What’s best for chronic spinal back pain? Physical, behavioural/psychologically or combined interventions?

Non-specific chronic spinal pain (NSCSP), particularly low back pain (LBP) and neck pain (NP), results in significant personal, social and economic burden(here and here).[1,2] Our research group has recently published a systematic review and meta-analysis[3] in the Journal of Pain comparing the effectiveness of conservative interventions for … [Read more...]

Making decisions about activity when your back hurts

Participating in physical activity is an important part of recovering from low back pain. The fear-avoidance model is often used to explain the way in which people who have pain approach activity. This model proposes that when someone experiences pain they may either avoid movement and activity due to fear of further pain or injury, or they … [Read more...]

A plausible, alternate hypothesis for patient reports of asymmetries within the pelvis

The existence of positional faults of the intra-pelvic joints (sacroiliac joints, symphysis pubis) resulting in pelvic asymmetries remains a hotly debated topic amongst clinicians and researchers in the field of pelvic girdle pain. Check Chapter 46 in the latest edition of Grieve’s Modern Musculoskeletal Physiotherapy for some different takes on … [Read more...]

Sex Differences in Knee Osteoarthritis: Not Just a Joint Issue

We have heard it countless times – Men are from Mars, Women are from Venus, a phrase (and dare I say, grossly overused one) coined by the author, John Gray, to denote the ubiquitous differences in communication and relationship styles existing between men and women. His book, by the same name, has certainly resonated with popular culture, evidenced … [Read more...]

The impact of pain on motivation:  Should I stay or should I go?

Contemporary biopsychosocial models of chronic pain argue that the experience of pain emerges, and is influenced by, an interaction and integration of biological, psychosocial, and social factors.[1]  However, among scientists who study biopsychosocial models, the “bio” part of the model is often underdeveloped.  A greater understanding of how … [Read more...]

Pain may or may not inhibit (chronic low back) pain

In 2014 David Yarnitsky hypothesised that people may be characterised by profiles that vary from pro- to anti-nociceptive. Those with pro-nociceptive profiles would likely show a reduced capacity to enrol the body’s own pain inhibitory mechanisms, and heightened sensitivity to repetitive, painful stimuli. Those with anti-nociceptive profiles would … [Read more...]

Skewed inspection and malleable hypotheses

Science isn’t perfect and research findings often stray from the truth [1]. Researchers miss the bullseye for a number of reasons, but one explanation might be that we let our intuitions give way to cognitive biases. Below, I’ve summarised a news article in Nature [3] that touches on why even the most rigorous thinkers are influenced by … [Read more...]

All cognition is flawed

Clinicians, like with researchers, can fall prey to potential cognitive bias (Kleinmuntz 1990). It lurks within our minds without us being aware of it, and can present itself in everyday life as a stereotype or an assumption. As clinicians though, the cognitive biases that we have, impact two common things we are required to do; diagnose a problem … [Read more...]

What is Cognitive Bias?

As Bill Nighy would say, “Cognitive bias is all around us”. Every time you make a decision that involves any element of human judgement, cognitive bias is introduced. While cognitive bias itself is not bad or evil, a failure to acknowledge cognitive bias is a failure to acknowledge the limits of human intuition. Cognitive bias is what makes us … [Read more...]

Who is healthy?

So-called healthy controls are often included in pain studies as controls to compare with patients or as the main study group in human experimental pain studies. However, the definition of what is considered “healthy” varies, depending on the different study centres or the aim of investigation. Furthermore, the assessment and investigation of … [Read more...]