Posted on

Changing health beliefs is like…

I’m in the business of trying to shape beliefs about health, but I am painfully aware that it’s like pissing into a headwind: it mostly goes nowhere, and there’s a lot of blowback.

[Go to this post on PainScience.com]

Changing health beliefs is like…


Orginally Published At: Pain Science

Posted on

About that damn paywall

I’m in a bit of a mood about the paywall today. All my nice new content about dry needling is behind the PainScience.com paywall, and it’s making me queasier than usual.

Unfortunately, I have to lock some premium content up back there. I have to sell books, or the lights go out. It’s the only viable alternative to running ads on PainScience.com … which I will never do, because “lousy ads are ruining the online experience,” and I do not want to contribute to that, no matter how much money I’m leaving on the table. Which is quite a lot: I have the traffic I need to sell out in that way. I just couldn’t sleep at night.


[Image caption] Ads make me grumpy. Paywalls make me grumpy. But paywalls make me slightly less grumpy than ads.


So paywall it is… which means that a lot of good stuff is unavailable to most of my readers, which is a bitter pill. I’m a writer—I like attention. I want to write stuff and flaunt it, not hide it away from 90% of my readers!

Which is why I share some excerpts here — in an ephemeral, limited fashion that isn’t going to kill book sales. 😉

[Go to this post on PainScience.com]

About that damn paywall


Orginally Published At: Pain Science

Posted on

Dr. Travell “dry needled” with a harpoon

I’ve been working on series of updates to the dry needling chapter in my trigger points book, gradually building it up to the point where it would make a good, substantive article on this topic in its own right. It must stay in the book, but here’s an interesting excerpt that I just have to share with everyone today.

A little context first, though: modern dry needling involves stabbing “trigger points” (sore spots in soft tissue of unknown origin) with acupuncture needles. Overlap between acupuncture and dry needling is partial/confusing, but the use of acupuncture needles for this purpose today is almost universal. No one’s using anything else. Which makes this rather interesting…

The term “dry needling” came from Dr. Janet Travell herself, many moons ago. In the original big red books, she used the term to describe lancing a trigger point with a hypodermic needle, but not injecting anything. (Ouch!) She did not go into any detail, but her method is definitely distinct from modern dry needling, which is much more directly “inspired” by acupuncture. Although Travell didn’t explain her rationale for dry needling, she did explain why she never used an acupuncture needle: she thought they were too fine!

There has never been a shred of empirical evidence that suggests that any rationale for dry needling is superior to any other. Like mutually exclusive religious beliefs, they clearly can’t all be right. The fact that Dr. Travell disapproved of acupuncture needles is fascinating and irksome — she is virtually worshipped, her book is still the bible of trigger point therapy… and yet no one using acupuncture needles today has offered an explanation of why they are ignoring her opinion on this. If she was wrong, then it casts doubt on the Mother of Trigger Point Therapy (doubt that is absent from nearly all references to her work). If she was right, then dry needlers have been barking up the wrong tree for a long time.

Or perhaps they are all wrong. Because how dry needling might work is a moot point if it doesn’t work. So…

And then the book continues with an evidence review that does not have a happy ending.


[Image caption] One hypothesis is that stabbing “inactivates” trigger points by wrecking the neuromuscular junction (motor endplate). Here’s four of those, at the ends of branching motor neurons, attaching to muscle fibres. Each one is about 3µm (.03mm) wide, roughly a tenth the diameter of an acupuncture needle. Trying to hit one of these like trying to use a spear to stab a raisin under a metre of Jello. Or a harpoon, if you’re using a hypodermic needle.

The “negative” trigger point book

My trigger point book is a 130,000-word beast, much longer than the average novel, and there are chapters in there I haven’t touched in a decade, like boxes in your attic that contain God-knows-what. Sometimes I open it to a random location, read three paragraphs that make my head explode, and I have to spend the morning bringing it up-to-date (instead of whatever 62 things were on my to-do list).

I never stop modernizing my books, and in the case of the trigger points book, “modernizing” mostly means making it more of a bummer for people who want to believe that trigger points are the key to all pain. It’s the only book about trigger points that discourages people from getting too overheated about trigger points. It’s all about managing expectations now, and the chapter on needling is an excellent example of this trend.

(If you think trigger points “don’t exist” and/or you’re still unclear on why I am not much more dismissive of the idea of trigger points than I am — I do still sell a book about them, after all, even if it is relatively “negative” — my position on this controversial topic is exhaustively spelled out here: Trigger Point Doubts. The highlights are covered by about dozen bullet points early in the article.)

[Go to this post on PainScience.com]

Dr. Travell “dry needled” with a harpoon


Orginally Published At: Pain Science

Posted on

Prescription Medication Use among Community-Based US Adults with Chronic Low Back Pain: a Cross-Sectional Population Based Study.

• Opioids were the most common prescription pain medications among US adults with cLBP.• Opioids were typically used long-term, and combined with other CNS-active agents.• Low level of education was strongly associated with opioid use in cLBP population.

Prescription Medication Use among Community-Based US Adults with Chronic Low Back Pain: a Cross-Sectional Population Based Study.

Orginally Published At: Pain Journal

Posted on

Randomized Controlled Trial of Nurse-Delivered Cognitive Behavioral Therapy Versus Supportive Psychotherapy Telehealth Interventions for Chronic Back Pain

• Two telephone-adapted behavioral therapies improved chronic low back pain• A nurse-delivered cognitive behavior therapy reduced pain and improved function• A nurse-delivered supportive care improved pain outcomes equivalent to CBT• Effect sizes were moderate, ranging from .33-.60 for pain severity and function.• 27-39% of the participants reported “much improved” or “very much improved”

Randomized Controlled Trial of Nurse-Delivered Cognitive Behavioral Therapy Versus Supportive Psychotherapy Telehealth Interventions for Chronic Back Pain

Orginally Published At: Pain Journal

Posted on

Feed URL correction, arg

Well, this is embarrassing! Just a few minutes ago I put out a post about the “new” correct URL for the blog RSS feed… and I used a slightly incorrect version of the URL. I left out the WWW.

And because RSS is what it is, I can’t take it back: that post will already have landed in many people’s inboxes, where it can’t be updated in place. *sigh* So I’m posting again, and triple-checking:

OLD:

http://SaveYourself.ca/rss.xml

NEW:

https://www.PainScience.com/rss.xml

[Go to this post on PainScience.com]

Feed URL correction, arg


Orginally Published At: Pain Science

Posted on

Swapping back pain scapegoats

This little article about back pain wisely challenges the fearful assumption that spines are fragile, and that’s great… but unfortunately it just shifts the blame to “weakness” instead. Sure, exercise is pretty good for back pain — that is well established — but probably not because backs are weak.

How about we stop blaming back pain on any tangible property of the spine? Fragility, weakness, posture, degeneration, etc…they all miss the point. Pain (especially chronic pain) is multifactorial and neurological by nature and rarely has a tidy physical explanation or solution. We need to be okay with that.

Personally, I would prefer to have a strong back, because reasons… but “back pain insurance” is far down the list. We can sing the praises of a strong back all we like: the people who have both strong backs and pain are not going to go away, and there’s plenty of them. There is no compelling evidence that weakness is a risk factor for back pain.

[Go to the link featured in this post]

[Go to this post on PainScience.com]

Swapping back pain scapegoats


Orginally Published At: Pain Science

Posted on

Hypnosis Enhances the Effects of Pain Education in Patients with Chronic Non-Specific Low Back Pain: a Randomized Controlled Trial

• Hypnosis can be combined with education in patients with chronic low back pain.• The addition of hypnosis improves pain intensity, disability, and catastrophizing.• The beneficial effects are enhanced, at least in the short and medium-term.• The intervention can be offered in group settings.

Hypnosis Enhances the Effects of Pain Education in Patients with Chronic Non-Specific Low Back Pain: a Randomized Controlled Trial

Orginally Published At: Pain Journal

Posted on

Anti–nerve growth factor therapy attenuates cutaneous hypersensitivity and musculoskeletal discomfort in mice with osteoporosis

Introduction:
The prevalence of osteoporosis is increasing with the aging population and is associated with increased risk of fracture and chronic
pain. Osteoporosis is currently treated with bisphosphonate therapy to attenuate bone loss. We previously reported that improvement in bone mineral density is not sufficient to reduce osteoporosis-related pain in an ovariectomy (OVX)-induced mouse model of osteoporosis, highlighting the need for new treatments. Targeting of nerve growth factor (NGF) with sequestering antibodies is a promising new direction for the treatment of musculoskeletal pain including back pain and arthritis. Its efficacy is currently unknown for osteoporotic pain.
Objective:
To investigate the efficacy of anti-NGF antibody therapy on osteoporotic pain in an OVX-induced mouse model.
Methods:
Ovariectomy- and sham-operated mice were injected with an anti-NGF antibody (10 mg/kg, intraperitoneally, administered 2×, 14 days apart), and the effect on behavioural indices of osteoporosis-related pain and on sensory neuron plasticity was evaluated.
Results:
Treatment with anti-NGF antibodies attenuated OVX-induced hypersensitivity to mechanical, cold, and heat stimuli on the plantar surface of the hind paw. The OVX-induced impairment in grip force strength, used here as a measure of axial discomfort, was partially reversed by anti-NGF therapy. No changes were observed in the rotarod or open-field tests for overall motor function and activity. Finally, anti-NGF treatment attenuated the increase in calcitonin gene-related peptide–immunoreactive dorsal root ganglia neurons observed in OVX mice.
Conclusion:
Taken together, these data suggest that anti-NGF antibodies may be useful in the treatment of prefracture hypersensitivity that is reported in 10% of patients with osteoporosis.
This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author. Address: Center for Preventive Medical Sciences, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba 2608670, Japan. Tel.: +81-43-226-2017; fax: +81-43-226-2016. E-mail address: miyakosuzuki170@chiba-u.jp (M. Suzuki).
Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.
Received October 05, 2017
Received in revised form February 24, 2018
Accepted March 13, 2018
© 2018 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The International Association for the Study of Pain.

Anti–nerve growth factor therapy attenuates cutaneous hypersensitivity and musculoskeletal discomfort in mice with osteoporosis


Orginally Published At: PAIN Reports

Posted on

Individual Variation in Pain Sensitivity and Conditioned Pain Modulation in Acute Low Back Pain: Impact of Stimulus Type, Sleep, Psychological and Lifestyle Factors.

• Enhanced sensitivity consistent with generalized hyperalgesia was observed• Acute back pain includes four subgroups with sensitivity and modulation profiles• Various factors including sleep and alcohol explain some variation in presentation

Individual Variation in Pain Sensitivity and Conditioned Pain Modulation in Acute Low Back Pain: Impact of Stimulus Type, Sleep, Psychological and Lifestyle Factors.

Orginally Published At: Pain Journal