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
Detailed, readable self-help for stubborn tension headaches, especially due to muscle pain in the neck and shoulders.| www.PainScience.com
Incredibly detailed, referenced, and readable tutorials for common pain problems for patients & pros.| www.PainScience.com
A complete index of articles and guides on PainScience.com.| www.PainScience.com
What works? What doesn’t? Why? Rational, opinionated reviews of treatment options, and many handy tips. Strong pro-science bias.| 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
Update after 48h “the comments” I thought I was playing it safe/respectful with this post when I choose to tackle this topic by absorbing and summarizing a female physician’s apparently evidence-based editorial in a credible scientific journal. But many readers have questioned the premise of Dr. Louise Tulloh’s argument that hormone therapy is over-hyped, over-medicalized, or has a problem with “unrealistic expectations.” Some of them have questioned it strongly indeed. I think th...| PainSci Updates
Everything there is to know about postural correction—and especially why it doesn’t matter very much. Heavily referenced.| www.PainScience.com
I wish I could claim that I knew about this nerdy bit of pain science before someone asked me about it … but I hadn’t even heard of it. Even though it’s been around since the early 2000s. It was published at about the same time that I was just discovering that science is cooler than superstition. I also wasn’t even interested in the paper at first. Pain as an … emotion? Huh? That sounded a bit fishy to me. Like I might take the author about as seriously as I would take a middle-aged...| PainSci Updates
5 citations that fail to support the good-news premise of a new paper.| www.PainScience.com
Hard, ropey muscle texture is not as useful a sign in massage therapy as you might think. Of course it matters sometimes, but it’s almost comically overemphasized. “You’re really tight” is mostly meaningless and misleading, a simplistic justification for the service: you are tight, therefore you need me to loosen you. But someone wisely pointed out to me that this emphasis on tightness isn’t all coming from massage therapists! Patients really like to have their subjective experience...| PainSci Updates
A new study shows a strong “link” — one of those notorious correlations — between physical inactivity and pain severity in older adults. This post isn’t so much about the results of the study as the fishy leap to the conclusion that inactivity is the problem and fitness is the solution. Because the result does not necessarily mean that sedentariness caused the pain (or that moving around more can prevent it). What it could mean is … wait for it… Many people move less because the...| PainSci Updates
If you want deep explanations for pain, you have to stare into the abyss of deep time and biology. Todd Hargrove did: in a post I missed last year, he explored the ways an evolutionary perspective might shed light on why pain sometimes transmogrifies from a useful alarm system into something that seems to be disconnected from reality, pain that’s too strong and goes on for too long, for no apparent reason, formally known as “nociplastic” pain. “One of [evolutionary medicine's] goals i...| PainSci Updates
If you’re iron deficient as a tiny baby, you’ve got a higher risk of chronic pain as an adult! No one knows quite how that works yet. A new study of the complex potential mechanisms had no obvious or simple results, but did show that perinatal iron deficiency “shapes glutamatergic signaling” and “changes the pattern of sensory input to the dorsal horn.” File under biology is destiny. Also yet another reason why chronic pain probably isn’t a mind thing. --- This is the FREE RSS f...| PainSci Updates
In addition to “rehab” after surgery, one should prepare by being as fit as possible before surgery: “prehab,” AKA preoperative physical therapy. Prehab is one of the best evidence-based things anyone can do to prevent pain. And prehab for surgery is also prehab for injury. So that’s a nice perk. Consider this 2024 study: Hirase et al. compared recovery in spinal surgery patients with more and less spinal muscle, specifically the cross-sectional area of the psoas muscle (pronounce...| PainSci Updates
From a Wired piece about robots trying to run a half marathon, and failing rather badly: “The robot immediately…| www.PainScience.com
As cynically feared by some, and eagerly anticipated by others, training in “Cognitive Functional Therapy” (CFT) is now available for purchase. A timeline … May 2023 — The RESTORE trial of CFT for low back pain is published, and it sure looks good, a seemingly strong scientific vote of confidence for “an individualized approach that targets unhelpful pain-related cognitions, emotions, and behaviours that contribute to pain and disability.” For a while, I want to believe. December ...| PainSci Updates
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
Mostly short posts about pain & injury science, in your inbox.| www.PainScience.com
