Exercise considerations for chronic musculoskeletal pain

Chronic musculoskeletal pain (CMP) encompasses a diverse range of conditions such as osteoarthritis, discogenic spinal pain, fibromyalgia and chronic widespread pain. There is consistent evidence for the benefit of exercise to improve pain and function in CMP, although there is considerable uncertainty concerning the best exercise modality and … [Read more...]

Assessment of movement control impairments of the neck

In a study on patients with and without neck pain we set out to evaluate a battery of ten movement control tests for the neck using a Rasch analysis (Sattelmayer, Hilfiker, Luomajoki, & Elsig, 2017). The aim was to establish whether all movement control tests measure the construct “movement control impairments of the neck”, to establish the … [Read more...]

Embodied Pain: negotiating action

We determine our world through the actions we take. Whether from the inside or out, our bodies provide us with the means to actively investigate our environment. This investigation is vital to survival. Active investigation enables us to reduce the uncertainty of the world, accommodate the unexpected, and better predict the consequences of our … [Read more...]

Frozen shoulder: fact or fiction?

The term ‘frozen shoulder’ captures the imagination, and carries the implicit suggestion that if frozen it can then thaw. Our paper “Natural history of frozen shoulder: fact or fiction?” published this year in the journal Physiotherapy [1], is a systematic review of the literature regarding the conventional story that a frozen shoulder progresses … [Read more...]

Managing low back pain in secondary care:  Should we screen to target those ‘at risk’ or treat them all?

This study [1] arose out of a clinical aspiration to do things better.  Daily practice in secondary care spinal clinics at a large metropolitan hospital saw distressed and disabled patients with low back pain (LBP) come and go.  Many had waited months or years for ‘surgical’ consultation, only to be promptly discharged – with “community-based … [Read more...]

Clinical prediction rules: Use the babies and throw the bathwater?

There are easily a thousand clinical prediction rules (CPRs) related to managing musculoskeletal pain. Okay, maybe a thousand is an exaggeration. My point is there are many. All designed with the aim of helping clinicians to make more certain decisions about diagnosis (diagnostic CPRs), prognosis (prognostic CPRs) or likely response to an … [Read more...]

Reductionism vs The Big Picture – can we have our kayak and heat it too?

I am down on sleep and have penned a rather personal post, because right now, on the back of some outstanding conversations with some truly impressive newly ‘graduating’ Anaesthetic and Pain Medicine fellows*, it seems an important reflection to share. Yesterday I caught up with my good mate Jono.  Conversation with Jono is always rewarding. He … [Read more...]

Cartographers need not apply: Skin-based maps are self-organising

Many of us will have heard of the visual blind spot, scotomas (an area of partial or complete loss of visual acuity in an otherwise clear field of vision) and phantom limb sensations, but what do these have in common? They show us that despite a void in our perceptual field, we can maintain a somewhat stable perception. Compensation for the missing … [Read more...]

Pain, Disparities, and the Perils of the Endless Loop

“I can’t stop thinking about how much it hurts!” “I’m scared the pain will get worse!” “There’s nothing I can do to make it better!” These and related expressions may ring familiar to pain sufferers – their friends, family, and clinicians too. They are 3 of the many examples of catastrophic reactions that often occur around pain. More … [Read more...]

Tactile acuity in acute pain: do we not see the wood for the trees?

It is well known that chronic pain is associated with changes in the brain: Several lines of research confirm alterations in the central nervous system in chronic pain syndromes including phantom limb pain, complex regional pain syndrome, patients with fibromyalgia, osteoarthritis and - the most prevalent syndrome - chronic non-specific low back … [Read more...]