Wired for touch: the neurons and circuits of the somatosensory system

Our tactile world is infinitely rich: a cold breeze, a sharp poke, raindrops, or a mother’s gentle caress all impose mechanical forces on our skin, and yet we encounter no difficulty in telling them apart and can react differently to each. How do we recognize and interpret the myriad of tactile stimuli to perceive our physical world? Aristotle … [Read more...]

Teaching people about pain – a kind of position paper

Some time ago, I wrote this paper, at the request of the journal Physical Therapy Reviews, on reconceptualising pain. It is a little old now but it has come to be a bit of a position paper. The position has four fundamentals, none of which will be very surprising to anyone I imagine: (i) pain does not provide a measure of the state of the … [Read more...]

The Brain in CRPS-More Barriers or New Opportunities

From a biological perspective, I find CRPS very perplexing. So do many other people—the community of scientists that are pursuing better treatments, through a better understanding of the basic mechanisms, or by developing better animal models of CRPS, or by undertaking clinical investigations and clinical trials, stretches across many countries and … [Read more...]

Reflections, imagery, and illusions: the past, present and future of training the brain in CRPS

More than a century ago, Harvard Professor Charles Burnett described a set of experiments in which healthy volunteers moved their hands in front of a mirror(1). He reported that watching the reflection of their own bodies disrupted the movement and perceived position of their limbs. Since then, many philosophers and psychologists have used mirrors … [Read more...]

Letter to the BMJ – Neuropathic pain – Management is more than pills

We have one important caveat in relation to Freynhagen and Bennett’s review—that evidence based non-pharmacological treatment for neuropathic pain was absent.[1] Several randomised controlled trials show that graded motor imagery reduces pain and disability in chronic complex regional pain syndrome 1 (CRPS1) and phantom limb pain after … [Read more...]

British Pain Society manoeuvres – why the desperation

Despite the grumblings about the National Institute for Health and Clinical Excellent (NICE) in the UK, it seems to be seen as a 'gold standard' in other countries.  See this comment in Nature Taking the NICE path The United States can learn from the UK body that rates the effectiveness of medical procedures.... and our letter to the British … [Read more...]