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...]

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...]

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...]

Extending scope of practice – physiotherapists’ perceptions of managing non-specific low back pain

There is considerable evidence demonstrating the multi-dimensional nature of non-specific low back pain (NSCLBP)[1], and recent guidelines and mission statements recommend a broad bio-psychosocial (BPS) approach to NSCLBP [2,3]. However, despite growing awareness of the value of embedding psychosocial factors into clinical practice recent studies … [Read more...]

Can video games help older people with back pain?

Low back pain is the leading cause of disability worldwide [1] and up to 90% of people will experience low back pain at some point in their life [2]. The small percentage of people who develop chronic and disabling symptoms account for most of the burden of low back pain, and these are mostly older people [3]. Low back pain becomes more severe … [Read more...]

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...]

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...]

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...]

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...]