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...]

Wired for touch: the neurons and circuits of the somatosensory system

Our tactile world is infinitely rich: a cold breeze, a sharp poke, raindrops, or a mother’s gentle caress all impose mechanical forces on our skin, and yet we encounter no difficulty in telling them apart and can react differently to each. How do we recognize and interpret the myriad of tactile stimuli to perceive our physical world? Aristotle … [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...]

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...]

Can fear of movement lead to physical inactivity in low back pain?

It’s well known for most health professionals who regularly treat patients with back pain that often patients are afraid of moving because they believe that movement will cause further pain and injury. This fear of movement, and belief that physical activities will cause (re)injury, is the central concept of the well-known Fear-Avoidance Model. … [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...]

A new method of assessing women with pelvic pain

Are you female? Do you know any females? Chances are, the majority of you are thinking ‘yes’. And chances are, the majority of those females you know have experienced pelvic pain. Almost every woman will experience pain during menstruation (dysmenorrhoea) at some point during her life[1] – and usually it seems like some kind of uterus-driven … [Read more...]