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.
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.
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.
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.
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.
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. Continue reading Whiplash Injuries & Trigger Points
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.
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.