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...]
Pain at your finger tips
April 9, 2013 by 4 Comments
Here, Gian Domenico Alessandro Magnifico Fantistico Iannetti and Flavia Eleganta Bellisima Mancini talk us through pain at your fingertips. They did a very groovy experiment that, for the first time, uncovered the pattern of receptive fields for nociception at the finger tips. Their results are remarkable insofar as they show that what we have long … [Read more...]
Clean teeth, bad back? Antibiotics for chronic low back pain.
March 22, 2013 by 34 Comments
It is unsurprising that there are few-to-no impressively effective treatments for chronic non-specific low back pain. The clue is in the “diagnostic” label. Non-specific low back pain represents the vast majority of cases for whom our traditional diagnoses don’t explain a great deal. If we can’t put our finger on what is causing it, we are … [Read more...]
Structural changes in chronic pain. The innocent bystander?
March 12, 2013 by 2 Comments
Most BiM readers will be familiar with a body of research indicating that chronic pain is associated with apparent structural changes in the brain. We’ve discussed this issue here at length (see here and here). These findings, principally of reductions in grey matter density across a smattering of brain regions, have led researchers, myself … [Read more...]
VBM – voxel-based morphometry or very bad measurement?
January 22, 2013 by 3 Comments
Brain imaging technology has become a big player in the world of pain research in the last 2 decades. In more recent years voxel based morphometry (VBM), which allows us to look at structural changes in the brain (specifically neuronal matter density) has produced some eyebrow raising research in chronic pain.It is this technology that produced … [Read more...]
A big hole in the control? Transcranial direct current stimulation blinding on trial
November 30, 2012 by Leave a Comment
You may or may not have heard of transcranial direct current stimulation (tDCS), but it is non-invasive method for stimulating the brain with low intensity electrical currents. Over the last decade or so there has been plenty of basic physiology research demonstrating that tDCS directly modulates cortical excitability. Neatly, anodal stimulation … [Read more...]
Woolly Undercrackers! For chronic back pain! This seasons methylene blue?
August 28, 2012 by 19 Comments
Keeping up to date in chronic back pain research is a busy process and yet it is rare that a new paper really catches the eye. A while back a trial of methylene blue injections appeared to demonstrate surprisingly impressive results. I blogged on it (here) and mused on how results that good really need to be independently replicated before we can … [Read more...]
A sparkling, glittery threat to evidence based practice
June 12, 2012 by 19 Comments
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 (answer it yourself and, well, be honest).“What sections of a research paper do you routinely read. Honestly.”Almost without exception the whole group will admit to reading the abstract and small proportion … [Read more...]
More fragility in core stability
March 6, 2012 by 17 Comments
The evidence for the role of exercise in chronic low back pain has been a bit of a theme on the blog here at BiM. We’ve discussed different perspectives regarding the evidence of its efficacy (see here, here and here), where it sits against other treatments in that regard and considered a recent review of its effects, or lack of, on parameters of … [Read more...]
Exercise for chronic back pain: The beige trouser effect?
December 16, 2011 by 22 Comments
Most commonly used exercise therapies for back pain are aimed at having an effect on some mechanical or tissue based aspect of spinal function. From range of motion exercises to muscle balance, endurance or strengthening exercises the (not unreasonable) rationale is that back pain is associated with abnormal spinal function - address that with … [Read more...]
Lumpers, Splitters and STarTers
October 21, 2011 by 17 Comments
In recent years there have been many debates about the disappointing results from clinical trials of treatments for non-specific low back pain. One argument has been about the targeting of treatment for back pain. Many folk have argued that trials which apply a one-size-fits-all treatment fail to show a reasonable effect because amongst those who … [Read more...]
Tennis elbow? You’re bleeding me dry!
September 13, 2011 by 4 Comments
A trial of a very very very old treatment for tennis elbow just grabbed my attention. In fact the treatment in question probably precedes tennis itself. Yep, this is a trial of leech therapy for tennis elbow, proving the old adage that old treatments never truly die. The trial itself compared the application of leeches to the common extensor origin … [Read more...]
Breaking Research News – The sensory cortex is not a brick
August 23, 2011 by 15 Comments
Stuck record time for me again. A new paper in BMC Neuroscience has demonstrated that electroacupuncture or acupressure induces changes in activity in the sensory cortex. Using magnetoencephalography (MEG) researchers have demonstrated that these treatments are reflected in altered activity in the sensory cortex. They go on to conclude that … [Read more...]
Low back pain research: The vegetarian barbeque?
July 21, 2011 by 11 Comments
I’m not a vegetarian. Perhaps that understates the issue, I am a fundamentalist carnivore and the idea of a barbeque without sausages and burgers is to me an unconscionable aberration; an affront to common decency. Just be honest and call it a salad party….and then don’t post my invitation.Just as the missing meat at a barbeque is a … [Read more...]
rTMS and chronic pain: Our two penny’s worth
July 5, 2011 by 9 Comments
Some of you might have heard of repetitive transcranial magnetic stimulation (rTMS) and its use in chronic pain. Basically rTMS uses magnetic fields to generate electrical currents within the brain. This is a direct way of altering neuronal firing or excitability in the brain and a number of research groups have been investigating whether it might … [Read more...]
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