httpvh://youtu.be/4b8oB757DKcc … [Read more...]
Lumpers, Splitters and STarTers
October 21, 2011 By 17 Comments
In recent years there have been many debates about the disappointing results from clinical trials of treatments for non-specific low back pain. One argument has been about the targeting of treatment for back pain. Many folk have argued that trials which apply a one-size-fits-all treatment fail to show a reasonable effect because amongst those who … [Read more...]
In the mind or in the brain? Central sensitization in chronic fatigue syndrome
October 11, 2011 By 1 Comment
Do you recall patients complaining of hypersensitivity to light, sound, cold, stress or mechanical pressure (e.g. jewellery on the neck)? This often relates to hypersensitivity of the central nervous system, a mechanism referred to as central sensitization. Brain orchestrated inhibitory mechanisms no longer work properly, while the brain activates … [Read more...]
What happens when systematic reviews tell us different things?
September 27, 2011 By 6 Comments
Conventional wisdom tells us that when we want an answer to a clinical question, such as what is the evidence for treatment ‘X’, we should look to systematic reviews because they collate all the available evidence on that topic. Problematically though, sometimes systematic reviews on the same topic don’t all give us the same conclusions. This … [Read more...]
There is no such thing as a new idea continued
September 22, 2011 By 5 Comments
(continued from last post)…Socio-cognitive models have been used by health psychologist to increase our understanding of a variety of health behaviours. What about disability associated with low back pain? If we can think of disability as made up of specific behaviours then and if these behaviours are intentional it follows that people with … [Read more...]
There is no such thing as a new idea
September 20, 2011 By 5 Comments
For my first BIM post I wanted to blog about an article that I read some years ago that had probably the biggest impact on my thinking on low back pain and disability and 15 years later still informs the way that I think about pain and disability. Around the mid 1990s when I first started research in low back pain a UK-based health psychologist … [Read more...]
Kahil Gibran on pain: Prophetic or pathetic?
August 25, 2011 By 16 Comments
Jason Tonley from Kaiser Permanente in LA, reminded me of this old beauty from Kahlil Gibran’s classic The Prophet. Now this stuff is written by a Lebanese American artist and poet, who was raised in poverty without formal education but with a gambling father who was jailed. After being evicted, his mum took him and his sisters and brother to … [Read more...]
Lorimer’s public lecture on a cold wet Adelaide evening
May 12, 2011 By 16 Comments
The University of South Australia runs these public lectures called the Knowledge Works series. The community here seems to enjoy these lectures and it is, in my view, a terrific thing for the Uni to be doing. What is more, I love the opportunity to get a look at a big room, chock-a-block full with bonafide, card-carrying, members of the … [Read more...]
Of shiny pictures and poorer outcomes: Spinal MRI and back pain
March 29, 2011 By 20 Comments
Diagnosing low back pain is a nightmare. It established that apart from the 15% of back pain cases which can be attributed to a specific spinal pathology, the majority of cases fall under the unsatisfactory umbrella label of “non-specific low back pain”. I was discussing with a colleague a new review that, while admittedly light on data, … [Read more...]
Maintenance spinal manipulation: The cherry-pickers quandary
March 10, 2011 By 14 Comments
The email from the industry was effusive. In a cock-a-hoop, caps lock-happy frenzy it bellowed “ALL MANUAL MEDICINE PROVIDERS SHOULD BE AWARE OF THIS STUDY”. The study in question, soon to be published in the journal “Spine” is a RCT that specifically looks at whether patients with chronic back pain benefit from a sustained period of … [Read more...]
Popping your disc – when ‘elegant simplifications’ are ‘catastrophic trivialisations’
March 3, 2011 By 9 Comments
I know a good number of well meaning clinicians who love telling patients how bad their injury is - "Wo George - you are lucky you didn't end up in a wheelchair!" - "Martha - you have the back of an 80 year old" - "Jeepers John - it's bone on bone in there!". How many surgeons visit their patient a week after surgery and say, with a glint in … [Read more...]
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