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...]

Injustice Perception in Chronic Pain: Shaped Through Expectation and Experience

A tendency to perceive pain as an irreparable or unjust experience may vary widely between people and across situations. Sullivan and colleagues have termed this pattern of thinking “injustice perception”, and have proposed that it is comprised of two, related ways of viewing pain: perceiving inequity or unfairness inherent within the experience of … [Read more...]

Physiotherapists struggle to identify and deal with psychological factors in chronic low back pain

Psychological factors including catastrophizing, fear of movement and psychological distress are predictors of negative outcomes in patients with chronic low back pain (CLBP).[1] Furthermore, patients with CLBP often have comorbid depressive and anxiety disorders.[2] Healthcare professionals involved in managing CLBP are therefore challenged to … [Read more...]

What about the clinimetric properties of sensorimotor measurement instruments?

That chronic low back pain (CLBP) is associated with functional and structural changes in the central nervous system is difficult to dispute and subject to wide-ranging ongoing research (Moseley and Flor, 2012, Omori et al., 2013, Vrana et al., 2016),  especially in the field of neuroimaging and neurophysiology (Henry et al., 2011). There are many … [Read more...]

Cognitive Biases and Young People’s Pain Experiences: What do we know and where to go next?

Many children and teenagers are affected by chronic pain, which can negatively impact their day-to-day activities, how they feel, and their likelihood of future health problems[1,2,3,4]. Psychological therapies are effective at treating pain and related disability across pain conditions in young people, but there is lots of room for improving their … [Read more...]

The pediatric pain equation: Where do parental injustice appraisals of pain fit in?

Pain is not a singular physical sensation. It can be amplified or reduced by a multitude of physical, psychological, and social factors. For example, we recently found that when children view their pain as “unfair” or “unjust” (pain-related injustice appraisals) they also report more pain, impairment, and worse functioning, even after we accounted … [Read more...]