“A Placebo Conundrum” by Michael Brooks

IT SEEMED like a good idea until I saw the electrodes. Dr Luana Colloca’s white coat offered scant reassurance. “Do you mind receiving a series of electric shocks?” she asked.

I could hardly say no – after all, this was why I was here. Colloca’s colleague, Fabrizio Benedetti of the University of Turin in Italy, had invited me to come and experience their placebo research first hand. Colloca strapped an electrode to my forearm and sat me in a reclining chair in front of a computer screen. “Try to relax,” she said.

First, we established my pain scale by determining the mildest current I could feel, and the maximum amount I could bear. Then Colloca told me that, before I got another shock, a red or a green light would appear on the computer screen.

A green light meant I would receive a mild shock. A red light meant the shock would be more severe, like the jolt you get from an electric fence. All I had to do was rate the pain on a scale of 1 to 10, mild to severe.

Let go of outdated paradigms and stop dwelling on Biomechanical tissue-based models when treating Back Pain.

This was the message from CSP fellow Dr Mick Thacker, director of the ‘Pain: Science and Society’ MSc course at King’s College London.

Giving a keynote lecture, Dr Thacker advised delegates to move away from purely mechanical-based therapies for back pain patients, and become more aware of the role of neuro-immnunology in relation to pain.

“Traditional physiotherapy has based its management of back pain on anatomical, tissue-based principles and biomechanics”, said Dr Thacker.

Yoga: A Cost-Effective Treatment for Back Pain Sufferers?

Specialised group Yoga Classes could provide a cost-effective way of treating patients with chronic or recurrent low back pain, according to the UK’s largest ever study of the benefits of Yoga.

Led by the University of York, and funded by Arthritis Research UK, the study provides an evaluation of a specially-developed 12-week group yoga intervention programme compared to conventional general practitioner (GP) care alone.

The results published in Spine, show that the Yoga intervention programme — “Yoga for Healthy Lower Backs” — is likely to be cost effective for both the UK National Health Service and wider society.

The cost assumed for yoga intervention is important in determining whether this is an efficient use of NHS resources. As Yoga classes are not currently available through the NHS, the researchers examined a range of possible costs.

They conclude that if the NHS was to offer specialist yoga and managed to maintain the cost below £300 per patient (for a cycle of 12 classes), there is a high probability (around 70 per cent) of the yoga intervention being cost effective.

Researchers also found that those taking part in the yoga programme had far fewer days off work than those in the control group. On average, a control group participant reported 12 days off due to back pain, whereas those in the yoga group had four days off. 

Hip resurfacing prone to failure

An operation used instead of a full hip replacement has a high failure rate and, in most instances, should no longer be offered, warn doctors.

Their advice is based on figures from the largest database on hip surgery.

Hip resurfacing – where the damaged bone is capped rather than replaced – is often recommended for younger, active patients who will need more surgery as the joint continues to wear.

Medical regulators say they will look at the Lancet journal findings.

The UK’s Medicines and Healthcare products Regulatory Agency (MHRA) has already advised annual checks for people with large head metal-on-metal full hip replacements due to safety concerns. It is thought tiny pieces of metal can break off and leak into the blood.

The current study did not look at the safety of the metal resurfacing implants, although the researchers say there could be the same theoretical safety risk as with metal-on-metal hips.

Instead it looked at failure rates with metal-on-metal resurfacing – where the socket and ball of the hip bone has a metal surface applied to it rather than being totally replaced.

About seven in every 100 hip patients go for resurfacing rather than a full hip replacement, although the rate has been decreasing in recent years.

Some 32,000 people in England and Wales had this type of surgery between April 2003 and September 2011.

Eating Cherries can help with Gout

Eating cherries can reduce the risk of gout attacks, a study has suggested.

US researchers found patients with gout who ate cherries over a two-day period had a 35% lower risk of attacks compared to those who did not.

The study in Arthritis & Rheumatism said cherries contain anthocyanins, antioxidants which contain anti-inflammatory properties.

UK experts said the research offered “good evidence” of the benefits of eating cherries for people with gout.

Gout is a common type of Arthritis that can cause sudden and very severe attacks of pain and swelling in the joints, particularly in the feet.

It is caused by too much uric acid in the bloodstream, which causes urate crystals to start to form in and around the joints and under the skin.

Gene flaw linked to Low Back Pain

Scientists have identified a gene flaw linked to disc problems that are a common cause of lower back pain.

The UK study, published in the Annals of Rheumatic Diseases, looked at 4,600 people and found the PARK2 gene was linked to age-related disc problems.

A third of middle-aged women have problems with at least one spinal disc – and the condition is known to be inherited in up to 80% of patients.

Experts said finding the gene could lead to new treatments being developed.

Back pain costs the UK about £7bn a year in sickness leave and treatment costs, but the causes of the condition are not fully understood.

In lumbar disc degeneration (LDD), discs become dehydrated and lose height, and the vertebrae next to them develop bony growths called osteophytes, leading to lower back pain.

The King’s College London researchers carried out MRI scans of all those in the study and looked at differences in their genetic make-up.

Medication overuse Headaches

Up to a million people in the UK have completely preventable  severe Headaches caused by taking too many painkillers, doctors have said.

They said some were trapped in a “vicious cycle” of taking pain relief, which then caused even more headaches.

The warning came as part of the National Institute for Health and Clinical Excellence’s (NICE) first guidelines for treating headaches.

NICE is also recommending Acupuncture in some circumstances.

This can end up getting into a vicious cycle where your headache gets worse, so you take more painkillers, so your headache gets worse and this just becomes worse and worse and worse”

“Medication overuse headaches” feel the same as other common headaches or migraines.

There is no definitive UK data on the incidence of the condition, but studies in other countries suggest 1-2% of people are affected, while the World Health Organisation says figures closer to 5% have been reported.

While painkillers would be many people’s instant response, they could be making sufferers feel even worse.

Whiplash Injuries & Trigger Points

Persistent muscle pain following whiplash is commonly considered the result of poor psychosocial status, illness behaviour, or failing coping skills. However, there is much evidence that this persistent  pain may be due to neurophysiologic mechanisms involving peripheral and central nerve sensitisation. Myofascial trigger points may play a crucial role in maintaing this sensitisation. Recent research suggests that the chemical environment of myofascial trigger points is an important factor. Several consequences are reviewed when central pain mechanisms and myofascial trigger points are included in the differential diagnosis and in the management of patients with persistent pain following whiplash.

Treating Chronic Muscle Pain by Robert Gerwin

Chronic muscle pain (myalgia) is a common problem throughout the world.

Seemingly simple, it is actually a difficult problem for the clinician interested in determining the aetiology of the pain, as well as in managing the pain.

The two common muscle pain conditions are Fibromyalgia and Myofascial Pain Syndrome.

Fibromyalgia is a chronic, widespread muscle tenderness syndrome, associated with central sensitisation. It is often accompanied by chronic sleep disturbance and fatigue, visceral pain syndromes like irritable bowel syndrome and interstitial cystitis.

Myofascial pain syndrome is an overuse or muscle stress syndrome characterised by the presence of trigger points in muscle.

The problem these syndromes pose lies not in making the diagnosis of muscle pain. Rather, it is the need to identify the underlying causes of persistent or chronic muscle pain in order to develop a specific treatment plan.

Chronic myalgia may not improve until the underlying precipitating or perpetuating factors are themselves managed.

Precipitating or perpetuating causes of chronic myalgia include structural or mechanical causes like scoliosis, localised joint hypo-mobility, or generalised or local joint laxity; and metabolic factors like depleted tissue iron stores, hypothyroidism or Vitamin D deficiency.

Sometimes, correction of an underlying cause of myalgia is all that is needed to resolve the condition.

Neck & Back Pain.

Neck & Back Pain

Patient: Woman 29 years
Occupation: Nurse
Pain: Can reach 6/10

Complaint: Back and Neck Pain can often occur simultaneously. This Woman works as a Nurse, and has developed left sided Neck & Back Pain over the few months. She recalls hurting her low back about 6 months ago, while lifting a heavy patient. She is unsure how neck pain has developed.

Treatment: This Woman responded well to Spinal Manipulation of her back and neck. The range of movement in her neck and low back was initially poor, but quickly improved with treatment.

She visited weekly for 4 treatments, and was pain free by this stage.

Prognosis: This Woman visits me if and when she feels the need.

She now goes to Pilates classes twice per week, and feels much stronger and able to cope with the demands of her job.