Do people with chronic pain have altered motor imagery?

The left/right judgement task (LRJT) is a common method of assessing motor imagery performance. The LRJT  involves viewing images of a hand or foot [1], for example, and determining whether the image belongs to the left or right side of the body. This determination is done implicitly meaning that we make an initial judgement then mentally position … [Read more...]

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...]

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...]

Are Modic changes associated with low back pain?

About thirty years ago, de Roos et al. [1] found some signal changes in the endplates of the lumbar vertebra on MRI that had not been described in the literature before. Dr. Modic and his group picked up on the findings and described them further, classifying them into three distinct types, Type 1, Type 2 and Type 3. [2, 3] These first papers were … [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...]

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...]

Creating an assessment tool to improve osteoarthritis knee pain treatment

The knee is one of the joints most commonly affected by osteoarthritis (OA), and pain is the most commonly reported symptom. In England, 1 in 4 individuals aged 55 or over report knee pain, which is often linked to osteoarthritis (OA)[1]. In individuals with OA-related knee pain, mechanisms within the central nervous system (brain or spinal cord), … [Read more...]

Pain after cancer. Let’s take it on.

Here’s an observation of two very different research fields: cancer and pain science education. Take cancer - truly gobsmacking investment in research and treatment globally has seen remarkable improvements in outcomes. Based on UK data, survival rates have doubled since 1970 and for some common cancers, they have quadrupled or more. Now take pain … [Read more...]

I can avoid pain, therefore I must be afraid!

Why is it that some people develop chronic pain after recovering from an injury, while others don’t? Suppose you are one of the many people who had an injury. Let us further assume that you were the one in five who develops chronic pain after injury. You might misinterpret the pain (e.g., you thought that the pain you were feeling was an indication … [Read more...]