International Collaboration Beyond the Culture Gap
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Based on my experience of international collaboration, I decided
to begin an opportunity for international exchange for Japanese young
doctors and created "The Study Group for Nerve and Spine" with
Japanese friends in 1996. Prof. Rydevik and Prof. Olmarker helped
us. Eisai, which sponsors the International Fellowship of ISSLS,
gave us financial support. |
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We have a meeting once a year and we choose a different theme every
year. Based on that theme we hold a symposium, where Japanese top
class young researchers present papers. We present papers and discuss
all in English. We invite foreign guest speakers distinguished in
that field. For ten years up to now, foreign guest speakers have
consisted of 22 researchers from 10 countries, the most from the
United States, 9. |
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International collaboration can be made unexpectedly beyond time
and national border. I published a report of "Metaphysial Dysostosis
(Jansen type)" on JBJS in 1976. It was a very rare congenital
systemic skeletal disease. In 1996, twenty years after that, I got
mail from the United States, asking to send a sample of the patient's
blood for a gene analysis of metaphysial dysostosis. This is my precious
experience to know that an early study can be reexamined by a new
technology many years later in a different country. |
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I think it is important that we, as doctors, be concerned about
our patients' pain. This is a topic that occupies me now. Descartes'
theory of pain was the origin of the organic model. Descartes thought
the impulse traveling from the site of injury to the brain produced
pain. The great development in anatomy and physiology in the nineteenth
century created the scientific basis for believing that pain was
just an electrical impulse traveling along the nerves. But there
had been a different concept before Descartes. In the right figure, "The
Flagellation" by Francesca, pain was presented "within
a complexly layered historical world of religious meaning, social
values, and personal loss." Pain had been considered emotional,
cognitive and social, not simply physiological, before modern science
developed. |
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There have been some studies suggesting that low back pain is not
caused by mere organic damage. The typical one is shown in this slide.
This study examined records of compensable injuries in 1977 in Washington
State. Patients with low back pain received more than one-third of
all compensation payments. Astonishingly, 75% of these patients showed
no finding of organic disease. This means pain should be considered
not in a one-dimensional organic model but in a multidimentional
model which encompasses physiological, emotional, cognitive and social
aspects of pain. |
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There is a saying in Japan that blind people touch the elephant.
Someone touches the ear and says the elephant is like a big fan.
Another says it is like a big pot, touching only the belly. Another
says, like a big hose, with the nose and another says, like a big
pillar, with a leg. This saying can be applied to a study of low
back pain. We cannot understand low back pain completely, if we study
only in our own limited field. |
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This is a slide in Prof. Nachemson's lecture. Now we should study
brain, because low back pain is perceived in the brain. It is important
to clarify the mechanism of perception of low back pain in the brain,
in order to improve the treatment of our patients. This means that
a multidisciplinary approach is essential for new knowledge in low
back pain. |
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The pain we see clinically is not the pain examined in the laboratory.
The pain experienced by a patient is "living pain," according
to Dr. Leriche. "Living pain" cannot be divided into physical
pain and mental pain. It can be considered two hands with fingers
interlaced. Pain, especially chronic pain, is interlacing of body
and mind. |
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We, all the members of ISSLS are working for the same purpose.
We should study in collaboration, crossing interdisciplinary borders.
I think it is the best way of improving diagnosis and treatment of
low back pain. |
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International collaboration beyond national and cultural borders
is also very important. The members discussing at the meeting are
good rivals and good colleagues, who can understand one another's
work best of all. Competition is important, but collaboration is
more important. The history of ISSLS demonstrates it, and I believe
it, based on my experience. I am sure it will lead to further development
in the study of low back pain in the 21st century. |
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