Physiospot Pain

Physiospot Redirect

All of our Physiospot blogs can now be found together at www.physiospot.com

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New Year, New Start!

With the expansion in the number of Physispot blogs available in 2007 it has become quite a large task to continually juggle them all and is not conducive to an effective service for our readers. We have therefore made the decision to amalgamate all the blogs into one place at www.physiospot.com.  Whilst you will be able to read all the  articles that have been selected as clinically relevant and posted we have developed separate areas of the site for research in different clinical areas. 

By making the management process more efficient not only will we be able to devote more time to actually posting articles but it will also provide a number of additional benefits:

• Each clinical area can be easily accessed from the navigation bar at the top of each page, no more flicking between different blogs.
• Articles can be tagged with more than one clinical area thereby adding more articles to each individual clinical area.
• The search function will search across all clinical areas so that you will be looking for what you need amongst all the articles posted.
• More easily keep up-to-date with recent additions in multiple clinicl areas by freely subscribing to one or more of our update options.
• Authors can easily work in more than one clinical area which may be useful for their own professional development and evidence based practice.

There is one small inconvenience to our readers which can be easily overcome.  As of today the email alerts and feeds for all the old physispot blogs will cease to function.  You will need to sign up again to receive the update alerts that you are interested in.  Go to the update options page to sign up now for your RSS feed and Email Alerts.  You can also download our toolbar to receive updates straight to your desktop and follow us on Twitter from this page.

We hope that all our readers are happy with the developments and that you enjoy the site and continue to find it useful, had we not done this we may not have been able to carry on with the juggling!  Visit the new site at www.physiospot.com

Systematic Review of the (Cost-)effectiveness of Spinal Cord Stimulation for People With Failed Back Surgery Syndrome.

Bala, Malgorzata M; Riemsma, Robert P; Nixon, John; Kleijnen, Jos

This systematic review assessed the (cost)effectiveness of spinal cord stimulation (SCS) in relieving certain kinds of pain for people with chronic pain owing to failed back surgery syndrome (FBSS). The studies show that SCS is effective in the treatment of FBSS in terms of pain reduction. Improvements were also reported for other outcomes, such as quality of life and functional status. All the studies reported some complications, most of which were technical problems. In terms of cost-effectiveness, 3 studies met the inclusion criteria and offered the same conclusion that SCS is both more effective and less costly in the long-term, but there is an initial high cost associated with device implantation and maintenance.

This review shows that  SCS is both effective and less costly in the treatment of FBSS.

Clinical Journal of Pain. 24(9):741-756

Link to Abstract

A preliminary fMRI study of analgesic treatment in chronic back pain and knee osteoarthritis

Marwan N Baliki, Paul Y Geha, Rami Jabakhanji, Norm Harden, Thomas J Schnitzer and A. Vania Apkarian

The effects of an analgesic treatment (lidocaine patches) on brain activity in chronic low back pain (CBP) and in knee osteoarthritis (OA) were investigated using serial fMRI. Prior to treatment brain activity was distinct between the two groups. After 5% lidocaine patches were applied to the painful body part for two weeks, CBP patients exhibited a significant decrease in clinical pain measures, while in OA clinical questionnaire based outcomes showed no treatment effect but stimulus evoked pain showed a borderline decrease. The lidocaine treatment resulted in significantly decreased brain activity in both patient groups with distinct brain regions responding in each group, and sub-regions within these areas were correlated with pain ratings specifically for each group.

We conclude that the two chronic pain conditions involve distinct brain regions, with OA pain engaging many brain regions commonly observed in acute pain. Moreover, lidocaine patch treatment modulates distinct brain circuitry in each condition, yet in OA we observe divergent results with fMRI and with questionnaire based instruments.

Molecular Pain, 2008, 4, 47

Link to Abstract

A randomized trial of behavioral physical therapy interventions for acute and sub-acute low back pain

Steven Z. George, Giorgio Zeppieri Jr., Anthony L. Cere, Melissa R. Cere, Michael S. Borut, Michael J. Hodges, Dalton M. Reed, Carolina Valencia and Michael E. Robinson

Psychological factors consistent with fear-avoidance models are associated with the development of chronic low back pain (LBP). As a result, graded activity (GA) and graded exposure (GX) have been suggested as behavioral treatment options. This clinical trial compared the effectiveness of treatment-based classification (TBC) physical therapy alone to TBC augmented with GA or GX for patients with acute and sub-acute LBP. There were no differences in 4-week and 6-month outcomes for reduction of disability, pain intensity, pain catastrophizing, and physical impairment. GX and TBC were associated with larger reductions in fear-avoidance beliefs at 6 months only. Six-month reduction in disability was associated with reduction in pain intensity, while 6-month reduction in pain intensity was associated with reductions in fear-avoidance beliefs and pain catastrophizing.

This trial suggests that supplementing TBC with GA or GX was not effective for improving important outcomes related to the development of chronic LBP.

Pain, 2008, 140(1), 145-157

Link to Abstract

Assessing fear in patients with cervical pain: Development and validation of the Pictorial Fear of Activity Scale-Cervical (PFActS-C)

Dennis C. Turk, James P. Robinson, Jeffrey J. Sherman, Tasha Burwinkle, Kimberly Swanson

This study reports on the development of a Pictorial Fear of Activity Scale-Cervical (PFActS-C). The instrument consists of a set of photographs depicting movements in which four factors that determine biomechanical demands on the neck are systematically varied – Direction of Movement, Arm Position, Weight Bearing, and Extremity of Movement. Patients who had been involved in motor vehicle collisions 143 with minimal symptoms and 212 with moderate to severe symptoms rated their fear of engaging in a set of activities depicted in the PFActS-C. Based on a principle components analysis, a 19 item measure was developed. Internal consistency, stability over time, and construct validity were all good to excellent.

The results indicate that the PFActS-C may be a useful tool for assessing fear of movement in patients with cervical pain. Research is needed to confirm the factor structure of the PFActS-C and to assess the generalizability of the results to other samples with neck pain.

Pain, 2008, 139(1), 55-62

Link to Abstract

Central mechanisms in the maintenance of chronic widespread noninflammatory muscle pain.

Desantana JM, Sluka KA

This article reviews the current and emerging literature about the pathophysiology and neurobiology of chronic widespread -musculoskeletal pain. Widespread musculoskeletal pain results in changes in the central nervous system in human subjects and animal models. These changes likely reflect alterations in supraspinal modulation of nociception, and include increases in excitatory and decreases in inhibitory modulation pathways. These alterations in excitation and inhibition likely drive changes observed in the spinal cord to result in central sensitization, and the consequent pain and hyperalgesia.

Current Pain and Headache Reports, 2008, 12(5), 338-43

Link to Abstract

Acute Opioid Administration Improves Work-Related Exercise Performance in Patients With Chronic Back Pain

Douglas P. Gross, Yagesh Bhambhani, Mark J. Haykowsky, Saifudin Rashiq

This study axamines the impact of acute opioid administration on work-related exercise performance in patients with chronic back pain. Subjects performed a continuous lifting and lowering test to voluntary fatigue at a load equivalent to 33% of their predetermined maximal lifting load twice: Once after receiving a single intravenous dose of 1 μg/kg fentanyl (a narcotic analgesic) and once after saline placebo.

This article presents the results of a clinical trial showing that acute opioid administration improves work-related exercise performance in individuals with chronic back pain. Longer trials of the effectiveness of opioid analgesia as an adjunct to functional restoration programs are recommended.

The Journal of Pain, 2008, 9(9), 856-862

Link to Abstract

MACP/PPA Collaborative Study Day 2007 - Online Now!

The Manipulation Association of Chartered Physiotherapists (MACP) have released their first online course. It is an online version of the 2007 MACP/PPA collaborative study day and is very much an evidence-based programme where both manual therapy and pain based approaches to treatment were respected and represented. The online course includes audiovisual presentaions plus related learning activities using materials from the sessions that were presented at this study day and provides a course certificate on completion of the course.

 

Session 1 - The Evidence for Manual Therapy presented by Dries Hettinga
Session 2 -CBT: What is it and can physios do it? presented by Zara Hansen
Session 3 - Exercise: Making It Happen presented by Zara Hansen
Session 4 - The Physiology of Manual Therapy presented by Stephanie Griffiths.

Go to the online course