Torture has received a great deal of deserved media attention in recent years. In large part this is due to people who should know better somewhat shamelessly jumping through legal hoops in attempts to distinguish which ways of abusing their fellow humans are acceptable and distinct from torture. This should be surprising in the current millennium … [Read more...]
Acupuncture, some dodgy maths and a cracking review paper
December 6, 2010 By 49 Comments
I have a challenge for you. Imagine you’re in ancient China and you’ve had this idea that health and disease hang on the flow of energy through invisible energy pathways called meridians that can be manipulated by applying needles in certain specific points. How do you go about systematically validating this theory? How do you know where the … [Read more...]
Location Location Location. Acupuncture and chronic shoulder pain – CAM or Sham?
October 12, 2010 By 11 Comments
Having written a number of posts on acupuncture (see here, here, and here) I guess my particular biases are reasonably apparent. So imagine my surprise when a large RCT published in the journal “Pain” reports a significant and substantial effect of Chinese acupuncture in comparison with sham acupuncture or conventional orthopaedic therapy for … [Read more...]
Now then, Pay Attention!
October 5, 2010 By Leave a Comment
To mark 10 years of Nature Reviews Neuroscience this month the journal has produced a kind of retrospective of the most highly cited reviews from each year. I got around to reading the 2002 “winner” from Maurizio Corbetta and Gordon Shulman which focused on attention networks in the brain, and a quality read it is. The authors build the case … [Read more...]
Psychological obstacles to recovery in back pain: A rumble in the journal
September 23, 2010 By 6 Comments
I’m a little late to this one but an interesting disagreement recently emerged in the letters to the editor in the journal Pain. This focused around a recent study from the impressive Arthritis Research Campaign National Primary Care Centre at Keele University, UK into the psychological obstacles to recovery from low back pain. The study … [Read more...]
Misinformed Consent? What not to tell a patient with back pain
August 19, 2010 By 14 Comments
We just came across a fancy patient information form that was given to a patient after an assessment by a clinician. The form just blew our minds (but not in a good way) because it seemed to be the perfect clinical tool for generating ongoing pain and disability, and all by the simple process of ramping up the fear. So, just for fun, we thought … [Read more...]
The morality of magic kisses: Ethics and placebo in physiotherapy
July 26, 2010 By 16 Comments
When my daughter hurts herself, her placebo of choice is a “magic kiss”. This therapeutic intervention must be applied with care specific to the area of injury. Anecdotal evidence suggests that it is very effective. I use placebo freely at home but is it right to do this in the clinic? In a recent post I suggested that we can be more confident … [Read more...]
Paul the Psychic Octopus: A watery lesson in understanding clinical evidence
July 15, 2010 By 2 Comments
So the World Cup justifiably goes to Spain and it seems that Paul, the now world famous psychic octopus, predicted the results. In fact Paul demonstrated a seemingly legendary clairvoyant ability. Wikipedia informs us that he predicted the outcome of all of Germany’s games and the final with unerring accuracy. You may not have realised it … [Read more...]
Back Pain Myths Closing Sale Everything must go
June 15, 2010 By 12 Comments
Everyone knows all about low back pain. This is probably by virtue of the fact that most of us have or will experience it at some stage. Everyone is an expert, clinicians and patients alike and there are a whole host of accepted truths about back pain that we all cling on to. Ideas that replicate themselves successfully across populations have been … [Read more...]
Acupuncture – the mysterious case of the missing razor
June 7, 2010 By 17 Comments
Acupuncture is all the rage in the treatment of pain. Recent clinical guidelines in the UK recommend it in the treatment of persistent back pain. This decision is somewhat controversial and has led to much discussion, because while the research in back pain suggests people feel somewhat better after acupuncture, it also demonstrates with clarity … [Read more...]
Acupuncture, Adenosine and Cycling Fish
June 3, 2010 By 5 Comments
You may have heard this story as it is all over the popular press right now. We are told that scientists have discovered some of the mechanisms underlying acupuncture analgesia. As always with alternative therapy reports the media have enthusiastically bitten off the hand of the press release (see this great account from the blog stuff and … [Read more...]
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