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Can We Kill the Term “Non-Specific Effects”?

November 03, 2013 by

What do we mean when we say “non-specific effects”? This phrase is being used at a higher and higher frequency. Even I’m beginning to take the lazy way and use the darn term! I don’t like it! Why are we choosing to be vague in describing what we truly mean? “Non-specific effects” gives the perception that “something” is happening, but we don’t know what.

Let’s take a look at “non-specific effects” and let’s say what we mean!

In my opinion, non-specific effects is a broad phrase. We can be much more specific in what we mean. First of all, let’s establish that the nervous system isn’t some hard-wired, static system. It can be sensitized; it can be desensitized. Cortical remapping can occur. There’s synaptic pruning. There’s the idea that “neurons that fire together, wire together” and of course the opposite, “neurons that fire apart, wire apart.” Is the somatosensory system changing due to cortical representation? Are new neuronal pathways being created due to blocked neuronal pathways? Maybe our interactions are inhibiting the amygdala. When we focus on our words and providing compassion and empathy, we are creating engaged brains. Emotional recognition, somatic states, attention and memories are being altered cognitively.

As you can see, what occurs in our interactions with our patients is far from “non-specific.” We need to determine what effect we want to have AND take steps to ensure it happens. We need to stop hanging onto “non-specific,” and own the specific effects we desire to occur!

Anyone else have thoughts? (Oh, please don’t use “non-specific effect” either. You see, if you do, I will immediately have a negative thought which will result in a deleterious effect on MY brain. )

Until next time,

~Selena

8 Responses

  1. Jay says:

    If ‘specific’ implies localized or singular, then things we do in the realm of pain neuroscience are certainly not specific. You provided quite a list yourself. It isn’t like I provide neuroscience education to a patients with the specific goal of changing function of the amygdala after all. The changes are diffuse and multi-pronged. I hear you that ‘non-specific’ sounds like “we don’t understand” (and in fairness we have much yet to understand), but what would you suggest as a replacement term? An outcome like changes in fear beliefs or catastrophization perhaps?

    • Selena Horner says:

      Interesting point, Jay. You already know that education affects the brain and the words we use affect the brain. Should we term the changes that happen in the brain as non-specific fluff?

      I provided a list because those cognitive responses seem to be what may happen in certain procedures that we do and with some interactions that happen clinically. I would tend to think that each example could have its own linking activity that flips the switch for the cognitive action to occur.

      I’m not sure if there can be a replacement term. I hate the current one and replacing it with any other phrase would be like using a thesaurus and providing the same like phrase which I’d probably still dislike.

      Why not just say what we think is occurring cognitively?

  2. Larry says:

    Selena: I think you are over thinking this as the word is a research word to describe a clinical effect. I agree with you that using it in a clinical context is not very useful (especially to a patient).

  3. And @Larry probably why your not a clinician i’m assuming?

    Agreed; even if we don’t know the particulars, i agree ‘non-specific’ is almost a term to say “i had a late night, and am too lazy to figure out what is actually causing your pain, so going to say non-specific, and do some non-specific treatment”. I think even if we got no idea, we have some clues to some stuff, and some contributing factors, and well other area’s contributing, we can say as you said ‘brain over interrupting your input’s, because you are afraid, there is ‘likely’ chances that this…and this and this,…is occurring”. It’s the same as you wouldn’t go with a Acute knee injury and go, your got “non-specific knee pain”, you would tell them, “hey your ACL is fine, your MCL & LCL for that also, your meniscus is cleared, you got no acute muscle damage, it ‘appears’ that you have some issue of irritation under your knee cap from biomechanical dysfunctions and weaknesses at your hips and pelvic control contributing’ …for example. You would still give them some idea’s. And yes you may not be right, that’s why we call it a ‘hypothesis’, and we give them things that may help. You told them they got non-specific knee pain, guess what they would go off and find someone else, get an MRI ect.. and post on a forum or blog (like this), ‘that physio is stupid”.

    For the sake of patient’s confidence in your treatment, confidence in your knowledge, confidence that what your doing is going to help them, and the impact that has at cognitive level (like you said) is of great impact. So even if we don’t know exactly (which i argue we do have an idea of some stuff occurring at least), at least lie for their confidence. I remember once one of my colleagues telling me, don’t you ever tell an athlete in a competition they have a serious injury, just lie to them that you will help it better. That affect on their brain, will at least allow them to perform still, and potentially fix the issue.

    Agreed Fully!! And research is going to keep giving ‘conflicting results’ and ‘inconclusive’; unless we break it down further to specific entities, and causes ect.

  4. John Ware, PT says:

    As long as the effect of care is to alleviate suffering while insuring that the patient maintains their locus of control, who cares what you call it?

    It’s impossible, really, to parse out the effects of many of our interventions, particularly those that fall into the manual therapy category (remember the Bialosky et al model of manual therapy from 2009?). I think we need to be much more concerned about keeping the patient in control of what’s happening to them during the treatment interaction and be careful about getting caught in the weeds of trying to figure out which pathway is being stimulated when we interact with them.

    Physical Therapy’s roots are embedded in patient empowerment, and I’m very concerned that we are losing sight of that.

  5. John Ware, PT says:

    And, Shane, good luck finding the cause of pain among the patients who need our care the most. Let me know if you find the Holy Grail while you’re at it.

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