Abstract: Griffin, Heather Complex regional pain syndrome (CRPS) is a relatively uncommon, but painful and disabling condition. It is characterised by limb pain with sensory, vasomotor, sudomotor, motor and dystrophic changes, usually occurring after injury. The diagnosis can be difficult to make, as it lacks an objective test. The diagnosis is therefore based on clinical findings. The Budapest criteria are the accepted standard for this.
Abstract: Patel, Vinay; Kanji, Giresh Lumbar spine pain is the most common musculoskeletal complaint we see in practice. The disc has been found to be the most common source of lumbar spine pain. A disc prolapse occurs when the nucleus of the disc protrudes through a torn annulus. Disc bulges and prolapses can often cause irritation to an adjacent nerve root, and may cause radicular symptoms down the leg. Disc prolapse is often preceded by actions involving bending and lifting that place some pressure on the disc. The annular ligament is a layered structure and layers may sequentially tear, hence the final force that causes the nucleus to protrude may be minimal such as bending over. Disc prolapse accounts for diminished quality of life, as well as associated costs financially from medical care and lost earnings.
Abstract: McKay, ABreck Academic blindness occurs when researchers and reviewers, believing their confirmation bias, obtain or support further research funding and waste that funding on error laden hypotheses and research programmes. This paper addresses three examples, one internationally recognised whiplash research study and two examples of erroneous internationally recognised chronic low back pain (CLBP) research. The researchers persist in pursuing these false models despite confirmation bias errors being repeatedly demonstrated. The secondary problem of many peer reviewers also blinded by academic and confirmation bias is identified.
The author uses his personal experience, primary care observation, analysis and clinical research of the underlying anatomy, physiology and whole body function models to identify where the errors exist and why they need to be corrected. By considering the results of this primary care research, new and simple explanations for the results seen in whiplash injuries and CLBP can be more readily provided with explanations and managements developed in primary care, and immediately applicable throughout the world.
Further interpretation of the results has led the author to propose a better, simpler hypothesis leading to an understanding of the importance of enthesis damage and periosteal biomechanical injury in the onset and persistence of musculoskeletal pain, fibromyalgia (chronic widespread pain syndrome), chronic low back pain (CLBP), vertebral or bony degeneration and osteophytes, or spur formation visualised on imaging of the spine and other bony tissues.
These identified issues form the often ignored pain elephant in the room. Pain researchers have frequently been enticed by confirmation bias and trapped by fiscal servitude, merely for academic survival. Those asked to peer review appear to have also suffered from similar bias. The author raises the issue of research funds being wasted on programmes involving confirmation bias (confounded by academic blindness) and promulgates a potential method to prevent further inappropriate fund application approval.
Abstract: Chandra, Nathaniel In Australia in 2013, there were an estimated 4.7 million people over the age of 50 with either osteoporosis or poor bone health1. Generally under-diagnosed, osteoporosis was associated with 144 000 fractures in 2013. With the total cost of osteoporosis estimated to be approximately $7.4 billion per year, the burden of the disease and its complications are enormous.
Abstract: du Toit, Paul Francois Background: Total Knee Arthroplasty is a common and costly surgical procedure. The majority of patients have successful surgery and post operative rehabilitation, however, there is a group that fail to gain adequate ROM and develop chronic pain. There have been many studies demonstrating the effect of preoperative pain catastrophising as a predictor of chronic postoperative pain. The aim of this study is to assess the effect of pain catastrophising on functional outcome following total knee arthroplasty.
Methods: 50 patients were included in a study over a period of one year at the Eden Rehabilitation Centre. The patients completed a Pain Catastrophising Scale (PCS) on admission and then their functional outcome was measured on their discharge using ROM, Timed Up and Go (TUG) and Functional Independence Measure (FIM).
Results: There was no statistical evidence that pain catastrophising postoperatively had any effect on functional outcomes. There was, however, a significant difference between the PCS reported by the male patients compared to the female patients. Conclusion: The data from this study does not support the PCS being used post-operatively as a screen for poor functional outcome.
Abstract: McBride, David Carpal tunnel syndrome (CTS) is a condition best described as a 'constellation of symptoms:' a pattern or arrangement which is more complex than most. A CTS patient may therefore present an 'ill structured clinical problem,' the diagnosis of which must be approached with caution, and a thorough understanding of the pathophysiological mechanisms which contribute.
Abstract: Ganderton, Charlotte; Cook, Jill; Docking, Sean; Rio, Ebonie; van Ark, Mathijs; Gaida, Jamie Achilles tendinopathy is commonly encountered in clinical practice yet can be quite difficult to successfully treat. Relative overload is the precursor to most presentations, while systemic conditions can decrease the amount of load that triggers overload. While there is evidence for the use of eccentric exercise, it is not recommended in isolation for most presentations of Achilles tendinopathy as it fails to address strength and kinetic chain deficits, which can leave the individual vulnerable to recurrence. Insertional tendinopathy requires a tailored management that avoids dorsiflexion, as this position compresses the tendon onto the calcaneus.
Purpose: This masterclass summarises the tendinopathy continuum and articulates the authors' clinical reasoning and hands-on experience managing Achilles tendinopathy. We outline graded loading concepts while emphasising that relying on recipes is likely to fail. We also provide a perspective on the role of central pain processing and peripheral input from nociceptive fibres in the context of tendinopathy.
Inplications: Rehabilitation should be tailored to address identified impairments (muscle bulk asymmetries, kinetic chain dysfunction, tolerance of energy storage and release in the Achilles tendon), and progressively work toward movements and activities relevant for the individual's sport or daily activities. Within the three-stage rehabilitation sequence, stage 1 aims to reduce pain and increase calf muscle bulk; stage 2 focuses on improving power within the whole kinetic chain, and movement control during jumping and landing; and stage 3 begins to retrain sport specific load, and carefully introduces movements that require energy storage and release within the tendon.
Abstract: Kanji, Giresh Low back pain is the most common musculoskeletal complaint. In surveys 60 to 69% of 40 year olds have experienced low back pain in the last year with over 80% experiencing low back pain within their lifetime1. The origin of spinal pain has been elusive with many pain textbooks stating that up to 85% of low back pain is of unknown origin. The integration of new technologies such as MRI for spinal pain has not been fully established. This article will attempt to outline pain generators in the lumbar spine to present a model of spinal pain which integrates pathology, neurophysiology and central nervous system pain sensitivity.
Abstract: Krechman, Belinda As a clinician dealing with musculoskeletal pains on a daily basis, patients often have a chief musculoskeletal pain complaint that becomes aggravated by their work situation; daily tasks or ergonomic settings. Office work is dominated by keyboarding while looking at visual display units often in a seated position. Poor sitting postures have been shown to have a strong influence in the development and perpetuation of musculoskeletal dysfunctions (MSD). Work related MSD as a result of prolonged poor sitting postures, means a musculoskeletal complaint that may have been induced by work and also worsens during working hours and days.
Abstract: Kanji, Giresh; Weatherall, Mark; Peter, Raja; Purdie, Gordon; Page, Rachel Objective: Chronic tension-type headache (CTTH) is a chronic syndrome characterized by frequent headache occurring more than 15 days per month. The intensity and duration of headache pain can be very distressing and disabling on an individuals' well-being. The purpose of this study was to examine the applicability of sauna bathing as a new method of treatment for reducing pain in patients with CTTH.
Methods: Thirty-seven people who fulfilled the International Headache Society criteria for CTTH were randomly assigned into two groups. The control group (n = 20) received advice and education while the intervention group (n = 17) received the same advice and attended a sauna regularly for 8 weeks. Reductions in subjective pain were determined using the numerical pain rating scale (NPRS). Disturbance in sleep, depression as assessed by Beckman Disability Index (BDI), and Headache Disability Index (HDI) were measured.
Results: Mean change in headache intensity significantly differed between the sauna and control group by 1.27 (95% confidence interval, 0.48-2.07; F = 10.17; df = 1, 117; p = 0.002). There was no statistically significant change in duration of headache or improvement in sleep, depression, or HDI between the sauna and control groups.
Conclusion: Regular sauna bathing is a simple, self-directed treatment that is effective for reducing headache pain intensity in CTTH.
Abstract: Brooks, Christine Review(s) of: Oxford handbook of sport and exercise medicine, 2nd edition, by Domhnall MacAuley, Oxford University Press, Oxford, UK. 2013, 755 pp. ISBN 9780199660155, softcover, New on Amazon for $39 - $60 and used for $22 plus shipping charges, Also available as a eBook.
Abstract: Masters, Scott Review(s) of: Emergencies in sports medicine, by Dr Julian Redhead and Dr Jonathon Gordon, Oxford University Press, Oxford, UK. 2012, Available from Oxford University Press or Amazon for around $47.95 plus shipping.
Abstract: Agraval, Kyal Since early times low back pain with radicular leg pain has been described by medical authorities, including Hippocrates, Schmorl and Dandy. However, the causal relationship between the disc and radicular leg pain was only first clearly made in the seminal article on disc herniation by Mixter and Barr in 1934. Key discoveries in history which helped establish our understanding of discogenic back pain are presented in this article. Method: Using Pubmed a search was undertaken to locate the relevant medical literature. Search terms, including discogenic back pain, discovery of causes of back pain, and historical perspective low back pain, were applied. Articles that seemed to be significant were sourced from the Peninsula Health Library. Any relevant articles that were discovered by cross-reference were also perused where available. Some of the literature was reviewed only in abstract form.
Abstract: Baster, Thomas The endocannabinoid system is an endogenous lipid signalling system in all vertebrates. It has multiple important functions including the modulation of pain and it could have a significant role in the future in the clinical management of both acute and chronic pain. It consists of several receptors and ligands, with the most studied components being the receptors CB1 and CB2 and the endogenous ligands AEA and 2AG.
Abstract: McGrath, Ella; Yelland, Michael; van Driel, Mieke Osteoarthritis (OA) is the most common form of arthritis and is a source of chronic pain, disability and decreased quality of life for many people, particularly adults over 50. It affects more than 1.3 million Australians and affects females to males in a 3 to 1 ratio. Management of OA is a challenge for health care professionals. There are a wide range of management options that have varying levels of evidence for their efficacy. These include exercise, ambulatory aids, weight loss, pharmaceuticals, surgery, intra-articular injections and complementary medicines (CAM). In 2004-5, the Australian Bureau of Statistics National Health Survey (ABS NHS) established that 40% of Australians with OA use pharmaceuticals and 46% use dietary supplements. One of the most common supplements taken in Australia is glucosamine. It is also available in a combination tablet with chondroitin. Twenty six per cent of females and 21% of males with OA in the ABS NHS reported taking glucosamine.
Abstract: Juul-Kristensen, B; Remvig, L; Engelbert, RHH There are no precise prevalence rates of adults with generalised joint hypermobility (GJH), and in a recent review the prevalence for adults varies from 2% to 57% depending on age, gender and ethnic origin. For children the prevalence varies from 7% to 36%, primarily depending on the tests and criteria (especially the cut-off points) used for diagnosing GJH.
Abstract: Lee, MWL; McPhee, RW; Stringer, MD The dermatome is a fundamental concept in human anatomy and of major importance in clinical practice. There are significant variations in current dermatome maps in standard anatomy texts. The aim of this study was to undertake a systematic literature review of the available evidence for the distribution of human dermatomes. Particular emphasis was placed on the technique of ascertainment, the location and extent of each dermatome, the number of subjects studied, and methodologic limitations. Our findings demonstrate that current dermatome maps are inaccurate and based on flawed studies. After selecting the best available evidence, a novel evidence-based dermatome map was constructed. This represents the most consistent tactile dermatomal areas for each spinal dorsal nerve root found in most individuals. In addition to highlighting the orderly arrangement, areas of consistency and clinical usefulness of dermatomes, their overlap and variability deserve greater emphasis. This review demonstrates the validity of an evidence-based approach to an anatomical concept.
Abstract: Koulouris, George; Mehta, Ojas Hrakesh Back pain is an enormous clinical, social and economic problem, with up to 85% of adults experiencing back pain at some stage during in their lifetime.1 Chronic low back pain has many causes that can generally be divided into degeneration of the intervertebral discs (39-42%), facet joints (31%) and sacroiliac joints (18%).2,3 Although disc disease is implicated in all ages, sacroiliac and facet joint arthropathy are more frequently seen in older patients.
Abstract: Murtagh, John As a septuagenarian reflecting on a medical career of over 50 years, I remain firmly convinced of the primary and key role of doctors, especially general practitioners, in physical and procedural musculoskeletal medicine (MSM). During my time in over a decade of rural general practice I said many times that I could not have managed effectively without the knowledge and associated skills of manipulative medicine and all that emanated from it. This conviction and philosophy developed from experiences (outlined in this paper) prior to studying medicine. The journey has been controversial and stressful at times but counterbalanced by the many rewards. My approach has modified over the decades and these changes and the reasons for them will be presented.
Abstract: Govind, Jayantilal Stakeholders who have a vested interest in the management of personal injury claims and more so in the management of chronic axial pain coincidentally demonstrated an acute attitudinal change with the publication of the International Association for the Study of Pain's (IASP) monograph on Back Pain in the Workplace. By denying the reality of chronic axial pain, this monograph defined chronic low back pain not as a "medical problem," but as a problem of "activity intolerance".
Abstract: McGuirk, Brian; Ghabrial, YAE; Bogduk, Nikolai General practitioners and the public have the impression that back pain is a condition for which there is a surgical treatment and which, therefore, warrants treatment by orthopedic surgeons. Consequently, patients with back pain constitute a substantial proportion of patients referred to orthopedic outpatients. This load limits the time available for consultants to provide comprehensive and non-surgical care. Meanwhile, evidence-based guidelines for the management of back pain emphasize the need for explanation, assurance, and activation, and the avoidance of passive treatment and the use of investigations. The required management is distinctly medical, and not surgical, in nature. The present study reports the results of an innovation in which a physician was appointed to provide care for patients with back pain referred to orthopedic outpatients.
Abstract: Broadhurst, Norman A; MacLaren, Shane F This is the final report of stage I of the Shoulder Imaging Project financed by the Commonwealth Department of Health and Ageing.
Abstract: Govind, Jayantilal; Bogduk, Nikolai; Lau, P According to the World Health Organization, patients with severe headaches or migraine suffer the same degree of disability as a patient with quadriplegia or dementia. Population-based studies confirm that the impact of severe headaches on the quality of life is substantially burdensome. Severe and persistent pain is often associated with profound personal suffering and the increased risk of suicide is not uncommon. ln the Australian context, headaches generate some two million consultations (13%) annually at a cost of greater than $700 million per annum.
Abstract: Baster, Thomas This paper reviews the current literature relating to the use of anaesthetic blocks and radiofrequency ablation of the rami communicans at the L2 level. It is based on searches of Pubmed and Scirus of keywords "rami communicans", "L2 block", "DRG block L2", "Radiofrequency ablation lumbar back pain", and "lumbar disc innervation" It was prepared with the assistance of the library service at Griffith University.
Abstract: Baster, Thomas Bob (not actual name) aged 48 was not happy, as his chronic low back pain (cLBP) prevented him riding his Harley Davidson motorbike. He had been involved in a serious accident whilst serving in the Armed forces when a heavy tank rear door had struck him, resulting in fractures to his left femur, right femur, dislocated hips and left potts fracture about 20 years previously. He had developed low back pain about eight years ago and had been on the usual treatment circuit: physiotherapy, chiropractic, specialists, acupuncture, and even had tried Blomberg injections.
Abstract: Douglas, William This article outlines the development of the current concept of fibromyalgia syndrome (FMS). It reviews current management strategies and discusses the medicolegal implications associated with FMS. The important, documented psychological associations with FMS have received little recognition by many rheumatologists. Psychological factors are not mentioned in either ACR Criteria. The EULAR 2010 guidelines for management of FMS have brief recognition of this association. Integrating the work done by psychiatry and internal medicine in relation to FMS would only benefit and not disadvantage sufferers with this condition.
Abstract: Cleary, Mike; Ng, Charlie We have been considering our place in the NZ medical system from the point of view of our colleagues in general practice and specialist practice. There has been frustration with the lack of recognition of our existence, experience, and expertise by the Health Workforce tasked with planning for the future of the NZ medical manpower. While we may seethe at this, it seems ignoring musculoskeletal conditions is an international problem with medical school curricula as judged by the recent article in the May 27th NZMJ, called "Basing musculoskeletal curriculum changes on the opinions of practicing physicians" who sought to survey "...practicing clinicians who manage these conditions, to find out their opinions on which disorders they regard as most important. This information will then be used to inform curriculum design." No prizes for guessing which group of practising clinicians was not surveyed! Charlie has sent the Health Workforce person briefed with musculoskeletal education a CV of our organisation and, as I write, I sense that the NZMJ is receiving correspondence on the above article.
Abstract: Harding, Geoff This year we have seen the topic of health raised almost daily in this country. Healthcare costs the community lots of dollars and the politicians are always trying to deal with the ever-increasing drain on the budget. Whilst the focus usually is on hospitals and general practice, there are many other areas where changes are being made.
Abstract: Chow, Roberta T; Johnson, Mark I; Lopes-Martins, Rodrigo AB; Bjordal, Jan M Background. Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects. Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain. We did a systematic review and metaanalysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. Methods. We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain. Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. Findings. We identified 16 randomised controlled trials including a total of 820 patients. In acute neck pain, results of two trials showed a relative risk (RR) of 1 69 (95% CI 1 22-2 33) for pain improvement of LLLT versus placebo. Five trials of chronic neck pain reporting categorical data showed an RR for pain improvement of 4 05 (2 74-5 98) of LLLT. Patients in 11 trials reporting changes in visual analogue scale had pain intensity reduced by 19 86 mm (10 04-29 68). Seven trials provided follow-up data for 1-22 weeks after completion of treatment, with short-term pain relief persisting in the medium term with a reduction of 22 07 mm (17 42-26 72). Side-effects from LLLT were mild and not different from those of placebo. Interpretation. We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Funding. None.
Abstract: Choong, Thomas Osteoarthritis is the most common form of arthritis. It affects millions of people in Australia and many more worldwide. Osteoarthritis, at this point in time, has no cure. The significance of this disease is illustrated not only by its prevalence in the community, but also by the impact it has on that community. It affects patients in terms of pain and disability, financial costs, and quality of life. It also imposes a financial burden on all levels of society - the family, local community, business, and government. And its impact is increasing with time in line with the phenomenon of the ageing population.
Abstract: Pietzsch, Tibor Thomas The first record of epidural injections is from France. In 1901 Sicard and Catherine and in 1909 Coussade and Chauffard used epidural injection to relieve back pain. I could find no actual record of what substance they injected, but there is a suggestion, that it was either cocaine or a narcotic.
Abstract: Douglas, Robert Objective. Acute tendinopathy is an injury that is commonly seen in general practice and sports medicine clinics. Management of the condition can be difficult, and has traditionally been limited to rest, NSAIDs, and adjuncts such as ice and physiotherapy. The aim of this study was to determine the efficacy and tolerability of a "polypill" comprising ibuprofen and doxycycline, with adjunctive use of omega-3 fatty acids ("fish oil") and green tea. Method. Patients with symptoms determined to be due to an acute tendinopathy were identified. After informed verbal consent, they were offered treatment with the polypill. Results. Initial review occurred 1-3 weeks after commencement of treatment - 19/20 patients reported an improvement in symptoms at this review. Half of the patients reported resolution of symptoms at five weeks or less. 15 patients (75%) were able to complete their prescribed polypill course. Only two patients (10%) ceased polypill treatment as a result of adverse effects. One patient failed to report any change in symptoms. The median and mode duration of treatment with the polypill was four weeks. Conclusion. The resolution (or improvement) of symptoms in most patients in four weeks or less suggests that the observed effect of the polypill therapy for most patients may be due to the combined anti-inflammatory and analgesic effects of ibuprofen. There may be only a subgroup of patients suffering from an acute tendinopathy for whom the polypill is appropriate treatment. Suggestions are made for areas of further polypill research.
Abstract: Williams, Nefyn H The initial clinical assessment of spinal pain consists of diagnostic triage into (i) serious spinal pathology, (ii) other pathological entities, and (iii) non-specific symptoms. The non-specific group comprises the major burden of spinal illness. There are two broad approaches to the diagnostic challenge of non-specific spinal pain. One approach is to split the group into sub-groups explained by separate pathophysiological abnormalities. The focus of this work is to describe these proposed abnormalities in greater detail and to discover which clinical features distinguish them. The other approach is to lump all of those with non-specific features into one group, and consider the common psychosocial factors that are relevant to the whole group. A variety of pathological and non-pathological models have been proposed. Pathological models include ligament laxity, facet syndrome, discogenic pain, spondylosis, and instability. Non-pathological models include a pain-spasm-pain cycle, muscle inhibition and deconditioning and somatic dysfunction. All of these models are problematic and do not fully account for all of non-specific spinal pain. Another approach is to consider these two different approaches together and to consider this non-specific category as orthogonal dimensions of pathology and dysfunction.
Abstract: Collinson, Gary The last six months has been busy for the officers and executive of the Association. Late in March many months of organization finally came to fruition with the conference "Spine in Action: Low Back Pain - Can Chronicity be Prevented'" This was held at the Rendezvous Hotel in Auckland.
Abstract: Harding, Geoff It has been almost 12 months since the AGM on the Gold Coast and my election as president of the AAMM. I am sorry to say that I had planned to ensure that we had had an issue of the Journal to you long before this. No excuses can be offered except that time seems to be in great demand these days.
Abstract: Watt, PJames Background and purpose. Patients with chronic headache and neck pain often were found to have continuing dysfunction in the cervical spine. The purpose of this study is to determine the effectiveness of a specific mobilization technique, sustained segmental post-isometric relaxation (SSPIR), for treatment of these patients. Subjects. There were 27 consecutive subjects with chronic neck pain. Methods. A specific mobilization technique was used. The technique was repeated at each follow-up, with a specific home-exercise prescribed between consultations. Results. Nineteen patients reported improvement to 85-100% of normal at one-year follow-up. Six relapsed after initial improvement and continued to have pain at one year. None was worse after treatment than at entry. One was lost to follow up. Discussion. The results suggest effectiveness of the treatment but there are significant sources of bias. Conclusion. The apparent effectiveness of this mobilization technique warrants further study. Summary. A case series of 27 consecutive chronic neck pain patients from the author's practice who had symptoms of neck pain or headache for a mean of 40 months were treated on average twice with a specific treatment technique. At telephone follow up, a minimum of a year later, 19 (70%) reported improvement to 85-100% of normal. While the study has a number of potential areas for criticism, the results warrant further investigation.
Abstract: Chou, Roger; Fu, Rongwei; Carrino, John A; Deyo, Richard A Background. Some clinicians do lumbar imaging routinely or in the absence of historical or clinical features suggestive of serious low-back problems. We investigated the effects of routine, immediate lumbar imaging versus usual clinical care without immediate imaging on clinical outcomes in patients with low-back pain and no indication of serious underlying conditions. Methods. We analysed randomised controlled trials that compared immediate lumbar imaging (radiography, MRI, or CT) versus usual clinical care without immediate imaging for low-back pain. These trials reported pain or function (primary outcomes), quality of life, mental health, overall patient-reported improvement (based on various scales), and patient satisfaction in care received. Six trials (n=1804) met inclusion criteria. Study quality was assessed by two independent reviewers with criteria adapted from the Cochrane Back Review Group. Meta-analyses were done with a random effects model. Findings. We did not record significant differences between immediate lumbar imaging and usual care without immediate imaging for primary outcomes at either short-term (up to 3 months, standardised mean difference 0.19, 95% CI -0.01 to 0.39 for pain and 0.11, -0.29 to 0.50 for function, negative values favour routine imaging) or long-term (6-12 months, -0.04, -0.15 to 0.07 for pain and 0.01, -0.17 to 0.19 for function) follow-up. Other outcomes did not differ significantly. Trial quality, use of different imaging methods, and duration of low-back pain did not affect the results, but analyses were limited by small numbers of trials. Results are most applicable to acute or subacute low-back pain assessed in primary-care settings. Interpretation. Lumbar imaging for low-back pain without indications of serious underlying conditions does not improve clinical outcomes. Therefore, clinicians should refrain from routine, immediate lumbar imaging in patients with acute or subacute low-back pain and without features suggesting a serious underlying condition.
Abstract: McGuirk, Brian; Ghabrial, YAE General practitioners and the public have the impression that back pain is a condition for which there is a surgical treatment and which, therefore, warrants treatment by orthopedic surgeons. Consequently, patients with back pain constitute a substantial proportion of patients referred to orthopedic outpatients. This load limits the time available for consultants to provide comprehensive and non-surgical care. Meanwhile, evidence-based guidelines for the management of back pain emphasize the need for explanation, assurance, and activation, and the avoidance of passive treatment and the use of investigations. The required management is distinctly medical, and not surgical, in nature. The present study reports the results of an innovation in which a physician was appointed to provide care for patients with back pain referred to orthopedic outpatients.
Abstract: Vivian, David Coccygeal pain (also known as coccydynia and coccygodynia) refers to pain derived from the coccyx. The term defines a symptom rather than a diagnosis. Coccydynia was first described by Petit in 1726, as "caries of the coccyx." Understanding of its etiology has varied significantly during its history. At the beginning of the twentieth century, coccydynia was thought to derive from trauma, and coccygectomy was a common procedure. During the early twentieth century coccydynia was understood to be the result of neurosis and hysteria. Coccydynia is now understood to result from a number of specific conditions, but the etiology of many cases remains unknown.
Abstract: Bogduk, Nikolai The fundamental reason I pursue the diagnosis of discogenic pain is that patients have no other valid alternative. Patients with chronic back pain get caught in a circus. They are told that there is nothing wrong with them medically; or they are told something fallacious, such as they once did have nociception, but that has now ceased, and now they have only a "memory" of that pain. Under those conditions, medical treatment will not help, and the only prospect of treatment is behavioural and physical rehabilitation. But that treatment does not work. The patients still have pain. Yet again they are told there is nothing wrong. They failed rehabilitation, and the only recourse is to repeat it.
Abstract: Collinson, Gary The year 2009 has started off fast enough for everyone and it is poignant to think we are already half way though the year. As always, there is so much to do and so little time to do it. The Executive has met regularly and continues to discuss a number of issues that affect the Association and musculoskeletal medicine in New Zealand. The exciting news is that the Department of Orthopaedics and Musculoskeletal Medicine at the Christchurch School of Medicine, University of Otago, has secured a Post-Graduate Masters in Pain Medicine and Management. The convener, Dr Jim Borowczyk, will be offering the program as of 2010. This is a unique and significant achievement that can only enhance the quality of pain management in New Zealand. The Christchurch Department of Orthopaedics and Muscu loskeletal Medicine can now offer a range of post-graduate qualifications from a Certificate, Diploma, and now a Masters in our field of interest and expertise.
Abstract: Oei, Michael As I am approaching the end of my term as president of the AAMM, I am sorry to say that musculoskeletal medicine in Australia as well as world wide has not made any inroads for specialty recognition. Musculoskeletal medicine is going through a difficult time in attracting new members. Unless there is a career path at the end of the training and better Medicare rebates, it will be difficult to entice our younger GP colleagues to commit their time and money to do any MSK postgraduate training. Currently the Association is too small a group to have any real bargaining power with the government policy makers. In order for the government to consider musculoskeletal medicine as an entity, we need to make back pain a national health issue.
Abstract: Wilk, V In an earlier paper the author examined the correlation between lumbar disc morphological changes and pain in the general population. Certain changes in the disc can be seen on MRI that do correlate with pain, but are nonetheless present in significant proportions of the normal population. The author also examined some of the key evidence questioning the validity of provocative discography as the gold standard in diagnosing discogenic pain. The debate on discography continues and whether there is a clinical role for discography. In this article the author examines the principle of provoking pain to make a specific diagnosis. (non-author abstract)
Abstract: Roselt, D; McKay, AB; Masters, S The author discusses the diagnosis of neurogenic, radicular and referred pain and the technique of paraspinal nerve injections. (non- author abstract)
Abstract: Lyftogt, J Recalcitrant lumbago with a mean duration of 5.5 years in 41 consecutive patients presenting over a one year period was treated effectively with a series of subcutaneous prolotherapy treatments. 90% improved by more than 50% from an initial mean Visual Analogue Score (VAS) of 7.6, with 29%, reaching VAS 0 at a mean treatment length of 8.3 weeks. Subcutaneous prolotherapy treatment has been shown to be highly effective in the treatment of a variety of peripheral neuropathic painful conditions. This clinical practice is founded on a proposed working hypothesis that subcutaneous prolotherapy is a suitable, effective and cheap treatment for prolonged pathological peripheral neurogenic inflammation. (author abstract)
Abstract: Frampton, C; Donaldson, B; Shipton, E; Rivett, D; Inglis, G This paper outlines the principles of exercise prescription, with an emphasis on the injured person. Patients with pain, particularly chronic pain often exhibit low levels of activity and fitness. The literature reports that if these patients increase their activity and fitness levels they will experience a corresponding improvement in their own sense of personal wellbeing. Post-discectomy patients generally experience pain and related decreased physical function for extended periods of time. As a consequence, they also frequently experience an increased level of psychosocial stress and decreased physical strength. By increasing their physical fitness and strength, these negative outcomes can be minimised or even neutralised. The key aim of any postsurgical exercise program is to achieve these goals without increasing pain. There are several concepts of exercise prescription that are critical when designing an exercise program for the injured person. These concepts will be discussed in relation to both postsurgical and pain patients. (non-author abstract)
Abstract: Taylor, Margaret E Research into prolotherapy continues in several centres and some recent published papers are presented here with comments.
Abstract: Thompson, Grant Greater trochanteric pain syndrome (GTPS) is a common and frequently debilitating condition presenting with pain at or around the greater trochanter, sometimes referring to the lateral hip or lateral thigh. The condition is often chronic.
Abstract: Jensen, Steve Shoulder pain is very common. It has been estimated that approximately 10% of the adult population will experience an episode of shoulder pain in their lifetime, whilst shoulder pain is the third most common musculoskeletal presentation in general practice, after low back and neck pain. It has also been reported that up to 41% may have persistent symptoms at 12 months. The astute clinician needs to be able to differentiate between potential sources of "shoulder" pain, including intrinsic conditions of the shoulder joint complex, the neck and, uncommonly, non-musculoskeletal conditions...This paper provides a summary of available data pertaining to pain referral zones as a result of musculoskeletal conditions which may present as "shoulder" pain.
Abstract: Baster, Thomas J A neurotrophin called nerve growth factor is present in the intervertebral disc in low levels and is upregulated following injury and by inflammation, with an increase in nociceptive neurons. Brain-derived neurotrophic factor is also upregulated by inflammation and this can lead to neo-vascularization and neo-innervation. Whilst glial-derived neurotrophic factor is increased in the dorsal root ganglion following disc inflammation, the implication of this is unclear. Finally a semaphorin known as Sema3A, which has an inhibitory effect on neuron growth, is reduced in the disc following injury and this may tip the balance towards neo-innervation.
Abstract: Mitchell, Bruce; Verrills, Paul; Vivian, David Over the last two decades, the sacroiliac joint (SIJ) has increasingly been recognized as an anatomical source of pain that figures in the differential diagnosis of a patient presenting with low back pain (LBP) and/or buttock pain with or without more distant referred pain.1-7 The SIJ is innervated and thus has the potential to be a source of pain.
Abstract: Brooks, Christine M Core stability training has gained wide acceptance as a treatment for low back pain rehabilitation, maintenance of a healthy back, and improved sport performance. This article examines aspects of core stability/strength exercise program approaches, with a focus on research suggesting that core stability and core strengthening programs are misconceived. It outlines a brief overview of spinal stability research and its application to core stability/strengthening programs within both the rehabilitation and sport performance enhancement sectors and briefly explains why these programs violate essential motor control and training theory principles.
Abstract: Bogduk, Nikolai What medical education did not teach is how to be discerning. Medicine never admitted that its professors might be wrong. It did not teach students how to question the professor. For undergraduate purposes this might be pragmatic. There is so much to learn. We cannot afford the time to question and justify everything, so we have to take what is taught on trust. But in the postgraduate arena these concessions should not apply. Trust can be abused. For new knowledge, serious questions serve to protect kindly but compliant practitioners from gullibility...Many examples might be invoked, but I shall illustrate with two. The first exemplifies simple, forensic, bibliographic enquiry. The second illustrates the application of the rules of biostatistics.
Abstract: Ng, Charlie During 2011-2012, NZAMM has been continuing its cycle of educational activities. Central to this are the musculoskeletal workshops presented around the country by musculoskeletal physicians. Last year's workshop theme was "The Shoulder". The workshops were well received by participants in Rotorua, Wellington, and Auckland. The theme for the 2012 workshops is "Low Back Pain". This along with other topics will be presented at the NZMA GP CME meeting in Rotorua on 7 June 2012 and at other meetings during the year.
Abstract: Harding, Geoff These days I find myself wondering about the state of medicine in Australia, especially that of general practice. Of course, I am no expert on the subject given that I have been in full-time musculoskeletal medicine since about 1989. However, I do read the press and have discussions with colleagues who are in general practice, and I am also privy to the impressions of those patients who come to see me about their musculoskeletal pain problems. There seems to be a paradoxical change underway where, in spite of care plans and improved technology, and the growth of large multi-doctor clinics, many patients are actually feeling depersonalised by the "system".
Abstract: Govind, J Stakeholders who have a vested interest in the management of personal injury claims and more so in the management of chronic axial pain coincidentally demonstrated an acute attitudinal change with the publication of the International Association for the Study of Pain's (IASP) monograph on Back Pain in the Workplace. By denying the reality of chronic axial pain, this monograph defined chronic low back pain not as a "medical problem" but as a problem of "activity intolerance". Yet paradoxically, the same monograph advocated that the "medical management" should not be "pain contingent" but rather "time contingent". The rationale for this was not articulated, and evidentiary basic science - as one would expect in cardiorespiratory and other medical disorders - was conspicuously absent. The taskforce further recommended that those who fail to achieve restoration of function and return to work were to be reclassified as "unemployed". Despite its irony, it is a sad commentary for the premier scientific body in pain medicine to deny the existence of chronic axial pain, to encourage unemployment and its psychosocial upheavals and for this Task Force to promote itself as a self-appointed surrogate gatekeeper to a non-medical system principally ensconced in claims management, cost containment and cost reduction. (non-author abstract)
Abstract: Lyftogt, J The growing scientific evidence supporting the view that neuropathic pain syndromes are caused by unremitting peripheral neurogenic inflammation involving the autonomic and sensory nerves may lead to renewed interest in prolotherapy and neural therapy as these treatments are effective and seem to target the PNS. The author has now treated more than a 1000 patients with subcutaneous prolotherapy targeting neurogenic inflammation of peripheral nerve trunks in much the same way as Zochodne's percutaneous near nerve injections with low- dose opioids. Published results are promising for recalcitrant lumbago, shoulder, knee, elbow pain, and achillodynia. Patients with chronic neuropathic pain will continue to suffer needlessly if physicians remain fixed on the reigning paradigm that can suggest only "pain management" when there are well documented alternatives available that may offer a cure. (non-author abstract)
Abstract: Lyftogt, J Inferior heel pain, also known as plantar fasciitis, is a peripheral neuropathic pain syndrome due to persistent neurogenic inflammation of the medial calcaneal branches of the tibial nerve. Vitamin D3 is considered to be a neurosteroid with neuroprotective properties. This is the first report of two patients responding favorably to twice daily applications of vitamin D3 transdermal cream for this difficult-to-treat condition. (author abstract)
Abstract: Bailey, MJ Meralgia paresthetica has a variable presentation with regards to both the nature of the symptoms and the area of skin affected. Patients may complain of pain, burning, aching, tingling, numbness, and dysesthesias with or without paresthesias involving pinprick and touch sensation. The anatomy, diagnosis and management are discussed. (non- author abstract)
Abstract: McKay, AB The author considers the issue of 'journalisation' in medicine, a term from the aviation industry conveying the 'ticking of boxes' on checklists without carrying out the task. (non-author abstract)
Abstract: McGuirk, B; Bogduk, N In their publication, Indahl et al described exercises to empower patients by giving them a treatment that they could administer to themselves, by themselves. Such exercises were also cited by McGuirk et al. There is no citable description of these exercises, however. The present article outlines how the exercises were developed, as a matter of historical anecdote. It describes the exercises themselves. Most importantly, it explains how patients should be instructed to use them and why. (non-author abstract)
Abstract: Kanji, G The theory of convergent referred pain is based on pathways of the somatic and visceral afferent nerves converging at the dorsal horn or other central nervous system centre. The message transmitted to the brain is of somatic pain, with nociception occurring at a visceral structure. The author outlines the visceral and somatic afferent pathways in the spinal cord to the brain and show that convergence of the neurons is unlikely and that convergent referred pain is not solely a phenomenon of somatic and visceral convergence. Convergent referred pain that causes arm and neck pain in patients with cardiac pain is more likely to arise from spatial and temporal summation of visceral afferents in the dorsal horn or higher centres. (non-author abstract)
Abstract: Kanji, G The origin of headache disorders and chronic widespread pain without pathology is likely to be visceral, with the afferent nerves entering the spinal cord via sympathetic pathways. The sympathetic nerves supply the blood vessels, sweat glands and the erector pilae muscles. The motor outflow of the sympathetic nervous system is from T1 to L2. The sympathetic afferents from throughout the body return to their parikayra of origin T1 to L2. The occurrence of nociception due to visceral structures is likely to cause the pain. Stretched blood vessels are likely to initiate the deep pain. (non-author abstract)
Abstract: Musculoskeletal physicians inevitably come across many sport- related injuries and frequently hear the sporting catch phrase "watch the ball!" The author explains the importance of this task and how it can relate to the many injuries musculoskeletal physicians see. (non- author abstract)
Subscription journal
[403 journals]
