Giving patients the whole truth

I am guilty of being the eternal optimist in my practice. I can’t recall ever telling a patient that the outlook isn’t great for them, even though on many occasions, I had that sinking feeling in my gut. Many patients in pain are distressed enough – they don’t need me to give them more to worry about, do they? Maybe I’m not the only clinician who … [Read more...]

Classification based cognitive functional therapy for back pain

This story of a 28 year old man with disabling low back pain illustrates the CB-CFT intervention trialled in the RCT in Bergen, Norway. ‘Eight years ago I had a lifting injury at work. It was terrible pain, I was worried so I went to the doctor who ordered a scan. The doctor said I had a back of a 70 year old. He said I couldn’t surf again and or … [Read more...]

Self-management for low back pain

I have had an interest in low back pain since the early stages of my career as a physiotherapist. My relatives, friends and patients complained about this condition and its recurrence even after receiving treatment. At that time, I was intent on finding a “cure” for this condition. I often browsed the literature to find the causes and possible … [Read more...]

The New Back Pain Choices Tool

The problem Back pain is something most of us will suffer at some point in our life. The good news is that we now understand a lot about how to effectively manage back pain. Unfortunately it is taking a while for that evidence to reach practice. Most Australians who self-manage their back pain or seek care from a GP do not receive effective … [Read more...]

Exercise for chronic back pain: The beige trouser effect?

Most commonly used exercise therapies for back pain are aimed at having an effect on some mechanical or tissue based aspect of spinal function. From range of motion exercises to muscle balance, endurance or strengthening exercises the (not unreasonable) rationale is that back pain is associated with abnormal spinal function - address that with … [Read more...]

Lumpers, Splitters and STarTers

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...]

There is no such thing as a new idea continued

(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 low … [Read more...]

There is no such thing as a new idea

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...]

Of shiny pictures and poorer outcomes: Spinal MRI and back pain

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

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 “maintenance … [Read more...]