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...]

Spinal manipulative therapy, Graston technique® and placebo for long standing non-specific mid back pain

Few controlled trials have assessed the efficacy of spinal manipulative therapy (SMT) for mid back pain. In addition no high quality trials have been performed to test the efficacy and effectiveness of Graston Technique® (GT), an instrument-assisted soft tissue massage therapy. The objective of this study was to determine the efficacy of SMT and GT … [Read more...]

Why physical therapy treatments for low back pain may not be living up to their potential

Low back pain (LBP) is a leading contributor to people living with disability throughout the world,1 and the problem appears to be getting worse rather than better.2 Scientists and clinicians, therefore, need to improve treatment for LBP to shift this trend and reduce disability. People with LBP change how they control their posture for … [Read more...]

Diagnostic uncertainty and pain-related guilt: new treatment targets for low back pain?

Low back pain (LBP) is a highly prevalent condition, with a devastating impact on society and it is now recognized as the leading cause of disability worldwide (Lim et al., 2012). Research suggests that several psychological factors play an important role in LBP, and among the most robust factors are depression, catastrophic cognitions, fear of … [Read more...]

Low Back Pain Treatment in Primary Care

In general, most acute low back pain (LBP) recovers spontaneously within a few days or weeks. No active treatment has shown to actually shorten the time it takes for acute back pain to recover. The purpose of medication, manipulation, acupuncture, physiotherapy etc. is at best to ease the pain while one is waiting for nature to heal. And one should … [Read more...]

Common psychologies in back pain?

Numerous psychological factors are associated with chronic low back pain (CLBP) and disability. Clinically, it would appear that the psychological profiles of individuals with CLBP can be dominated by different psychological factors. For example, some people are significantly depressed while others might exhibit strong fear-avoidance beliefs. In … [Read more...]

Could telling right from left be a way forward in low back pain

Lately more and more research has indicated changes in cortical processing and disruptions of bodily representations in patients with low back pain (LBP). Among these findings, which have also been noted with other painful conditions, is impaired performance in laterality judgments [1,2]. While the exact relationship between LBP and laterality … [Read more...]

What’s best for chronic spinal back pain? Physical, behavioural/psychologically or combined interventions?

Non-specific chronic spinal pain (NSCSP), particularly low back pain (LBP) and neck pain (NP), results in significant personal, social and economic burden(here and here).[1,2] Our research group has recently published a systematic review and meta-analysis[3] in the Journal of Pain comparing the effectiveness of conservative interventions for … [Read more...]

Making decisions about activity when your back hurts

Participating in physical activity is an important part of recovering from low back pain. The fear-avoidance model is often used to explain the way in which people who have pain approach activity. This model proposes that when someone experiences pain they may either avoid movement and activity due to fear of further pain or injury, or they … [Read more...]

Pain may or may not inhibit (chronic low back) pain

In 2014 David Yarnitsky hypothesised that people may be characterised by profiles that vary from pro- to anti-nociceptive. Those with pro-nociceptive profiles would likely show a reduced capacity to enrol the body’s own pain inhibitory mechanisms, and heightened sensitivity to repetitive, painful stimuli. Those with anti-nociceptive profiles would … [Read more...]