Posted on

IASP Updates Classification of Chronic Pain

A task force of the International Association for the Study of Pain proposes a classification of chronic pain as either chronic primary or chronic secondary pain, when chronic pain represents the major complaint and when chronic pain is secondary to a chronic disorder, respectively.

IASP Updates Classification of Chronic Pain


Orginally Published At: Neuropathic Pain

Posted on

Too big to fail: the power of big webpages

It’s not common, but occasionally I get a complaints like this:

Way, way more information than I needed. Just get to the point need tell me what I need to do to fix my back! Sheesh!

Ironically, this overwhelmed readers probably wouldn’t trust me to tell them what they need to do if they weren’t bewildered by my verbosity. And yet I actually agree: my books and feature articles are indeed way too long. Concision is a virtue! If writing quality was the only consideration, I would never drone on the way that I do. Shorter would be better by purely “literary” standards.

But there are other standards. My unrestrained delving is a powerful selling feature: it distinguishes my content in the marketplace, establishing authority and trust in a way that shorter documents cannot hope to match. No matter how crafty and brilliant, even a 5,000-word article — quite long for a blog post — just cannot compete with the gravitas implied by 50,000 words. Especially if the deep dive is also well-written.

It’s impossible to measure, but I believe that my business depends on this equation. So I let myself be long-winded (while also mitigating the tedium as much as I can).

[Go to this post on PainScience.com]

Too big to fail: the power of big webpages


Orginally Published At: Pain Science

Posted on

Anti-inflammatories and tendons

A few months ago I updated my guide to repetitive strain injuries with some nifty science showing that, contrary to a popular belief among professionals, chronically painful tendons are actually inflamed — not in the usual sense, with obvious immune system activity and redness and swelling, but in a subtler way (see Dakin et al). Inflammation is a complex family of tissue states, and at least some more obscure markers of inflammation are present in distressed tendons.

So if they are inflamed, do anti-inflammatory medications help? I’ve always thought it’s unlikely, either because there is no inflammation at all, or it’s too different from classic acute inflammation to be affected by drugs known for their effects on that condition. I wondered about this for ages and finally looked for relevant evidence. In another update last week, I reported on one rare and interesting example of useful research about it, a 2003 study that showed a measurable effect on a couple of obvious inflammation markers (see Marsolais et al). Unfortunately, and predictably, this effect “did not translate into a reduction of tissue damage or a promotion of tissue healing.” So while it attenuated some gross signs of inflammation, what little was present, it had no impact on the “mechanical properties” of injured Achilles tendons — and, I’m betting, probably not on the subtler signs of inflammation measured by Dakin and friends either.

[Go to this post on PainScience.com]

Anti-inflammatories and tendons


Orginally Published At: Pain Science

Posted on

The (parental) whole is greater than the sum of its parts: A multifactorial model of parent factors in pediatric chronic pain

Parents are important influencers of symptoms and functioning in youth with chronic pain.37 A number of parental factors are associated with child pain and functioning, including responses to child pain (e.g., protectiveness),10, 33 psychological functioning (e.g., anxiety),4, 34 and chronic pain history.4, 7, 22, 40 However, these parental factors typically have been evaluated as separate domains with few studies examining their interrelations.28, 30, 37, 45, 46, 56 Understanding the extent to which parental factors are interrelated, and exhibit differential associations with child adjustment to chronic pain may help improve interventions for parents of youth with chronic pain.

The (parental) whole is greater than the sum of its parts: A multifactorial model of parent factors in pediatric chronic pain

Orginally Published At: Pain Journal

Posted on

18-year Trends in the Prevalence of, and Health Care Use for, Non-Cancer Pain in the United States: Data from the Medical Expenditure Panel Survey

Pain is a major cause of morbidity in the United States, costing billions of dollars annually in conventional28 and complementary44 health care and lost productivity.28 The prevalence of condition-specific pain in the United States is generally estimated using data from national surveys. These surveys have routinely found increases in arthritic conditions,14,45,75,76 headaches7, and spine conditions1616,22,38,40,58 since the 1990s. Increases in the prevalence of spine conditions have also been observed at the state level.

18-year Trends in the Prevalence of, and Health Care Use for, Non-Cancer Pain in the United States: Data from the Medical Expenditure Panel Survey

Orginally Published At: Pain Journal

Posted on

Discrete trajectories of resolving and persistent pain in people with rheumatoid arthritis despite undergoing treatment for inflammation: Results from three UK cohorts

Arthritis is a common cause of chronic musculoskeletal pain and disability; especially across ageing populations. Arthritis has traditionally been classified as either inflammatory (e.g. rheumatoid arthritis; RA) or non-inflammatory (e.g. osteoarthritis; OA, the commonest reason for joint replacement surgery). RA is a systemic, autoimmune condition with a predilection for synovial joints of the hands and feet. Synovitis (inflammation of the joint lining) contributes to pain, and also leads to joint damage.

Discrete trajectories of resolving and persistent pain in people with rheumatoid arthritis despite undergoing treatment for inflammation: Results from three UK cohorts

Orginally Published At: Pain Journal

Posted on

Sick of lame citing

I consider it my job to always cite the best relevant science that I can find, such as it is, and that’s still the rule pretty much everywhere on PainScience.com, in hundreds of articles. But there is an exception now.

Over many years of grinding out dozens of informal narrative reviews I have grown weary and disillusioned with the extremely poor average quality of trials of interventions in musculoskeletal medicine. More and more, I think the best “evidence-based” can mean is just a rigorous critical analysis of plausibility and safety. Good direct evidence of efficacy is hardly ever actually available. It sucks, but that’s where we’re at.

So in my new article on laser therapy, published last October, I did something new: I decided not to cite any “garbage in, garbage out” meta-analyses, because I am frankly just sick to death of citing science that only muddies the waters, and of having to explain the same problems with it ad nauseum. How many times have I had to come with fresh ways to describe “methodological flaws” or how “more and better research is needed”? I’m running out of patience. So in this case, I decided to drop it. If the citations aren’t useful, then don’t use them!

This upset some people, of course. After decade of constantly being in people’s crosshairs for citing, suddenly I was getting flak for not citing. If by some staggering coincidence I chose to do this with a topic where there actually is good, positive research that I missed… well, wouldn’t that be ironic! Ultimately I’d enjoy being wrong in that way, but I am not holding my breath for that satisfaction.

Even if the evidence is useless, maybe it was a tactical mistake to not to cite it. Obviously its absence makes the article easier to criticize and dismiss; maybe I can’t escape the need to cite the research for the sake of scholarly appearances. But, for the record, I didn’t neglect the allegedly “positive” evidence because I was unaware of it, but because it’s lame.

[Go to this post on PainScience.com]

Sick of lame citing


Orginally Published At: Pain Science

Posted on

More mail than Stephen King?

It’s January 12, and I just caught up with the email backlog that built up in just a few days over the holidays, almost two weeks of grinding away it at least a couple hours per day. And I was being choosy! I deliberately ignore many kinds of messages (like requests for consults, or product manufacturers who want to send me something to review). There’s truly not enough time for it all, not even close.

It occurred to me wading through this mess that I may get more email than your average popular author got back in the 80s, when pop culture was already immense, but before the Internet made its creators so much more accessible. I’m sure Stephen King’s mail bag today is insanely deeper than mine, but I bet back in the 80s the number of letters he was getting was roughly comparable to what one man with a lot of website traffic gets today

Plus, the kinds of things I write about tend to really inspire correspondence, especially in this “send us your reckons” world.

[Go to this post on PainScience.com]

More mail than Stephen King?


Orginally Published At: Pain Science