Acupuncture once more. A debate in Anesthesia and Analgesia.

We’ve covered acupuncture  a lot on BiM and regular readers will be in little doubt about my interpretation of the evidence. The weight of acupuncture evidence is consistent with an inactive intervention. To my mind further research is pointless (heh). It represents, as we argued in The Conversation recently, an increasingly desperate exercise in … [Read more...]

How should we treat CRPS? Navigating the evidence hodgepodge.

There is no shortage of clinical guidelines for CRPS. Since 2010 we have had guidelines from the Netherlands, from the UK and in the last few months from the USA. Guidelines are always an interesting beast.  They usually involve an exercise in evidence synthesis, consideration by a panel of experts, many of whom are (and I shudder to use the term) … [Read more...]

Pain at your finger tips

Here, Gian Domenico Alessandro Magnifico Fantistico Iannetti and Flavia Eleganta Bellisima Mancini talk us through pain at your fingertips. They did a very groovy experiment that, for the first time, uncovered the pattern of receptive fields for nociception at the finger tips. Their results are remarkable insofar as they show that what we have long … [Read more...]

Clean teeth, bad back? Antibiotics for chronic low back pain.

It is unsurprising that there are few-to-no impressively effective treatments for chronic non-specific low back pain. The clue is in the “diagnostic” label. Non-specific low back pain represents the vast majority of cases for whom our traditional diagnoses don’t explain a great deal. If we can’t put our finger on what is causing it, we are likely … [Read more...]

Structural changes in chronic pain. The innocent bystander?

Most BiM readers will be familiar with a body of research indicating that chronic pain is associated with apparent structural changes in the brain. We’ve discussed this issue here at length (see here and here). These findings, principally of reductions in grey matter density across a smattering of brain regions, have led researchers, myself … [Read more...]

VBM – voxel-based morphometry or very bad measurement?

Brain imaging technology has become a big player in the world of pain research in the last 2 decades. In more recent years voxel based morphometry (VBM), which allows us to look at structural changes in the brain (specifically neuronal matter density) has produced some eyebrow raising research in chronic pain. It is this technology that produced … [Read more...]

A big hole in the control? Transcranial direct current stimulation blinding on trial

You may or may not have heard of transcranial direct current stimulation (tDCS), but it is non-invasive method for stimulating the brain with low intensity electrical currents. Over the last decade or so there has been plenty of basic physiology research demonstrating that tDCS directly modulates cortical excitability. Neatly, anodal stimulation … [Read more...]

Woolly Undercrackers! For chronic back pain! This seasons methylene blue?

Keeping up to date in chronic back pain research is a busy process and yet it is rare that a new paper really catches the eye. A while back a trial of methylene blue injections appeared to demonstrate surprisingly impressive results. I blogged on it (here) and mused on how results that good really need to be independently replicated before we can … [Read more...]

A sparkling, glittery threat to evidence based practice

Here at Brunel I run an MSc module on evidence based practice. In the first session of the module I run an honesty test. Here it is (answer it yourself and, well, be honest). “What sections of a research paper do you routinely read. Honestly.” Almost without exception the whole group will admit to reading the abstract and small proportion … [Read more...]

More fragility in core stability

The evidence for the role of exercise in chronic low back pain has been a bit of a theme on the blog here at BiM. We’ve discussed different perspectives regarding the evidence of its efficacy (see here, here and here), where it sits against other treatments in that regard and considered a recent review of its effects, or lack of, on parameters of … [Read more...]