What Works for Patellofemoral Pain? What Doesn’t? Why?
The complete guide to patellofemoral pain syndrome (runner’s knee) for patients & pros: facts and myths, science & treatment options.| www.PainScience.com
The complete guide to patellofemoral pain syndrome (runner’s knee) for patients & pros: facts and myths, science & treatment options.| www.PainScience.com
The finer points of resting strategy when recovering from injury and chronic pain (hint: it’s a bit trickier than you might think).| www.PainScience.com
Mostly short posts about pain & injury science, in your inbox.| www.PainScience.com
Welcome to the third and final instalment of my series about why so many people with chronic pain are frustrated with healthcare — especially if they have unexplained pain (fibromyalgia), or more obvious pain that is inexplicably stubborn (like frozen shoulder or Achilles tendinitis that drags on for years). Today I’ll cover the last five of the original list of fifteen — which I could easily expand to twenty. Or twenty-five! But I need to move on to other projects for now! Trigger warn...| PainSci Updates
Not all fat is unhealthy. But when it does cause health problems … it also drives chronic pain. And it’s mostly the belly fat that does this — the visceral fat tucked around your organs like foam packing peanuts. Some people with high body mass index are just fine, while others with a low BMI are still at risk — the “obesity paradox” — usually because they have too much belly fat specifically. [Image caption: Not all fat is unhealthy. But when it is unhealthy … it is a risk fa...| PainSci Updates
I recently got the nicest possible kind of note from a reader, a serious alpinist with equally serious knee issues.| www.PainScience.com
Journavx is finally in the wild. Widely touted as an opioid replacement, it hit the market this year — the first new type of non-opioid pain medication to be approved by the FDA in twenty years. [1] Most media coverage of Journavx has been extremely positive. The New Yorker: Scientists working in pain research described the underlying scientific achievement as “a magisterial first step,” “just marvellous,” and “the holy grail.” Okay, technically that was scientists being extreme...| PainSci Updates
I’ve just banged out a “new” article about implausibly complex compensatory injuries — like blaming a new shoulder pain on a ten-year-old toe stub, which is satirical only in the sense that the dumbest examples are rare. This article was in the pipeline for ages. I did a small blog post back in 2023, answering the FAQ: “Can compensation for an old injury cause a new pain?” Yes, but mostly just the boringly obvious, short-term, and relatively minor examples. The profound “everyth...| PainSci Updates
I’m working through a big update to my plantar fasciitis book chapter on “regenerative” treatments, especially autologous whole blood (AWB) and platelet-rich plasma (PRP) therapy — literally withdrawing blood from a patient and then re-injecting it, or just the platelets. The idea is to stimulate healing by putting more of the active ingredients of blood right where they are most needed. “Increased circulation,” the hard way! [Image caption: Give blood! To … yourself?!] (Remind...| PainSci Updates
Who knew? Hardly anyone! The anterolateral ligament is entirely missing from my library of anatomy texts.| www.PainScience.com
A toxic tradition of ego-driven, trademarked treatments in massage therapy, chiropractic, and physiotherapy.| www.PainScience.com
Every shin splints treatment option reviewed, and a detailed guide to the nature of the beast.| www.PainScience.com
This large retrospective study analyzed over 20,000 cases of medial tibial stress syndrome (MTSS) in the British Armed Forces between 2010 and 2018…| www.PainScience.com
Rather than a “new study” post, this is about a new retraction of a 2022 study of treating aging-associated decline. The experiment supports a drug, and the lead researcher advises the company that’s making it. And one of the co-authors calls it a conspiracy. 🙄 Against pharmaceutical research? An odd gambit! The concerns about the paper seem like a more serious version of the usual sort of quibbles about most papers, but the journal decided it was just a bit too much to tolerate. May...| PainSci Updates
For decades, we’ve been warned to “lift with your knees, not your back” — and most people still believe it. Even physical therapists believe it (in droves), despite plentiful evidence that it’s just not that simple. It might be going too far to say that it’s a “myth” that you shouldn’t lift with your back, but it’s definitely more nuanced than the traditional, one-size-fits-all demonization of stooping. A new study in the European Journal of Pain emphasizes the nuances, an...| PainSci Updates
I recently updated my book about muscle strains with more scientific detail about the exact mechanism of hamstring strains, particularly explaining the dominant theory, and then looking at who disagrees and why. Here’s a good sneak peak behind the paywall, including 8 footnotes visible only to logged-in PainSci members. Most muscle tears happen during contractions that are not only eccentric, but fast and powerful.12 They are most common in sprinting, for instance, and the harder you run, t...| PainSci Updates
The myth of feminine fragility perpetuated yet again.| www.PainScience.com
The science of hands-on treatments like massage and spinal manipulation to “fix” tissue.| www.PainScience.com
Most controversial therapies are fighting over scraps of "positive" evidence that damn them with faint praise.| www.PainScience.com
Detailed analysis of a major, promising trial of Cognitive Functional Therapy for back pain| www.PainScience.com
In part one, I started explaining why chronic pain is such a tough medical problem. “It’s not rocket science,” I wrote, “it’s much harder than rocket science.” There are some reasons for optimism, and some things that probably work, but pain patients feel very poorly served on average, and the last time I covered the first five of (at least) fifteen major reasons why: Pain is an extremely hard problem There’s not enough good science about pain Pain is too easy to ignore, trivial...| PainSci Updates
Is Cognitive Functional Therapy evidence-based yet? Three years after the RESTORE trial, a follow-up report says…| www.PainScience.com
I got into a bit of hot water for this late June blog post: “Menopause and pain, hormones and exercise: a beginning.” It mostly summarized and amplified a fresh editorial by Dr. Louise Tulloh. I try to be an ally to women; three quarters of my subscribers and members are women. I hoped I was playing it safe and respectful with a female physician’s seemingly evidence-based perspective in the British Journal of Sports Medicine. It was not “safe”! 😜 Some of you were displeased. A fe...| PainSci Updates
Fibromyalgia is the unexplained disease of widespread pain and fatigue — with symptoms that have now been diabolically “transplanted” from humans to mice, in a new experiment. That intro is identical to how I started a 2021 post — but that was about blood transplants, and today’s post is about a study of fecal transplants. Fibromyalgia can be moved from humans to mice in at least two ways! Apparently fibromyalgia is “in” both the blood and poop. Blood matters, and fecal matters ...| PainSci Updates
There there. 🤗 I hear you. I understand your pain (seriously). I’ve got your back. And now I bet you’re feeling better already, less pain just from reading these empathetic words! You’re welcome! A new study by Karos et al concludes that even online social support can blunt pain. And from strangers, no less! If they’re nice. The active ingredient of empathy can be delivered through the internet’s tubes, perhaps. Good to know, if true. There are disclaimers, of course — small ...| PainSci Updates
Some frozen shoulders could be caused by P. acnes hitching a ride into shoulder joints on needles.| www.PainScience.com
This post was inspired by a reader who was justifiably outraged by a string of examples of egregiously incompetent care she’d gotten for a stubborn injury. It was all routine nonsense from my perspective — I hear about stories like this daily — but she was in a state of disbelief, gobsmacked: How can medical help for such a simple problem be so amateurish? What is wrong?! The main problem, of course, is that pain is rarely as “simple” as it seems. It’s not rocket science … it’...| PainSci Updates
In theory, expectations are the engine of placebo, and they are inflated in many ways — even by subtle cues like the colour, size, or quantity of pills. A handful of big red pills seems like it really means business compared to a couple little white ones, and supposedly that will produce a bigger, better placebo response. This is a very useful idea, because it also amplifies placebo propaganda: if placebo is eerily powerful, then any alternative treatment can “work” just by impressing t...| PainSci Updates
Almost everyone thinks that almost everyone with fibromyalgia is a woman, with a traditionally accepted proportion of greater than ninety percent. Imagine my surprise when I learned that this immense gender gap was never supported by good data! Wolfe et al used validated criteria and unbiased selection of patients to get a female proportion of less than 60%. That’s quite the difference! That’s only a minor gender gap, not an immense one. In an ironic twist, this distortion was probably ...| PainSci Updates
SKEPTICS: Spinal manipulation is a big ol’ nothing burger. SPINAL ADJUSTMENT FANS: It’s all in the wrist. Got to do it right. You just suck at it. BIG NEW SCIENTIFIC REVIEW: Nope, doesn’t matter how you manipulate the spine. “None of the SMT procedures were superior to others in terms of pain relief.” Sooo much energy has been poured into spinal manipulation “technique” over the years … without much to show for it. Nim et al is now the go-to citation for “it does not matte...| PainSci Updates
How much does chronic pain interfere with your life? Probably more if you’re a woman routinely exposed to sexism! Probably due to the stress. Pain is more of a burden when you’re already angry/scared…as women tend to be. “Men are afraid women will laugh at them. Women are afraid men will kill them.” Margaret Atwood (attribution endorsed by Quote Investigator) That’s the implication of a new study by Boring et al, reporting a link between the frequency of daily experiences of gen...| PainSci Updates
The PACING of therapeutic exercise for an injury may be more of an active ingredient than any specific exercise.| www.PainScience.com
You can learn something new every day, if you’re trying — and I never stop trying. Amazingly, I can still be surprised by the discovery of seemingly obvious things I have somehow missed after almost thirty years of constant study. Like “myotonometry” — a muscle-tone measuring technology that has been around since the late 1980s. Missed it! I knew about elastography: imaging technology that shows tissue stiffness and elasticity. And I knew about algometers: gadgets that measures sens...| PainSci Updates
[Image caption: AMG0103 targets very specific anatomy (the nucleus pulposus of an intervertebral disc) and very specific physiology: it interferes with inflammatory degeneration of tissues in an intervertebral disc.] A small new study is a big (early) win for a new kind of medication for back pain (and probably more). For now, it’s known as “AMG0103,” a working title for this mouthful of a molecule, which is an NF-kappa B oligonucleotide decoy. Its goal is to suppress inflammation-powe...| PainSci Updates
As cynically feared by some, and eagerly anticipated by others, training in “Cognitive Functional Therapy” (CFT)…| www.PainScience.com
Got a crick in your neck? What’s going on in there? Very detailed neck pain tutorial for patients & pros.| www.PainScience.com
An extremely detailed guide to back pain science, diagnosis, treatment options.| www.PainScience.com
This clinical guideline paper is based on Wang, a major new review of interventional pain medicine (IPM) — the “block and burn” approach to chronic spinal…| www.PainScience.com
The science of stopping neck pain or back pain with nerve blocks or ablation and joint injections.| www.PainScience.com
