Beyond Balance: outpatient opioid taper without pain increase is possible

Opioid policy debates are often framed in terms of balancing opioid risks with chronic pain relief. This assumes, not only that opioids provide long-term pain relief, but that opioids are necessary for pain relief. Based on our many years’ experience with successful opioid dose reduction in our structured multidisciplinary pain rehabilitation … [Read more...]

Is “how much?” the right question to ask about exercise for pain?

  Exercise is widely accepted to be beneficial for health and is increasingly prescribed as treatment for many diseases and other chronic health conditions. Many studies in both humans and rodents have investigated the effectiveness of exercise as a treatment for chronic pain. Although the efficacy of exercise in rodent models of persistent … [Read more...]

Oldies but Goodies – What is Complex Regional Pain Syndrome – in plain English

Over this holiday season we are posting the most read articles from the last five years.  Here is the first. What is Complex Regional Pain Syndrome – in plain English What is Complex Regional Pain Syndrome? Well, complex regional pain syndrome (CRPS) is exactly that Complex: Many, many different problems have been identified in people with … [Read more...]

Giving patients the whole truth

I am guilty of being the eternal optimist in my practice. I can’t recall ever telling a patient that the outlook isn’t great for them, even though on many occasions, I had that sinking feeling in my gut. Many patients in pain are distressed enough – they don’t need me to give them more to worry about, do they? Maybe I’m not the only clinician who … [Read more...]

Group Cognitive Behavioural Therapy – can we do better?

Cognitive behavioural therapy (CBT), a  management strategy for chronic pain and its consequences [1], is frequently conducted in groups to minimise cost [2] and maximise efficiency. Although clinicians often report knowing when a group will go well or badly based on who is in the group, evidence that group composition can influence outcomes is … [Read more...]

The Pain Squad App

We know that pain is one of the most common and distressing symptoms for children with cancer. This pain results from many different aspects of cancer and its treatment, including things like chemotherapy, surgeries and repeated needle pokes with blood work and other tests. Pain can negatively impact on many aspects of a child’s life. To best treat … [Read more...]

Is cognitive-behavioural therapy useful for neck pain?

Recently, I had the opportunity to complete a Cochrane systematic review on the effects of cognitive-behavioural therapy on pain, disability, psychological factors, and the quality of life among individuals with subacute and chronic neck pain. This review is the result of a fruitful two year collaboration , between my research team at the … [Read more...]

No brain, no pain: it is in the mind, so test results can make it worse

This post was first published on TheConversation. Here it is in a slightly longer format. NPS Medicinewise has just launched its Choosing Wisely Australia, tagged with the line ‘An important conversation about unnecessary tests, treatments and procedures’. They have gathered an impressive collection of collaborators … [Read more...]

Medical exercise therapy breaks the chronic pain cycle, even in the longer term, in patients with persistent anterior knee pain

In general there is a lack of long-term success in treating people with persistent musculoskeletal pain and long-term anterior knee pain or patellofemoral pain syndrome (PFPS), is no exception [1].  It is reported that approximately 25% of patients with PFPS continue to have pain and dysfunction one year or more after physiotherapy, the most … [Read more...]

Breast pain an issue for 1 in 3 female marathon runners

The breast itself has limited support of its own and as a result moves during activity. This can result in exercise related breast pain, experienced by up to 70% of exercising women [1].  We surveyed 1,285 female marathon runners [2] taking part in the 2012 London Marathon whose bra cup sizes ranged from an AA cup to an H cup, and underband … [Read more...]