The false promises of shared decision making in rehabilitation

In the recent years, Shared Decision Making (SDM) has been increasingly advocated as an ideal model of treatment decision-making during the medical encounter, as it has been shown to increase benefits for both clinicians and the health-care system (1).  But does SDM result in better outcomes for patients with painful musculoskeletal conditions?  In … [Read more...]

Could Virtual Reality Dodgeball motivate fear-avoidant CLBP patients to move? Implications for future treatment.

Chronic low back pain (CLBP) is one of the most common musculoskeletal conditions health care professionals encounter. Unfortunately, despite ever increasing costs in regards to clinical management, the results remain underwhelming[1,2] giving CLBP an enigmatic nature. As a masters student I am interested in understanding how the neuromodulatory … [Read more...]

One-to-one or strength in numbers – is there a best way to deliver exercise based physiotherapy?

Musculoskeletal (MSK) conditions are common and costly, resulting in significant personal, social and economic burden (here and here) [1, 2]. While physiotherapists deliver many interventions (e.g. massage, spinal manipulation, dry needling, etc.), exercise is probably the most commonly used and researched component of physiotherapy, with many RCTs … [Read more...]

The phantoms in our dreams

Ask yourself for details in your latest dreams and you will recognize how hard it is to recall your own dream content in a precise and valid manner. In William Shakespeare’s world-renowned tragedy ‘Hamlet’, the protagonist says ‘a dream itself is but a shadow’, emphasizing the transience of this cognitive phenomenon. As such, dreams hardly lend … [Read more...]

The healthy hand in the CRPS brain –  digging deeper

‘Cortical reorganisation’ is a commonly used term in pain. In CRPS there has long been evidence of cortical changes; specifically that representation of the CRPS-affected hand in the primary somatosensory cortex (S1) is smaller than that of the S1 representation of the other, healthy, hand [1-5]. In 2015 we performed our own functional MRI … [Read more...]

Cognitive penetration: nowhere or everywhere? Either way you should probably wear protection

Over the past three decades there has been growing consensus that our experiences are not isolated forms that emerge unscathed from the influences of our beliefs, motivations and desires. Rather, they are penetrated by these cognitive or so-called ‘top-down’ effects to the point where the traditional boundaries between cognition and perception are … [Read more...]

Expressing pain: which patients do we trust?

Trustworthiness is one of those instant judgements we automatically make about other people, affecting our behaviour towards them [1]. We wanted to know whether clinicians’ judgements of patients’ trustworthiness affected their estimation of patients’ pain [2]. There seem to be so many grounds on which the complaint and expression of pain is met … [Read more...]

Chronic Pain: Can we reduce long-term painkillers use?

In our recent review in PAIN, the journal of the International Association for the Study of Pain, we presented a provocative perspective on introducing dose-extending placebos in therapeutic plans to boost patients’ outcomes while reducing use of painkillers (e.g, opioids).  This was based on our (and others’) studies showing that placebos produced … [Read more...]

R.I.P. Prescriptive Clinical Prediction Rules

A lot of very good ideas have had a positive influence on clinical practice. Simple concepts such as washing one’s hands, restricting unnecessary care from those who don’t need it, and crowdsourcing in research have helped revolutionize clinical care and healthcare research. Some simple ideas, while well intended, fail to lead to a positive change … [Read more...]

Long-term elbow pain: is the brain more at fault than the tendon?

Tennis elbow (known in medical terms as lateral epicondylalgia) is a common condition that presents with pain on the outer aspect of the elbow. Despite its name, the condition is not restricted to tennis players and can affect anyone performing repetitive movements of the forearm (manual labourers, typists etc). In fact, tennis elbow affects up to … [Read more...]