המוח הכל יכול

אנחנו בעיצומו של לימוד המודל הביו – נוירו – פסיכולוגי (גוף-מוח-נפש) שלפיו אני עובד. במאמר הקודם הרחבתי על המרכיב הפיזי (ביו) וכעת ארחיב על המרכיב התודעתי – קוגנטיבי (נוירו).

המוח שלנו הוא מערכת לומדת. הוא לומד לזהות אנשים, סגנון דיבור, ריח וכד' ולשייך את זה לדברים אחרים ("אם הבוס מדבר אלי בטון כזה, אולי כדאי לבקש כעת העלאה במשכורת…"). הוא לומד לעבוד 'על אוטומט' כמו לנהוג לעבודה או לעשות פעולות שגרתיות אחרות, והוא לומד מהסביבה תובנות שונות.

כך ממש גם לגבי כאבים. המוח לומד את הבעיה ואת המשמעות שלה ומתנהג בהתאם.

ניקח למשל את גברת רוזנטל (שם בדוי כמובן). הגברת קמה בוקר אחד עם כאב גב איום ונורא המקרין לאורך רגל שמאל. כעת ישנם שני תסריטים אפשריים (כמובן שישנם אינסוף תסריטים אבל אלה השניים המייצגים ביותר):

  • גברת רוזנטל מבינה שהגב תפוס, וייתכן שבזמן האחרון היא ניקתה את הבית לפסח, וגם היתה במתח כי ההורים שלה אינם בקו הבריאות. היא משתדלת להמשיך לתפקד כפי יכולתה, ומצד שני לנוח ככל הנדרש. היא מנסה לא לתת לבעיה הזו להלחיץ אותה ושומרת על בטחון שזו תופעה חולפת ובקרוב היא תחזור לשגרה מלאה. במילים אחרות, היא מלמדת את המוח שלה להתייחס לבעיה הזו כאל סוג של 'שפעת' בגב התחתון.
  • גברת רוזנטל מבינה שאם הכאב כל כך חזק ואפילו מקרין לרגל כנראה קרה משהו רציני. היא אפילו חושבת על המושג 'פריצת דיסק' אבל חוששת לדבר על זה. היא מיד מקלידה בגוגל פריצת דיסק ורואה שהכאבים שלה עונים ממש להגדרה הזו… בצר לה היא פונה לאורטופד, ששולח ל MRI ואומר : "יש לך פריצת דיסק ענקית, וגם ככה הגב נראה על הפנים. פלא שזה לא קרה עד עכשיו". הוא ממליץ על זריקת קורטיזון ועל פיזיותרפיה ואם זה לא יעזור – ניתוח..

בשתי הדוגמאות מצבה הפיזי של גברת רוזנטל אינו שונה במאומה, אך המצב התודעתי (וחשוב להדגיש – לא מדובר כאן על מצב נפשי אלא רק על התובנה שקשורה לבעיה) שונה מאוד.

בתסריט הראשון סיכויי ההחלמה של גברת רוזנטל גבוהים מאוד אפילו ללא שום התערבות טיפולית כלשהי. בתסריט השני, גברת רוזנטל נמצאת בסיכון גבוה להפוך להיות חולת גב כרונית. כן, המוח והתודעה משפיעים מאוד על סיכויי ההחלמה שלנו.

אז מה עושים?

גם במקרים בהם המוח כבר למד תובנות שליליות שגויות כמו בדוגמא לעיל, שום דבר לא אבוד!

המוח יכול ללמוד מחדש. בדיוק כמו אדם שמחליף מקום עבודה, והמוח שלו צריך להתרגל למסלול נהיגה חדש. העקרון זהה.

כמובן, במקרים בהם התובנות השגויות קיימות זמן ממושך והן שקועות עמוק בתודעה, נדרשת עבודה קוגנטיבית מאומצת יותר.

בכדי לתת מענה לכך פיתחתי בקליניקה תוכנית ליווי טלפונית המסייעת לאנשים, מעבר לטיפול הראשוני, ל"חשב מסלול מחדש" בכל הנוגע לכאבים מהם הם סובלים.

במאמר הבא אסקור בקצרה את המרכיב הפסיכולוגי של בעיות אורטופדיות.

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