Making sense of research and helping it guide our practice

Another in our golden oldie series celebrating BiM's 5th birthday since it published it's first blog post on 17th August 2009.  This one by Neil O'Connell. A sparkling, glittery threat to evidence based practice Here at Brunel I run an MSc module on evidence based practice. In the first session of the module I run an honesty test. Here it is … [Read more...]

tDCS – negotiating the “rising tide” of hype.

By now most of you will have heard of transcranial direct current stimulation (tDCS). It’s been all over the media in recent years and original research has been flooding through the neuroscience and clinical journals. In a nutshell it involves the non-invasive delivery of low intensity direct current applied to the brain via electrodes that are … [Read more...]

Exercise for chronic whiplash – the road to Nullville.

It seems like only yesterday I was blogging about an important trial of targeted care for acute whiplash, which like other such trials returned a convincingly negative result. It seems that our best efforts at improving outcomes in the early stages after whiplash injury do not achieve their goals. But what about when we intervene with a group of … [Read more...]

Spinal manipulative therapy: a slow death by data?

Neil O'Connell 2

I am a recovering manual therapist. In my physio career I have moved from freshly qualified apprentice, eager to learn the secrets of what was sold as a powerful tool, particularly for spinal pain, via what might be classed as a skilled practitioner, certainly in terms of courses attended and assessment hoops jumped through, to someone who now … [Read more...]

Bisphosphonates for chronic low back pain? An early test.

Bisphosphonates are well-established in the management of osteoporosis. These drugs retard bone resorption by targeting osteoclast cells. They encourage osteoclast apoptosis, a type of cell self-destruction. But bisphosphonates have been indulging in a bit of mission creep as they have been demonstrated to have analgesic properties. It is thought … [Read more...]

Antibiotics for low back pain revisited. Important questions asked.

Back in March we blogged about a new and intriguing trial published in the European Spine Journal (ESJ) that appeared to demonstrate that for a group of low back pain sufferers, a course of antibiotics may be an effective treatment. We got to this trial early, when it was published online but not yet in print, and we reported it in a gently … [Read more...]

Targeted therapy for acute whiplash gets it in the neck (again)

What to do about whiplash? Trials have historically produced disappointing results across the board for our management strategies. As is so often the case the interpretation of those results can be broadly divided into 2 camps. One camp (often rather small) who accept that current treatments are not really doing the job, the other who find fault … [Read more...]

Fear, disability, chickens and eggs

Chicken or egg

The Fear Avoidance Model (FAM) has been a big player in the recent history of chronic pain research and clinical practice. Simply put, the premise of the model is that in the acute stage of an injury or painful event, the presence of fear and catastrophic beliefs regarding the meaning of pain or the possible consequences of activity leads to … [Read more...]

Acupuncture once more. A debate in Anesthesia and Analgesia.

We’ve covered acupuncture  a lot on BiM and regular readers will be in little doubt about my interpretation of the evidence. The weight of acupuncture evidence is consistent with an inactive intervention. To my mind further research is pointless (heh). It represents, as we argued in The Conversation recently, an increasingly desperate exercise in … [Read more...]

How should we treat CRPS? Navigating the evidence hodgepodge.

There is no shortage of clinical guidelines for CRPS. Since 2010 we have had guidelines from the Netherlands, from the UK and in the last few months from the USA. Guidelines are always an interesting beast.  They usually involve an exercise in evidence synthesis, consideration by a panel of experts, many of whom are (and I shudder to use the term) … [Read more...]