1. Pain is 100% of the time, an output from the brain. In 1996, Ronald Malzack developed the concept of the neuromatrix. The neuromatrix, in simplistic terms, is all of the mechanisms within the brain, that when activated, produce pain. So when your ankle hurts, the pain is generated by information gathered by the brain. Pain is simply a defense mechanism developed to protect the body.

2. The degree of injury does not always equal the degree of pain. Research has told us that very major injuries may not hurt at all and very minor injuries may hurt alot. The degree of pain you experience is more related to past experiences. For example, if you have sprained your ankle in the past and then you sprained it again, the second sprain will likely hurt more. This is because the brain has learned to protect that ankle following the prior injury and defends it through pain.

3. Despite what MRIs X-Rays and CT Scans show objectively, this may not be the root cause of your pain. While diagnostic imaging may give us excellent views of your internal anatomy, it gives us little information about pain. A study performed on individuals 60 years or older, who had no symptoms of low back pain, found that 36% had a herniated disc, 21% had spinal stenosis and over 90% had a degenerated or bulging disc. What shows up on an image may or may not be related to your symptoms.

4. Psychological variables, such as depression and anxiety, can make your pain worse. Pain can be influenced by many different things and psychological components are one of them. A recent study in the Journal of Pain showed that psychological variables pre-total knee replacement was highly related to long-term pain post-total knee replacement. The treatment of these co-morbities may actually be more effective than surgery.

5. Arthritis does not cause pain. Despite the two being related, not all individuals with arthritis experience pain. Pain from arthritis is often correlated to secondary variables such as inactivity, depression, etc.

For the 6-10, Check out my full article @ Yahoo.com

http://www.change.org/petitions/the-commission-on-accreditation-in-physical-therapy-education-to-ensure-that-pain-science-is-incorporated-into-pt-program-curriculums

For decades, physical therapists, osteopaths and chiropractors have manipulated the spine in countless patients with low back pain.  Despite proposed theories to explain the effects and prediction rules to forecast who will receive benefit, little evidence has been produced to tell us what is actually occurring when the back is manipulated.   A prospective case series, published in last months edition of Spine , investigated the immediate and short-term effects of a high-velocity, low amplitude spinal manipulation on those with low back pain.

Keep Reading…

In 2004, Lorimer Moseley published a RCT which assessed the use of a graded motor imagery protocol for the treatment of Complex Regional Pain Syndrome, Type 1 (CRPS-1).  I find this protocol to be quite helpful in my treatment of CRPS-1 (when occuring in a patients hand or foot, unilaterally).   Each step is performed for 2 weeks.

1. Recognition of laterality in the hand or foot: Moseley states that “recognizing a pictured hand to be a left or right hand activates brain areas involved in higher-order aspects of motor output, the so-called pre-motor cortices, whereas explicitly imagined movements also activate the primary motor cortex.”  Perform this step by making flash-cards of pictures of hands or feet in different positions.  The patient is then asked to identify these as left or right as quickly as possible and as the examiner, you calculate the % identified correctly.  This is to be performed as quickly as possible.  Software has also been developed to perform this exercise/test and is found here.

2.  Imagined movements: Use the flash-cards of the hands and feet in exercise.  The patient will imagine moving the affected limb to the position demonstrated on the card.  They will then imagine returning to neutral and repeat this 3+ times.

3. Mirror-box therapy: Create a box to place the affected limb into with a mirror on the side.  Place the affected limb inside of the box and using the unaffected limb, assume positions as illustrated on the flash-cards used in the first 2 exercises.  While moving the unaffected limb, look into the mirror so that the patient has the illusion that the affected limb is performing the activity.  Eventually progress this so that the affected limb is moving inside the box with the unaffected limb, but still paying attention to the mirror.

Read more at www.PhysioTherapyInfo.com

Update: For a limited time, the NoiGroup has offered the Recognise Application for iphones for free.

Moseley GL. Graded motor imagery is effective for long-standing complex regional pain syndrome: a randomized controlled trial. Pain 2004: 108; 192-198.

A recent article in Pain highlighted the effects of presurgical expectancies on the postsurgical outcomes in individuals who have undergone a total knee arthroplasty (TKA). The study appears to be well constructed and followed 120 individuals over a one-year period. It measured: 1. Pain and function via the WOMAC 2. Comorbidities effects on outcomes 3. Pain-related fear of movement via the Tampa Scale for Kinesiophobia 4. Depressive symptoms via the Patient Health Questionnaire 5. Expectancies via four questions (”How likely is it that one month following surgery; your pain will have decreased? your sleep will return to normal? you will have assumed your household responsibilities? you will have resumed your social and recreational activities?)

The results: As previous studies have shown, psychological factors have significant prognostic value in predicting post-operative pain severity and function following a total knee arthroplasty. Presurgical pain catastrophizing predicts poorer recovery as well as pain-related fear of movement and depression.

Recommendations: Prior to having a total joint replacement, individuals who have psychological factors that may impede a good outcome, should undergo pain psychology consultations and treatment to improve post-surgical outcomes. The Pain Catastrophizing scale is a great tool to use to predict who will have residual pain.

Fun Fact: Despite objective indicators of surgical success, literature indicates 15-30% of individuals who undergo a TKA will report post-surgical pain and disability.

Sullivan M, Tanzar M, Reardon G, et al. The role of presurgical expectancies in predicting pain and function one year following total knee arthroplasty. Pain 2011.

Read more of Joe’s Blogs @ www.physiotherapyinfo.com

As physiotherapists, we routinely see patients who present to our clinics with complaints of persistent, chronic pain.  These patients are often dissatisfied by other clinicians who have simply dismissed their complaints due to negative diagnostic imaging, clinical patterns that don’t make sense and lengthy rates of healing.  As “movement experts”, we often assume that pain is due to a limitation in movement and by allowing one to move better, pain will resolve.  But what if in reality, the issue wasn’t pain resulting from movement limitations but the opposite.  What if the movement limitation happened as a result of pain?  Recent neurophysiologic literature is  tackling this “chicken and the egg” debate and suggests that some of the patients we see may not be experiencing pain as a symptom, but instead a disease. 

To read more, click here or check out my full article in this months edition of SportEx: Medicine (page 2-3).