Should I stay or should I go? When goals conflict in the context of pain

Why is it that some individuals with chronic pain stay fairly active, and others are not? Why do individuals act the way they do? One possible answer to both questions might be motivation. Imagine being an individual suffering from chronic pain. When you experience pain, it may push you to pursue or avoid activities in order to control pain or … [Read more...]

Prickly issues: The biopsychosociality of pain might not necessarily mean biopsychosocial treatments work. 

A little while ago now*, O’Keeffe et al published a systematic review and meta-analysis that showed little difference in effect between treatments they described as physical, psychological or combined. The paper was vigorously criticised by Robert Gatchel—of functional restoration fame—and John Licciardone, who run a combined all-on-one-site … [Read more...]

Lifestyle behaviour change with chronic pain isn’t a piece of cake

Chronic pain and other chronic health issues appear to have considerable links. For example, data published by the Australia Institute of Health and Welfare show 64.5% of people with chronic back problems also report another chronic condition, such as cardiovascular disease, diabetes, chronic obstructive pulmonary disease. One hypothesis for why … [Read more...]

The MultiDimensional Symptom Index: A New Tool for Rapid Phenotyping of People in Pain

I like to measure things. I mean, I really like to measure things. Not entirely sure where that comes from, possibly my love of The Count on Sesame Street during my younger days, or possibly stemming from my philosophical positions on the nature of knowledge and reality:  I believe that any exploration of natural events that includes a … [Read more...]

A national initiative to advance pain education across Canadian physiotherapy programs

Integrating best evidence on pain management within the entry-level training of healthcare professionals is arguably one of the most comprehensive and effective ways of closing the knowledge-to-practice gap within our field. This, however, is no simple feat. One important challenge is that there are a multitude of factors and invested stakeholders … [Read more...]

Balancing confidence and compassion when responding to children’s chronic pain

A diagnosis of chronic pain is not a milestone that parents and young people plan for. Similarly, knowing how to effectively respond to and care for a child who is experiencing pain that sticks around for longer than anticipated is not part of most parents’ parenting toolkit. Thus, parenting a child with chronic is pain is uniquely difficult- not … [Read more...]

A mechanistic approach to pain management: Applying the biopsychosocial model to physical therapy

“Physicians and patients usually harbor a concept of pain that involves a linkage between body damage and the pain reported by the patient. This is an inadequate concept that leads both physicians and their patients into unnecessary difficulties in the management of chronic pain.” Loeser, 1982 [1] We recently read the classic article by Loeser … [Read more...]

Biased towards pain: the role of expectancy in impaired selective learning in fibromyalgia patients

Associative learning is the process by which people and animals learn that two events or stimuli occur together. One of the evolutionary advantages of associative learning is to identify predictors of adverse situations or consequences (i.e., those that produce harm), so that we can anticipate and avoid them. For example, a person suffering from … [Read more...]

A simple question with a complex answer: Why do people seek healthcare?

The obvious answer to the question, why do people seek healthcare for musculoskeletal conditions might be because of pain, loss of function, or disability. To some degree, all of these reasons are suitable answers.  However, as the British economist E.F. Schumacher once stated “everything can be seen directly except through the eye through which we … [Read more...]

Difficulties with cluster randomized trials in primary care

Cluster randomized trials (cRCT) are a popular and common design option for trials based in primary care. Because the number of eligible patients are limited within each primary care facility, to collect a large enough sample it becomes necessary to involve multiple health care providers from multiple health care clinics. This raises the question … [Read more...]