anticipation** **Stage 1. Patient expectations and anticipation**
  
-The patient unfamiliar with MVF use will likely have their preconceptions of what will follow in terms of the experience and the clinical outcome. It should be noted that patients with the most amount of distress and the most to gain may be apprehensive and fearful that the method will be ineffective, and clinicians should note that the greater the distress, then the greater the level of disappointment and added distress will be in the event of MVF proving to be ineffective.+The patient unfamiliar with MVF use will likely have their preconceptions of what will follow in terms of the experience and the clinical outcome. It should be noted that patients with the most amount of distress and the most to gain may be apprehensive and fearful that the method will be ineffective, and clinicians should note that the greater the distress, the greater the level of disappointment and added distress will be in the event of MVF proving to be ineffective.
  
 Clinicians should seek to ascertain and neutralise the patient's expectations, regardless of their beliefs and expectations. The attitude to foster is that of, "//We are finding out what is possible with this process//" rather than, "//This is a treatment for your condition//." Discussion of outcomes should also be avoided other than to offer that "outcomes are largely irrelevant at this stage, as we are simply exploring what is possible." Clinicians should seek to ascertain and neutralise the patient's expectations, regardless of their beliefs and expectations. The attitude to foster is that of, "//We are finding out what is possible with this process//" rather than, "//This is a treatment for your condition//." Discussion of outcomes should also be avoided other than to offer that "outcomes are largely irrelevant at this stage, as we are simply exploring what is possible."
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 ===== 4. Appendices ===== ===== 4. Appendices =====
-  ==== A: Recommended Resources ==== +==== A: Recommended Resources ==== 
-    * Books and Articles for Further Reading+    - "Phantom Limb Pain: A Case Study and Review" by K. L. Jensen - Discusses the mechanisms and management of phantom limb pain post-amputation. 
 +    - "The Challenge of Pain" by Ronald Melzack and Patrick Wall - Explores the complex nature of pain, including neuropathic and chronic pain.  
 +    - "The Sensory Homunculus: Anatomy of a Neurological Concept" by Penfield and Rasmussen - This foundational work explores the sensory and motor representations of the body in the brain. 
 +    - "Neuroscience: Exploring the Brain" by Mark Bear, Barry Connors, and Michael Paradiso - Offers detailed insights into the homunculus and its relation to sensory processing and phantom limb pain. 
 +    - "Phantom Limbs and the Neuroplasticity of the Brain" by V.S. Ramachandran - Discusses the role of the homunculus in the perception of phantom limb sensations. 
 +    - "Pain and Brain: Chronic Pain, Phantom Limb Syndrome, and Neural Plasticity" by Vilayanur S. Ramachandran - Covers neural mechanisms behind phantom limb pain. 
 +    - "Coping with Limb Loss" by Ellen MacKenzie - Focuses on psychological adaptation and coping mechanisms post-amputation. 
 +    - "Phantom Limb: From Medical Knowledge to Folk Understanding" by Robert G. Frank - Explores the psychological impact of phantom limb syndrome. 
 +    - "Psychological Aspects of Amputation and the Stump" by Hugh Watts - Discusses the mental health challenges faced by amputees, including depression, anxiety, and body image issues. 
 +    - "Amputation and Prosthetics: A Case Study Approach" by Bella J. May - Includes sections on the psychological adjustment to amputation. 
 +    - American Chronic Pain Association - Website - Provides resources on managing chronic pain, including phantom limb pain. 
 +    - Amputee Coalition - Website - Offers comprehensive resources on coping with limb loss, including mental health support. 
 +    - National Institutes of Health (NIH) - Article on Phantom Limb Pain - Provides detailed information on the neurological aspects of phantom limb pain. 
 +    - Mind.org.uk - Mental Health and Amputation - Offers resources for mental health issues specific to amputees. 
 +==== B: References ==== 
 + 
 +Austin, Andrew, T. (2015). Integral Eye Movement Therapy. In Neukrug, Edward S. (Ed.), //The SAGE Encyclopedia of Theory in Counseling and Psychotherapy// (pp. 539–541, 718). Los Angeles: Sage Publications. [[https://en.wikipedia.org/wiki/Special:BookSources/978-1452274126|ISBN 978-1452274126]] 
 + 
 + 
 +Richards, S. (2021) Integral Eye Movement Techniques - The Definitive Guide. //Integraleyemovement.com//. [[https://en.wikipedia.org/wiki/Special:BookSources/1838496408|ISBN 1838496408]] 
 + 
 + 
 +Ramachandran, V. S. (1998) Phantoms in the Brain: Probing the Mysteries of the Human Mind, coauthor Sandra Blakeslee [[https://en.wikipedia.org/wiki/Special:BookSources/0688172172|ISBN 0688172172]] [[https://archive.org/details/phantomsinbrainh0000rama|archive.org]] 
 + 
 + 
 +Ramachandran, V. S. (2010) The Tell-Tale Brain: A Neuroscientist's Quest for What Makes Us Human [[https://en.wikipedia.org/wiki/Special:BookSources/9780393077827|ISBN 9780393077827]] [[https://archive.org/details/telltalebrainunl0000rama|archive.org]] 
 +==== C: Glossary of Terms ==== 
 +**Abreaction**:  Psychological process involving the reliving and expression of emotional distress, particularly effective in mirror box therapy for reprocessing emotional trauma associated with limb loss. 
 + 
 + 
 +**Amplitude Scale**:  A scale used to measure the intensity of a sensation or feeling, typically ranging from 1 to 10, with 10 representing the highest intensity. 
 + 
 + 
 +**Body Image Disruption**:  Profound alteration in self-perception following physical changes like limb amputation, leading to persistent identity loss and self-consciousness. 
 + 
 + 
 +**Bridge Effect**:  Dysmorphic distress acts as a link intensifying the bidirectional relationship between pain and depression by increasing pain sensitivity and exacerbating depressive symptoms. 
 + 
 + 
 +**Catharsis**:  Emotional release and relief achieved through expressing and reliving emotional turmoil, allowing patients to interrupt the cycle of pain and depression. 
 + 
 + 
 +**Chronic Pain**:  Long-lasting pain, such as in phantom limb syndrome, causing significant stress on mental health and increasing the risk of depression. 
 + 
 + 
 +**Clinical Evaluation**:  A comprehensive assessment conducted by healthcare professionals to diagnose and evaluate the severity of mental health conditions, ensuring accurate diagnosis and appropriate treatment. 
 + 
 + 
 +**Core Training Group**:  A group composed of both clinical and non-clinical members tasked with receiving training and disseminating knowledge to relevant stakeholders. 
 + 
 +**Dysmorphic Distress**: Dysmorphic distress refers to a profound psychological disturbance characterized by intense dissatisfaction or discomfort with one's physical appearance. It often involves a distorted perception of body image, leading to significant emotional distress and impaired functioning in daily life. 
 + 
 +**DSM-5**:  The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published by the American Psychiatric Association, provides criteria for the diagnosis of various mental disorders, including PTSD. 
 + 
 + 
 +**Edit Points**:  In the context of IEMT, edit points refer to specific moments within traumatic memories that can be targeted and adjusted through therapeutic techniques to disrupt their recurrent and debilitating nature. 
 + 
 + 
 +**Identity Disturbance**:  A disruption or alteration in an individual's sense of self-identity, often observed in PTSD patients due to the impact of traumatic experiences on their core beliefs and perceptions of themselves. 
 + 
 + 
 +**Imprinting Event**:  The initial experience or memory associated with a particular emotional response or sensation. 
 + 
 + 
 +**Integral Eye Movement Therapy (IEMT)**:  A psychotherapeutic approach aimed at alleviating emotional distress and identity-based issues through specific eye movement techniques, particularly effective in addressing PTSD symptoms. 
 + 
 + 
 +**Kinesthetic Pattern (K-Pattern)**:  A technique within IEMT aimed at eliciting and addressing undesired physical sensations or feelings associated with trauma or emotional distress. 
 + 
 + 
 +**Living Dead Metaphor**:  A metaphorical concept describing the feeling of emotional detachment or numbness experienced by individuals with PTSD, reflecting a sense of existing rather than truly living. 
 + 
 + 
 +**Lynchpin Concept**:  In the context of PTSD and IEMT, the lynchpin refers to a pre-trauma personality trait that becomes a central causative factor in an individual's PTSD following a traumatic event. It triggers distressing flashback experiences when encountered in similar contexts, representing a key focus for therapeutic intervention. 
 + 
 + 
 +**Mirror Box Therapy**:  Therapeutic approach utilizing a mirror to create a visual illusion of the missing limb, facilitating emotional processing and reducing phantom limb pain. 
 + 
 + 
 +**Mirror Visual Feedback (MVF)**:  A therapeutic technique used in treating phantom limb pain, where patients use a mirror to create the illusion of the presence of their amputated limb. This visual feedback helps reconcile the discrepancy between perceived and actual physical body, reducing pain and discomfort associated with phantom sensations. 
 + 
 + 
 +**NGOs (Non-Governmental Organizations)**:  Organizations independent of government involvement, typically focused on humanitarian, environmental, or social causes. 
 + 
 +**Pain Perception Threshold**:  The level of pain intensity required to evoke a response, which can be lowered by chronic pain or depression, leading to heightened pain experiences. 
 + 
 + 
 +**Phantom Limb Pain**:  Pain or discomfort experienced in a limb that is no longer present, often occurring after amputation or loss of a body part. 
 + 
 + 
 +**PTSD (Post-Traumatic Stress Disorder)**:  A mental health condition triggered by experiencing or witnessing a traumatic event. Symptoms may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. 
 + 
 + 
 +**Rapport-building**:  The process of establishing a positive and trusting relationship between therapist and client, often through empathetic communication and mutual understanding. 
 + 
 + 
 +**Retroactive Alteration**:  The attempt to change or amend past events, often observed in individuals with PTSD who seek to revert to their pre-trauma selves or alter the outcome of the traumatic event. 
 + 
 + 
 +**Therapeutic Modalities**:  Various approaches or methods used in therapy to address mental health conditions, including PTSD, such as cognitive-behavioral therapy (CBT), exposure therapy, and eye movement desensitization and reprocessing (EMDR). 
 + 
 + 
 +**Transderivational Search**:  A process in which an individual accesses memories or experiences related to a specific feeling or sensation. 
 + 
 + 
 +**Trauma**:  Psychological distress resulting from a disturbing experience that overwhelms an individual's ability to cope, often leading to long-lasting emotional and psychological effects. 
 + 
 + 
 +**Vicious Cycle**:  A detrimental loop where pain exacerbates depressive symptoms, which in turn intensifies pain perception, perpetuating the cycle. 
  
-  ==== B: Glossary of Terms ==== 
-==Abreaction== 
- Psychological process involving the reliving and expression of emotional distress, particularly effective in mirror box therapy for reprocessing emotional trauma associated with limb loss. 
-==Advisory Board== 
- A group responsible for guiding and advising the project's direction and implementation. 
-==Amplitude Scale== 
- A scale used to measure the intensity of a sensation or feeling, typically ranging from 1 to 10, with 10 representing the highest intensity. 
-==Body Image Disruption== 
- Profound alteration in self-perception following physical changes like limb amputation, leading to persistent identity loss and self-consciousness. 
-==Bridge Effect== 
- Dysmorphic distress acts as a link intensifying the bidirectional relationship between pain and depression by increasing pain sensitivity and exacerbating depressive symptoms. 
-==Catharsis== 
- Emotional release and relief achieved through expressing and reliving emotional turmoil, allowing patients to interrupt the cycle of pain and depression. 
-==Chronic Pain== 
- Long-lasting pain, such as in phantom limb syndrome, causing significant stress on mental health and increasing the risk of depression. 
-==Clinical Evaluation== 
- A comprehensive assessment conducted by healthcare professionals to diagnose and evaluate the severity of mental health conditions, ensuring accurate diagnosis and appropriate treatment. 
-==Clinicians== 
- Healthcare professionals, such as doctors, therapists, or counselors, responsible for providing medical treatment or therapy to patients. 
-==Core Training Group== 
- A group composed of both clinical and non-clinical members tasked with receiving training and disseminating knowledge to relevant stakeholders. 
-==DSM-5== 
- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, published by the American Psychiatric Association, provides criteria for the diagnosis of various mental disorders, including PTSD. 
-==Edit Points== 
- In the context of IEMT, edit points refer to specific moments within traumatic memories that can be targeted and adjusted through therapeutic techniques to disrupt their recurrent and debilitating nature. 
-==Identity Disturbance== 
- A disruption or alteration in an individual's sense of self-identity, often observed in PTSD patients due to the impact of traumatic experiences on their core beliefs and perceptions of themselves. 
-==Imprinting Event== 
- The initial experience or memory associated with a particular emotional response or sensation. 
-==Integral Eye Movement Therapy (IEMT)== 
- A psychotherapeutic approach aimed at alleviating emotional distress and identity-based issues through specific eye movement techniques, particularly effective in addressing PTSD symptoms. 
-==Kinesthetic Pattern (K-Pattern)== 
- A technique within IEMT aimed at eliciting and addressing undesired physical sensations or feelings associated with trauma or emotional distress. 
-==Living Dead Metaphor== 
- A metaphorical concept describing the feeling of emotional detachment or numbness experienced by individuals with PTSD, reflecting a sense of existing rather than truly living. 
-==Lynchpin Concept== 
- In the context of PTSD and IEMT, the lynchpin refers to a pre-trauma personality trait that becomes a central causative factor in an individual's PTSD following a traumatic event. It triggers distressing flashback experiences when encountered in similar contexts, representing a key focus for therapeutic intervention. 
-==Mirror Box Therapy== 
- Therapeutic approach utilizing a mirror to create a visual illusion of the missing limb, facilitating emotional processing and reducing phantom limb pain. 
-==Mirror Visual Feedback (MVF)== 
- A therapeutic technique used in treating phantom limb pain, where patients use a mirror to create the illusion of the presence of their amputated limb. This visual feedback helps reconcile the discrepancy between perceived and actual physical body, reducing pain and discomfort associated with phantom sensations. 
-==NGOs (Non-Governmental Organizations)== 
- Organizations independent of government involvement, typically focused on humanitarian, environmental, or social causes. 
-==Pain Perception Threshold== 
- The level of pain intensity required to evoke a response, which can be lowered by chronic pain or depression, leading to heightened pain experiences. 
-==Phantom Limb Pain== 
- Pain or discomfort experienced in a limb that is no longer present, often occurring after amputation or loss of a body part. 
-==PTSD (Post-Traumatic Stress Disorder)== 
- A mental health condition triggered by experiencing or witnessing a traumatic event. Symptoms may include flashbacks, nightmares, severe anxiety, and uncontrollable thoughts about the event. 
-==Rapport-building== 
- The process of establishing a positive and trusting relationship between therapist and client, often through empathetic communication and mutual understanding. 
-==Retroactive Alteration== 
- The attempt to change or amend past events, often observed in individuals with PTSD who seek to revert to their pre-trauma selves or alter the outcome of the traumatic event. 
-==Therapeutic Modalities== 
- Various approaches or methods used in therapy to address mental health conditions, including PTSD, such as cognitive-behavioral therapy (CBT), exposure therapy, and eye movement desensitization and reprocessing (EMDR). 
-==Transderivational Search== 
- A process in which an individual accesses memories or experiences related to a specific feeling or sensation. 
-==Trauma== 
- Psychological distress resulting from a disturbing experience that overwhelms an individual's ability to cope, often leading to long-lasting emotional and psychological effects. 
-==Vicious Cycle== 
- A detrimental loop where pain exacerbates depressive symptoms, which in turn intensifies pain perception, perpetuating the cycle. 
 ===== 5. Quality Assurance ===== ===== 5. Quality Assurance =====
   * Standards for Training Delivery   * Standards for Training Delivery
   * Feedback and Continuous Improvement Processes   * Feedback and Continuous Improvement Processes
 +  * Preparation of material ahead of training delivery
 +  * Compliance with ethical guidelines
 +  * Collaboration with the core group to ensure challenges are dealt with promptly
  
  • Last modified: 2024/04/27 07:32
  • by tom