Patient education: panacea, public relations, or path to better care for patients with low back pain?

Part 2 What should patient education involve? Clinical guidelines provide little detail on the what, where, and how long of patient education. There are common features on what should be included: advice to stay active, reassuring of a good prognosis, nothing seriously wrong. Unfortunately, there isn’t much more than that. We don’t, for example, … [Read more...]

Patient education: panacea, public relations, or path to better care for patients with low back pain?

Part 1 Should patient education be part of my treatment? Patient education gets physiotherapists so worked up! I am often surprised at how virulent discussions of patient education can become. “Nocebo language”—language that worsens pain– seems to be a major concern. “Words can harm!” Did you just use a pathoanatomic label for non-specific low … [Read more...]

Explaining Pain for Acute Back Pain – reflections on Traeger et al. part 2

4. Why am I excited? First up, one of the great liberators of being a scientist is that we are not just permitted to change our minds, we are actually required to do so when the data say so. The Very Excellent Kevin Vowles uses the phrase ‘dance to the data’ and I like it. So, I have changed my mind about the likely benefit of just adding a two … [Read more...]

Explaining Pain for Acute Back Pain – reflections on Traeger et al. part 1

The PREVENT trial published recently in JAMA Neurology seems to have created a storm. If  views and tweets and general social noise are your metric, then this one weighs in pretty well – over 15K views and altmetric score passing 260 inside a week. But if impact on the community and likelihood to move the field forward is more your thing, then this … [Read more...]

Aerobic exercise and pain perception in people with headache – what’s the latest?

Now the paper is actually called “Has aerobic exercise effect on pain perception in persons with migraine and co-existing tension-type headache and neck pain?  A randomised controlled, clinical trial” and I confess I did have to read the title several times to get my head around it, but I was instantly intrigued. What do we know about this? There … [Read more...]

Talking the talk: starting the conversation

As physios we spend much of the working day talking with patients (and colleagues!) and consider it one of our core skills, whatever field we work in. These interactions are unique and personal, and have the ability to make or break the outcome of any and every treatment.  If communication is the most important skill that health professionals have … [Read more...]

A Journey to Learn about Pain – a book about pain education for children

Persistent pain in children is an increasingly recognized clinical problem with high prevalence rates found in some populations. A conservative estimate posits that 20% to 35% of children and adolescents are affected by persistent pain worldwide (1). The most commonly reported pain problems in children and adolescents are headache; abdominal pain; … [Read more...]

The disconnect between tissue pathology, load and pain: implications for clinicians

For at least two decades, we have known that for chronic pain conditions there is discrepancy between tissue damage seen on clinical imaging and clinical presentation. You can have a severely osteoarthritic X-ray with no pain, or a completely normal X-ray with severe pain. Despite this disparity, imaging findings, such as meniscal tears, rotator … [Read more...]

How does prolonged experimental back pain alter measures of pain inhibition and facilitation?

Facilitation of central pain mechanisms is proposed to be a potential missing link between identifiable tissue damage and the severity of pain experienced across a range of painful conditions [1]. Clinically, it is purported to manifest as widespread hyperalgesia, due to impaired descending nociceptive inhibition and enhanced nociceptive … [Read more...]

Can we learn to feel tired?

At BiM, we have often discussed the idea that learning processes might contribute to chronic pain (e.g., 1, 2, 3, 4). Researchers are also investigating whether other unpleasant states, such as fatigue, can be learned. For this reason we have invited researcher and psychologist Bert to tell us about his work. It is normal to feel tired after a … [Read more...]