This story of a 28 year old man with disabling low back pain illustrates the CB-CFT intervention trialled in the RCT in Bergen, Norway. ‘Eight years ago I had a lifting injury at work. It was terrible pain, I was worried so I went to the doctor who ordered a scan. The doctor said I had a back of a 70 year old. He said I couldn’t surf again and … [Read more...]
Self-management for low back pain
January 3, 2013 by 6 Comments
I have had an interest in low back pain since the early stages of my career as a physiotherapist. My relatives, friends and patients complained about this condition and its recurrence even after receiving treatment. At that time, I was intent on finding a “cure” for this condition. I often browsed the literature to find the causes and possible … [Read more...]
The New Back Pain Choices Tool
July 31, 2012 by 12 Comments
The problem Back pain is something most of us will suffer at some point in our life. The good news is that we now understand a lot about how to effectively manage back pain. Unfortunately it is taking a while for that evidence to reach practice.Most Australians who self-manage their back pain or seek care from a GP do not receive effective … [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...]
There is no such thing as a new idea continued
September 22, 2011 by 5 Comments
(continued from last post)…Socio-cognitive models have been used by health psychologist to increase our understanding of a variety of health behaviours. What about disability associated with low back pain? If we can think of disability as made up of specific behaviours then and if these behaviours are intentional it follows that people with … [Read more...]
There is no such thing as a new idea
September 20, 2011 by 5 Comments
For my first BIM post I wanted to blog about an article that I read some years ago that had probably the biggest impact on my thinking on low back pain and disability and 15 years later still informs the way that I think about pain and disability.Around the mid 1990s when I first started research in low back pain a UK-based health psychologist … [Read more...]
Of shiny pictures and poorer outcomes: Spinal MRI and back pain
March 29, 2011 by 23 Comments
Diagnosing low back pain is a nightmare. It established that apart from the 15% of back pain cases which can be attributed to a specific spinal pathology, the majority of cases fall under the unsatisfactory umbrella label of “non-specific low back pain”.I was discussing with a colleague a new review that, while admittedly light on data, … [Read more...]
Maintenance spinal manipulation: The cherry-pickers quandary
March 10, 2011 by 14 Comments
The email from the industry was effusive. In a cock-a-hoop, caps lock-happy frenzy it bellowed “ALL MANUAL MEDICINE PROVIDERS SHOULD BE AWARE OF THIS STUDY”. The study in question, soon to be published in the journal “Spine” is a RCT that specifically looks at whether patients with chronic back pain benefit from a sustained period of … [Read more...]
Popping your disc – when ‘elegant simplifications’ are ‘catastrophic trivialisations’
March 3, 2011 by 9 Comments
I know a good number of well meaning clinicians who love telling patients how bad their injury is - "Wo George - you are lucky you didn't end up in a wheelchair!" - "Martha - you have the back of an 80 year old" - "Jeepers John - it's bone on bone in there!". How many surgeons visit their patient a week after surgery and say, with a glint in … [Read more...]
Chronic back pain: Behavioural treatments sent to the naughty step?
February 1, 2011 by 15 Comments
We have written a fair amount here about back pain. We’ve criticised some of the information patients get, shown how data has undermined many widely held beliefs about back pain (here and here), and acknowledged the rather desperate state of the evidence in terms of treatment efficacy. It is becoming more popular to see back pain as a problem of … [Read more...]
Back pain: It ain’t what you do it’s ….?
November 22, 2010 by 32 Comments
Every now and then I stumble across a paper that evokes the reaction “I wish I’d though of that”. Such a paper recently turned up in the journal Rheumatology by Majid Artus and his colleagues at Keele University. They performed a systematic review that aimed to assess not the effectiveness of interventions but instead the overall pattern of … [Read more...]
Psychological obstacles to recovery in back pain: A rumble in the journal
September 23, 2010 by 6 Comments
I’m a little late to this one but an interesting disagreement recently emerged in the letters to the editor in the journal Pain. This focused around a recent study from the impressive Arthritis Research Campaign National Primary Care Centre at Keele University, UK into the psychological obstacles to recovery from low back pain.The study … [Read more...]
Chronic Low Back Pain and Advanced Mathematics
August 25, 2010 by 1 Comment
It is tempting, in research, to apply the normal rules of summation - where adding one treatment that you think is effective to another treatment that you think is effective should give you a combined treatment that is more effective than either. However, as Cormac Ryan from Glasgow Caledonian University points out, it does not necessarily work … [Read more...]
Teaching people about pain – a kind of position paper
August 23, 2010 by Leave a Comment
Some time ago, I wrote this paper, at the request of the journal Physical Therapy Reviews, on reconceptualising pain. It is a little old now but it has come to be a bit of a position paper. The position has four fundamentals, none of which will be very surprising to anyone I imagine:(i) pain does not provide a measure of the state of the … [Read more...]
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