It’s time for a shake up: Driving system wide change to improve musculoskeletal pain care and outcomes

Shaking it up Most of us working in the pain field know the many challenges well. Challenges are widespread, reaching from the health systems (macro) level, downstream through service delivery level and into the clinical (micro) coalface. How can we approach this complexity to achieve person-centred care and respond to the escalating burden … [Read more...]

When can you say you are well again? How do people with Complex Regional Pain Syndrome define recovery?

Complex Regional Pain Syndrome (CRPS) is diagnosed according to a clear and distinct description of the signs and symptoms of the condition [1]. Clinician observations and patient reports are used and reaching a threshold “score” determines a positive diagnosis. This all seems simple enough, and, for the majority of patients, the signs and symptoms … [Read more...]

Take a step back to understand muscle behaviour in chronic low back pain

There is a popular belief that chronic non specific low back pain (CNSLBP) patients need to have higher activation of their trunk muscles during simple functional tasks in order to stabilize their spine. Changes in pain and disability, however, do not seem to be mediated by deep muscle activity changes targeted by some exercise interventions during … [Read more...]

Self-efficacy and paradoxical dependence in chronic back pain

Chronic back pain is one of the most common medical problems patients experience, and it may also be psychologically and socially disabling. People with chronic back pain are significantly more likely to experience depression, anxiety, and other mental health conditions than the general population. I wanted to get a deeper appreciation of how … [Read more...]

A “protection mode” in pain costs

A very simple and clinical way to screen how humans perceive touch is to do a tactile acuity assessment. Tactile acuity is a measure of the precision of the sense of touch and there has been fervid interest in tactile acuity and pain in the past decade. Patients with chronic pain, especially chronic low back pain have reduced tactile acuity.[1] … [Read more...]

Pain, please: Why would anybody volunteer to participate in pain research?

When I am asked what my life’s work is, I often respond that I spend my days in a dark basement laboratory, and recruit volunteers who I then subject to painful stimuli (usually electrical shocks). I am an experimental pain researcher after all. My wife, in disbelief, asks a similar question: “Why on Earth would anybody volunteer to participate in … [Read more...]

Pain? Where?! Attentional bias for pain in the brain

Shortly after starting my PhD, my father had a work accident. He broke his wrist in 2 places, and after surgery had to undergo weeks of physiotherapy. While I do not particularly enjoy seeing others in pain, I must say that, as an experimental psychologist, his timing could not have been better. Indeed, his accident proved to be the perfect … [Read more...]

Will this pain treatment program make my child better?

In 2008 (eek, that’s a decade ago…) I began my faculty career as an attending psychologist in the newly minted Mayo Family Pediatric Pain Rehabilitation Center (PPRC) at Boston Children’s Hospital, Boston, MA, USA. I was lucky enough to be a part of an interdisciplinary team that watched many young people change the trajectory of their lives - once … [Read more...]

A break from pain! How do task interruptions by pain affect performance?

Pain is unpleasant but important for our survival: it is almost as if it is “designed” to tell us that we are in danger. Since people are often busy with something when pain occurs, the usual reaction to pain is to interrupt whatever one is doing at that moment in order to act – be that to run away from whatever causes the pain, or to simply take … [Read more...]

Unravelling Fibromyalgia

Oh for the dream of precision medicine in the world of fibromyalgia (FM)! But how can one possibly apply precision medicine to a condition with the character of a chameleon? Why do we say FM is like a chameleon? The suffering experienced by persons with FM is camouflaged by an outside appearance of normalcy, and the symptoms of FM come and go … [Read more...]