A national initiative to advance pain education across Canadian physiotherapy programs

Integrating best evidence on pain management within the entry-level training of healthcare professionals is arguably one of the most comprehensive and effective ways of closing the knowledge-to-practice gap within our field. This, however, is no simple feat. One important challenge is that there are a multitude of factors and invested stakeholders … [Read more...]

Balancing confidence and compassion when responding to children’s chronic pain

A diagnosis of chronic pain is not a milestone that parents and young people plan for. Similarly, knowing how to effectively respond to and care for a child who is experiencing pain that sticks around for longer than anticipated is not part of most parents’ parenting toolkit. Thus, parenting a child with chronic is pain is uniquely difficult- not … [Read more...]

Are Modic changes associated with low back pain?

About thirty years ago, de Roos et al. [1] found some signal changes in the endplates of the lumbar vertebra on MRI that had not been described in the literature before. Dr. Modic and his group picked up on the findings and described them further, classifying them into three distinct types, Type 1, Type 2 and Type 3. [2, 3] These first papers were … [Read more...]

A mechanistic approach to pain management: Applying the biopsychosocial model to physical therapy

“Physicians and patients usually harbor a concept of pain that involves a linkage between body damage and the pain reported by the patient. This is an inadequate concept that leads both physicians and their patients into unnecessary difficulties in the management of chronic pain.” Loeser, 1982 [1] We recently read the classic article by Loeser … [Read more...]

Biased towards pain: the role of expectancy in impaired selective learning in fibromyalgia patients

Associative learning is the process by which people and animals learn that two events or stimuli occur together. One of the evolutionary advantages of associative learning is to identify predictors of adverse situations or consequences (i.e., those that produce harm), so that we can anticipate and avoid them. For example, a person suffering from … [Read more...]

A simple question with a complex answer: Why do people seek healthcare?

The obvious answer to the question, why do people seek healthcare for musculoskeletal conditions might be because of pain, loss of function, or disability. To some degree, all of these reasons are suitable answers.  However, as the British economist E.F. Schumacher once stated “everything can be seen directly except through the eye through which we … [Read more...]

Difficulties with cluster randomized trials in primary care

Cluster randomized trials (cRCT) are a popular and common design option for trials based in primary care. Because the number of eligible patients are limited within each primary care facility, to collect a large enough sample it becomes necessary to involve multiple health care providers from multiple health care clinics. This raises the question … [Read more...]

Creating an assessment tool to improve osteoarthritis knee pain treatment

The knee is one of the joints most commonly affected by osteoarthritis (OA), and pain is the most commonly reported symptom. In England, 1 in 4 individuals aged 55 or over report knee pain, which is often linked to osteoarthritis (OA)[1]. In individuals with OA-related knee pain, mechanisms within the central nervous system (brain or spinal cord), … [Read more...]

Pain after cancer. Let’s take it on.

Here’s an observation of two very different research fields: cancer and pain science education. Take cancer - truly gobsmacking investment in research and treatment globally has seen remarkable improvements in outcomes. Based on UK data, survival rates have doubled since 1970 and for some common cancers, they have quadrupled or more. Now take pain … [Read more...]

Pain sensitivity in migraine: specific alterations related to stimulus parameters and location

Migraine is the second most prevalent neurological disorder [1] with prevalence of 11-23% worldwide  [2-6]. Understanding the mechanisms of migraine may be the key to identifying and developing new treatments. Quantitative sensory testing (QST) methods are established techniques to assess and measure pain sensitivity in order to gain insight into … [Read more...]