Development and testing of pain education programme for low back pain in Nepal: The PEN-LBP trial

Similar to developed countries, low back pain (LBP) is the biggest cause of disability in developing countries such as Nepal [1]. Surprisingly, most research on LBP in Nepal has focused on low value care - treatments with questionable effects but often with known risks or side effects and significant costs. As most health expenses in Nepal are … [Read more...]

Acute low back pain: Can screening predict recovery?

There is substantial variability in the clinical course of people presenting with acute low back pain (LBP) – pain that lasts for up to 3 months. The majority of patients with acute LBP recover from the episode within a few weeks or months;[1] however, substantial variability exists between patients: some will recover within a few days, others will … [Read more...]

Seeing your pain site – continued

Some time ago we reported here about the effect of visual induced analgesia on experimental pain in chronic back pain patients. In short to remind you: we used real-time video feedback; a video camera filmed the back and presented the video in real-time on a monitor in front of the subjects, and that was compared to watching a plain hand video. We … [Read more...]

Who’s goal is it anyway?

Goal setting is well accepted amongst healthcare workers and is included in guidelines in the management of chronic low back pain (CLBP). Most self-management programs, aimed at motivating a person to change behaviour to achieve a specific outcome, include goal setting. The majority of clinicians agree that goal setting is important and think they … [Read more...]

Pain neuroscience education: Effects on pain and disability in chronic low back pain

Pain neuroscience education (PNE) has changed our practice as clinicians, our knowledge and the way we interact with patients. But does it change short-term or long-term pain and disability in patients with persistent low back pain? Until recently, three systematic reviews had been undertaken to evaluate the effect of PNE in persistent non-specific … [Read more...]

Embedding psychology into physiotherapy for low back pain – why is it so difficult to change our minds?

“The way I look back at physio now, was that it was just the hell I had to go through in order to eventually get to pain services”. Those were the words a patient with chronic low back pain (LBP) used to describe their experience of musculoskeletal physiotherapy in a patient involvement group I’d been invited to speak at. I was stunned. As a … [Read more...]

Do words matter when you’re a woman with pelvic pain talking to your clinician?

How do you describe a pain like dysmenorrhea, or painful sex, or vulval pain, or the pain of endometriosis, to someone who has never experienced these things, and possibly never will? Around 20% of women suffer from persistent pelvic pain, and their symptoms can be a confusing mix of period pain, pelvic muscle spasms, bowel symptoms, bladder … [Read more...]

What does high value care for musculoskeletal pain look like?

A middle aged patient with slow onset shoulder pain was concerned about the results of a left shoulder ultrasound that showed a partial tear in her rotator cuff. Since the result she had taken to wearing a sling to protect the shoulder from “further tearing”. A patient with a three year history of work related, disabling low back pain, and a … [Read more...]

An incongruent answer to the incongruence theory

Around 20 years ago, researchers started asking questions about the relationship between sensorimotor incongruence (SMI) and chronic non-specific pain conditions. Initially the relationship was raised within the framework of phantom limb pain, but since cortical reorganisation was also present in people with other types of chronic pain (e.g., … [Read more...]

Do physiotherapists effectively deliver psychological interventions?

Many of you will be asking why this topic? I had an accident in 2012 where I was diagnosed with whiplash/fibromyalgia. I tried physiotherapy and conventional medicine, all the while my health deteriorated. After two years, I added meditation to my physical therapy routine, and by 2015, I had fully recovered physically and mentally. This experience … [Read more...]