MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'back pain'. Sat, 03 Sep 2011 01:52:20 +0100 http://www.medworm.com/index.php?rid=5182238&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F08%2Fmedical-misadventures.html Yesterday I had such a wonderful day I needed chocolate ice cream at the end of it. Why was it such a wonderful day you ask? Well I am signed up for more medical (mis)adventures. I am so (un)excited. I had an appointment with my back pain doctor, also known as the doctor who prescribes the good drugs. He told me that I looked in good shape, and didn't comment on my high blood pressure reading that concerned the nurses. He told me that I have pain from my facet joints (the little joints along the side of your spine), my right sacroiliac joint (the long joint along the side of your tail bone next to your hip bone), and from greater tronchanteric bursitis in my left hip. All the previous treatments/injections have worn off and I need to start over again. He insisted on squeezing me in on W... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=5182238 Tue, 30 Aug 2011 10:12:00 +0100 5182238 http://www.medworm.com/index.php?rid=5125738&cid=t_103331_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-new-meaning-of-the-refrigerator-nurse%2F2011.08.13 Meet Nurse Prudence Perfect. She is the unit’s refrigerator nurse. It’s her job to make sure that everything is perfect and meets Joint Commission standards because you never know when the old JC will drop by for an unannounced visit. Insulin vials labeled and dated? Check. Refrigerator thermometer easily accessible and log up to date? Check. Hey, who put their lunch in here? There is to be no food in medication refrigerator! Prudence is gearing up. Stand by for one of her Joint Commission inservices. For you nursing history buffs, the term “refrigerator nurse” goes way back to a time when Prudence was a graduate nurse. The term was coined back when it only took one paycheck to support a family, and when nurses, typically women, quit working once they got married. A nurse who went... Better Health blogs http://www.medworm.com/rss/comments.php?id=5125738 Sat, 13 Aug 2011 12:00:50 +0100 5125738 http://www.medworm.com/index.php?rid=5050955&cid=t_103331_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Fcome-sit-in-my-seat-with-me%2F As most of you who read this blog regularly know, I am plagued by sacroiliac joint pain. I have other problems but today, since I am lying here on a painful behind and have been intensely trying to get out of this current flare, it is on my mind. I thought you might be interested in knowing what life is like in my shoes, my seat and my life right now. It’s been almost three months since I flew to California with my daughter to begin the process of cleaning out my mother-in-law’s house. I don’t fly well…at least without my wings. Even on an airplane I am bottom challenged and find them grossly uncomfortable. Three days after flying home I picked up our 31 pound rough-coated Jack Russell, Annie because she couldn’t get into the car to go to the vet’s. The combination of all of t... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5050955 Thu, 21 Jul 2011 20:27:49 +0100 5050955 http://www.medworm.com/index.php?rid=5036231&cid=t_103331_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fstudy-investigates-relief-for-chronic-back-pain%2F2011.07.17 This study confirmed what I have known for a long time.  They looked at relaxation massage and structural massage, which focuses on correcting soft-tissue abnormalities.  At 10 weeks they found (more…) *This blog post was originally published at EverythingHealth* (Source: Better Health) Better Health blogs http://www.medworm.com/rss/comments.php?id=5036231 Sun, 17 Jul 2011 12:00:00 +0100 5036231 http://www.medworm.com/index.php?rid=5008472&cid=t_103331_129_f&fid=36035&url=http%3A%2F%2Fwww.everydayhealth.com%2Fblog%2Flife-with-chronic-pain%2Flife-can-become-very-weird-living-with-chronic-pain%2F I know. You’re thinking life is weird already but let me say, if you’re newly diagnosed, “You ain’t seen nothin’ yet!” If you are one of us who live with connective tissue or rheumatoid disease you may see a certain set of weirdness. If you suffer from back pain or had a previous injury, you’re not excluded, either. It’s amazing what life can do to twist, shape and torment us. If our diseases or injuries don’t do enough in that department then there are always the medications to take up the slack and pile it on. Get your sense of humor ready and if you don’t have one, well, blessings upon you my friend because you’re going to need one. The other day I was fitted for a sacroiliac belt to aid my sacroiliac joints to stay put. All that was missing at the fitting was Scar... Life with Chronic Pain blogs http://www.medworm.com/rss/comments.php?id=5008472 Thu, 07 Jul 2011 20:13:33 +0100 5008472 http://www.medworm.com/index.php?rid=5008158&cid=t_103331_87_f&fid=36941&url=http%3A%2F%2Fwww.mazecordblood.com%2Fblog%2F%3Fp%3D1412 sci·at·i·ca –noun 1.  pain and tenderness at some points of the sciatic nerve, usually caused by a prolapsed intervertebral disk; sciatic neuralgia. 2. any painful disorder extending from the hip down the back of the thigh and surrounding area. Unfortunately, sciatica is one of the most painful types of back pain and is common in pregnancy. It usually occurs when the baby shifts or moves and lands on a nerve. Tips to alleviate the pain might include, getting off your feet , if only for a little while, while sitting, raise one leg on a step stool or a pile of books.  You can read more here for other tips and helpful hints to ease the pain of sciatica.   (Source: Cord Blood News) Cord Blood News blogs http://www.medworm.com/rss/comments.php?id=5008158 Wed, 06 Jul 2011 16:45:44 +0100 5008158 http://www.medworm.com/index.php?rid=5008384&cid=t_103331_113_f&fid=38494&url=http%3A%2F%2Fcuretogether.com%2Fblog%2F2011%2F07%2F05%2Flower-back-pain-study%2F For the live-updated, interactive version of this infographic, click here. Lower Back Pain is our 12th most popular condition community at CureTogether. 2,398 of you have contributed your experiences with 21 symptoms and 46 different treatments that worked well and didn’t work so well. We are proud to announce the current results of our Lower Back pain study, in the chart above. The top patient-reported treatments for Lower Back pain are: Yoga/stretching, Hot tubs, Hydrocodone, Massage, Aleve, and Improved posture. To navigate the graph above: The top right quadrant shows the most popular and effective treatments, and the top left quadrant shows treatments that not many people have tried but that have above-average effectiveness, so they may be options to think about (e.g. Hot tub,... The Collective Well blogs http://www.medworm.com/rss/comments.php?id=5008384 Tue, 05 Jul 2011 14:49:01 +0100 5008384 http://www.medworm.com/index.php?rid=5159031&cid=t_103331_90_f&fid=36413&url=http%3A%2F%2Fwww.dcscience.net%2F%3Fp%3D4582%26utm_source%3Drss%26utm_medium%3Drss%26utm_campaign%3Dapologists-for-andrew-wakefield-at-southampton-university-a-russell-group-university-teaching-some-dangerous-nonsense Conclusion Electrodermal testing cannot be used to diagnose environmental allergies", published in the BMJ .[download reprint]. In 2003 he published "A randomized, double-blind, placebo-controlled proving trial of Belladonna 30C” [download reprint] that showed homeopathic pills with no active ingredients had no effects: The conclusion was "”Ultramolecular homeopathy has no observable clinical effects" (the word ultramolecular, in this context, means that the belladonna pills contained no belladonna). In 2010 he again concluded that homeopathic pills were no more than placebos, as described in Despite the spin, Lewith’s paper surely signals the end of homeopathy (again). [download reprint] What i cannot understand is that, despite his own findings, his pri... DC's goodscience blogs http://www.medworm.com/rss/comments.php?id=5159031 Sun, 03 Jul 2011 17:10:30 +0100 5159031 http://www.medworm.com/index.php?rid=4893948&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F02%2Fcatastrophising-and-pain-ii%2F What are some of the indications that someone tends to catastrophise about their pain? How do we know? Do we have to use a questionnaire? Is it really my job to know about this if I’m not a psychologist – and what do I do about it? These are the kinds of questions that have been posed to me as I’ve explored the topic of catastrophising, and I propose to answer the last question in my next post (sorry to keep stringing you along like this – I think many may know my take on that already!). I work in a wonderful interdisciplinary team setting, in a centre where everyone who attends the Centre gets to complete a set of psychometrically sound questionnaires that all of the team are encouraged to use and interpret, so any of the team can be confident about identifying and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4893948 Thu, 02 Jun 2011 08:26:50 +0100 4893948 http://www.medworm.com/index.php?rid=4893949&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F06%2F01%2Fpain-behaviours-persist%2F In this study by Martel, Thibault and Sullivan (2010), people with back pain were recorded on two separate occasions (on averge 22 days apart) while carrying out two lifting tasks designed to elicit pain behaviours.  These recordings were reviewed by trained observers who recorded the number of pain behaviours in each segment of film using a standardised coding scheme (developed by Keefe and Block, 1982).  Participants in the lifting tasks also completed a range of questionnaires – the Tampa Scale for Kinesiophobia, the McGill Pain Questionnaire, and the Pain Catastrophising Scale. Before I describe the findings, in this study two different forms of pain behaviour were identified – communicative behaviours are things like grimacing, speaking, sighing, moaning and so on; while... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4893949 Wed, 01 Jun 2011 05:26:00 +0100 4893949 http://www.medworm.com/index.php?rid=4876386&cid=t_103331_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-less-is-more-how-to-improve-the-quality-of-primary-care%2F2011.05.28 On the NPR Shots blog, Scott Hensley writes, “Quality Prescription For Primary Care Doctors: Do Less,” about an article in the Archives of Internal Medicine. Excerpt: “A group of docs who want to improve the quality and cost-effectiveness of primary care tinkered with some Top 5 lists for of dos and don’ts for pediatricians, family doctors and internists. After testing them a bit, they published online by the Archives of Internal Medicine. Most of the advice falls in the category of less is more. So what should family doctors not be doing? The Top 5 list for them goes like this: 1. No MRI or other imaging tests for low back pain, unless it has persisted longer than six weeks or there are red flags, such as neurological problems. 2. No antibiotics for mild to moderat... Better Health blogs http://www.medworm.com/rss/comments.php?id=4876386 Sat, 28 May 2011 16:00:55 +0100 4876386 http://www.medworm.com/index.php?rid=4872373&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fi-am-not-capable-of-technology.html I just created a long blog post about whether I was capable of technology and the answer is I am not. I accidentally deleted it before it posted and have to start over. It was all about how advances in technology can be good - this is coming from someone who survived the release of Windows 3.0 and first used Lotus 123 Version 2 for Dos (the computer operating system back when the world was flat and in black and white). But apparently I am not good enough to use my own phone for anything but making phone calls.Now I have moved to a desktop computer and am being assisted by the cat-on-the-lap syndrome so it is a long slow process - but the cat is happy.Speaking of long, today will be long. My back decided I had too much fun recently and woke me up early to tell me about this. Unfortunately I... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4872373 Thu, 26 May 2011 14:26:00 +0100 4872373 http://www.medworm.com/index.php?rid=4829230&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F05%2Fim-cranky.html this week. I have a lot going on and am feeling stressed. This is what is making me cranky:Blogger was down for most of two days. I find this one of the most epic cases of mismanagement. Yes it is a free service we use to host our blogs but it is part of Google's money making tools (where they are trying to take over the world) but they just severely shot themselves in the foot. Apparently there were some upgrades and maintenance issues and things went wrong and the Blogger service was done for parts of Thursday and most of Friday with no real updates or explanation. I am ready to move my blog to a provider which actually runs parallel servers to ensure these issues don't happen. Its not the problems with service but the lack of communication through the issues. Just imagine if the Google... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4829230 Sat, 14 May 2011 11:19:00 +0100 4829230 http://www.medworm.com/index.php?rid=4775617&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F05%2F03%2Fpsychological-stuff-isnt-in-my-scope-of-practice-so-what-can-i-do%2F A common cry from various clinicians who work in the field of pain management but who are not psychologists is “but now what?” when they recognise that a key factor in recovery is something psychosocial. The answer is not, I suspect, heading off to become a psychologist! For several reasons, I think it’s critical for non-psychologists to get comfortable with psychosocial language and principles. All clinicians use psychological principles in their interactions with patients.  Like it or not, when we give advice or encouragement we’re using knowledge gleaned from psychological study.  We might call it something like “developing rapport”, but no matter what we call it, these interpersonal skills are psychosocial in nature.  If we use these approaches, ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4775617 Tue, 03 May 2011 00:22:24 +0100 4775617 http://www.medworm.com/index.php?rid=4734245&cid=t_103331_112_f&fid=34971&url=http%3A%2F%2Fblog.drmalpani.com%2F2011%2F04%2Fwhy-id-trust-expert-patient-more-than.html This may be a terrible confession for a doctor to make, but when I have a medical problem, I'd trust an expert patient rather than a doctor. Let me explain.I have chronic back pain and this can be quite severe at times. However, I am very reluctant to go to an orthopedic surgeon, because I know pretty much what he is going to say. He's going to do a cursory examination and then ask me do do a MRI scan. The MRI scan will find some bulges in my intervertebral discs - and the radiologist will happily report this as prolapsed intervertebral disk ( slipped disc, in layman's terms). The doctor will be happy he's made the right diagnosis; and will advise bed rest; pain-killers ; and physiotherapy - with the caveat that if it gets worse, he'll be happy to do "minimally invasive surgery" to fix the... The Patient's Doctor blogs http://www.medworm.com/rss/comments.php?id=4734245 Wed, 20 Apr 2011 03:02:00 +0100 4734245 http://www.medworm.com/index.php?rid=4724124&cid=t_103331_130_f&fid=34938&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEvidenceInMotion%2F%7E3%2FeSNvxFE7f3A%2Fchanging-processes-will-change-results.html It can't be easy to problem-solve the current state of health affairs. Nothing like having a growing population of older adults requiring care... an unfit society for all age groups... and dumping a boatload of people into a system that will be bursting at the seams to accommodate all their needs. Timely access to care isn't going to happen. Cutting the budget will just hurt the majority even more because providers can't accept lower payments for services. Adding a "quality" reporting system (of more than 100 quality measures) won't actually change the final outcome. A resubmergence of a health maintenance organization spin-off isn't going to solve the problem either. Am I the only one who sees the insanity of the proposed solution(s)? Chances are the current solutions will fail because ... MyPhysicalTherapySpace.com blogs http://www.medworm.com/rss/comments.php?id=4724124 Sun, 17 Apr 2011 20:55:25 +0100 4724124 http://www.medworm.com/index.php?rid=4693386&cid=t_103331_122_f&fid=35055&url=http%3A%2F%2Fsarasotaneurology.com%2F2011%2F04%2F08%2Fmri-scans-lower-back-pain%2F Lower back pain is a common complaint seen by almost every primary care doctor in the United States. So common in fact that 80% of the population will experience at least one episode of significant low back pain in their life. Many will experience recurrent episodes of lower back pains. Of those patients, one third will have some degree of leg pain in one or both legs. Back pain and most cases of associated leg pain do not originate from lumbar (lower back) spinal disc problems. There are many pain fiber bearing structures in the lower back including muscle, tendons, ligaments, vertebral joints and bone itself. The good news is that over 97% of all low back pain problems can be treated without surgery. Low back surgery is the most commonly overly performed surgical procedure in the United ... Sarasota Neurology blogs http://www.medworm.com/rss/comments.php?id=4693386 Fri, 08 Apr 2011 05:00:48 +0100 4693386 http://www.medworm.com/index.php?rid=4622370&cid=t_103331_122_f&fid=35055&url=http%3A%2F%2Fsarasotaneurology.com%2F2011%2F03%2F23%2Fall-massage-therapy-is-not-created-equal-in-pain-treatment%2F What do you think of when you think of neck or back massage therapy? Most people think of the type of massage you would receive if you went to the spa for the day.  That type of massage therapy is known as a Swedish Massage. Swedish Massage is only one of over 40 types of massage that a person can receive. When you say you went to see your doctor today, what do you think of?  If I went to see my family doctor, my image would be different than if I said I went to see my Cardiovascular surgeon.  They are both doctors, but the exams and procedures that they perform are vastly different. The field of massage is similar in its sub-specialization within the scope of massage therapy. Swedish Massage is great for relaxation and stress reduction, but if your back just went into spasm and is  lo... Sarasota Neurology blogs http://www.medworm.com/rss/comments.php?id=4622370 Wed, 23 Mar 2011 05:00:03 +0100 4622370 http://www.medworm.com/index.php?rid=4560526&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F03%2Fback-pain-and-tests.html It turns out there was a study (like we need another study) that says back scans can find things that aren't causing pain. Well, I know medical scans can find all sorts of thingys (very technical I know) that are there inside our bodies but don't mean much. I happen to know I have a thingy in my lungs that has been there and is stable for about 30 years - and I have an annual x-ray to prove it. I also have a couple thingys (also known as hemangiomas) on my liver. They are just fine. They can hang out but they won't kill me.Most people's backs are not perfect. Heck, most bodies aren't perfect. (If you have a perfect body, let me know and we'll figure out how you can become a fashion model or professional body builder or something.) Now we have these high tech procedures and tests that uncov... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4560526 Tue, 08 Mar 2011 10:49:00 +0100 4560526 http://www.medworm.com/index.php?rid=4478026&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F02%2Fpain-business.html I was talking to my mother yesterday. She knows about pain as she has had Rheumatoid since 1989, I have only had back pain for 2 years so she is a little bit ahead of me. We aren't medical people at all. We have very useful liberal arts degrees from good colleges. We are experienced patients who have heard to much 'with your condition, blah, blah, blah..." from doctors and know the best back way to the hospital which goes by the cheap full serve gas station and never need to look at the hospital directory to know which way to head for our next appointments.She told me about studies on pain and how little is known. We were talking about it. A little pinch can hurt a lot - ask any parent who's ear lobe has been twisted by an energetic toddler - but not mean much at all. The child lets go and... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4478026 Tue, 15 Feb 2011 11:07:00 +0100 4478026 http://www.medworm.com/index.php?rid=4477734&cid=t_103331_87_f&fid=36941&url=http%3A%2F%2Fwww.mazecordblood.com%2Fblog%2F%3Fp%3D1118 This article is very clear and gives a lot of information about what to do for pregnancy related back pain.Plan carefully when you decide which method you are comfortable with in order to alleviate your back pain. As with every pregnancy, you need a plan for the unexpected as well as the normal every day ins and outs of pregnancy. Early in your pregnancy, (if not before you become pregnant) find a chiropractor or orthopedist specializing in pregnancy back pain.  This is a good time to start making your “list”, questions to ask the doctor, cord blood banking and all things labor and delivery related. (Source: Cord Blood News) Cord Blood News blogs http://www.medworm.com/rss/comments.php?id=4477734 Mon, 14 Feb 2011 18:20:37 +0100 4477734 http://www.medworm.com/index.php?rid=4472948&cid=t_103331_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fwhen-your-health-hinders-your-love-life%2F2011.02.13 This is the time of year when stores are filled with red hearts and other reminders that Valentine’s Day is approaching. It’s a mood booster, not to mention a nice break from all that winter grey (at least up here in Boston). After all, what would life be like without romance, love — and sex? Unfortunately, a variety of health problems — as well as some of the treatments for them — can get in the way of sexual desire and functioning. Here’s a quick look at some of the main sources of trouble and suggestions about what to try first. If these initial strategies don’t work, have a heart to heart with your doctor about what to do next. There may not be a quick fix for health-related sexual problems, but there are steps you can take to help ensure that you can still en... Better Health blogs http://www.medworm.com/rss/comments.php?id=4472948 Sun, 13 Feb 2011 21:00:26 +0100 4472948 http://www.medworm.com/index.php?rid=4436748&cid=t_103331_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fback-pain-why-yoga-might-make-me-a-better-doctor%2F2011.02.04 I’m a physician trained in sports medicine, and a chronic back pain sufferer. I first injured my back in 2001 when lifting a heavy bag and trying to sling it onto my shoulder. The pain was so severe that I couldn’t get off the floor for three days. I eventually ended up in the ER with an “unremarkable” MRI. The cause of my pain was never explained — all I knew is that I hadn’t herniated any disks. Years later my back pain still flares up occasionally, and I’ve never really understood how to prevent it or treat it effectively. This has been very embarrassing for me, since I’m supposed to be an expert in this field. But today I finally got some insight into the real cause of my pain — not from a physician or physical therapist, but from ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4436748 Fri, 04 Feb 2011 20:00:29 +0100 4436748 http://www.medworm.com/index.php?rid=4399841&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F26%2Fpulling-it-all-together-biopsychosocial-assessment%2F Over the past little while I’ve been writing about how a comprehensive pain assessment can be carried out.  Today it’s time to pull that information together to develop a formulation, or set of possible explanations for why this person presents in this way at this time – at least for one or two aspects of his presentation. For example, if the person’s pain is low back pain, where surgery has failed to improve the person’s pain, but he has maintained working in a teaching job where physical demands are reasonably light, but is having trouble with sleep, feels irritable, can’t manage things like mowing lawns, and is very careful not to bend because he was advised after surgery to avoid bending because it may affect healing.   Limited forward flexion, si... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4399841 Wed, 26 Jan 2011 01:00:45 +0100 4399841 http://www.medworm.com/index.php?rid=4389378&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2011%2F01%2F24%2Fpulling-the-biopsychosocial-assessment-together%2F Over the past couple of posts I’ve described one way to assess a person’s chronic pain presentation from a medical, psychosocial and functional perspective.  I don’t think there is much difficulty in seeing how these three perspectives can help us develop a biopsychosocial explanation, or formulation, for why this person is presenting in this way at this time – and that’s what assessment is about, when it comes to chronic pain. A quick note on why explanations or formulations are useful when working in chronic pain.  Acute pain is, as most people know, usually directly related to some sort of tissue damage, potential or actual.  The usual rule for helping someone with acute pain is to diagnose the underlying cause of the pain, remediate that causal factor,... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4389378 Mon, 24 Jan 2011 01:25:20 +0100 4389378 http://www.medworm.com/index.php?rid=4349663&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2011%2F01%2Fouch.html Yesterday morning I made a significant mistake. I tried to emulate a normal human being and pull the top blanket back over me (after being stolen by my husband) using my right arm. Don't ask. Why should I think I am normal? Instantly my left shoulder, on my shoulder blade blossomed into a huge wall of pain. I had to lie still and breathe slowly and quietly. It didn't subside. Finally I tried moving a tiny bit, and then a bit more, and more. I rolled over enough for my husband to massage it which helped. After taking a shower and running hot water on it, popping a pain pill and applying two lidoderm patches, I felt like I could survive the day. I did. I survived. I lasted the day.Today I feel okay but there is looming pain in there. So what am I doing? I am going to stand at a trade show al... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4349663 Fri, 14 Jan 2011 11:10:00 +0100 4349663 http://www.medworm.com/index.php?rid=4300622&cid=t_103331_122_f&fid=35055&url=http%3A%2F%2Fsarasotaneurology.com%2F2010%2F12%2F30%2Fplatelet-rich-plasma-in-sarasota-for-joint-pain-new-therapies%2F Patients are being treated currently at Sarasota Neurology with PRP (platelet rich plasma) for a wide variety of joint pain and other pain issues. Among the more common uses for PRP are knee pain, shoulder pain and other painful conditions such as plantar fasciitis, tennis elbow, some types of low back pain. PRP can also be used in patients that have residual joint pain from having had orthopedic arthroscopic knee or shoulder surgery. PRP works to heal painful joints by using the patients’ own natural biological healing mechanism. The injured or damaged tissue in the joints, ligament and tendons or muscle send out chemical signals that there is injury or incomplete healing. PRP has receptors on the active platelets that seek out these damaged tissues. The PRP graft then biologically ... Sarasota Neurology blogs http://www.medworm.com/rss/comments.php?id=4300622 Thu, 30 Dec 2010 17:58:13 +0100 4300622 http://www.medworm.com/index.php?rid=4298773&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F12%2Fbenefits-of-exercise-blah.html They talk about the benefits of exercise. I joined an exercise class to make me feel better. I do feel better. But I still have all sorts of back pain. In fact I have new areas of pain in my back, and hips, and shoulders, and legs. So much for this exercise class. Okay I don't think that its been all bad. Its not that I can touch my toes again - I can't - but its not part of the class. I don't have to touch my toes. In some ways I feel better but I want the magic class to make everything stop hurting. So much for exercise. BLAH!Enough whining, for now. I'm sure I'll have something to whine about in the future (and I won't ask for corroboration from my husband on that). My back still hurts. (Source: Caroline's Breast Cancer Blog) Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4298773 Wed, 29 Dec 2010 12:32:00 +0100 4298773 http://www.medworm.com/index.php?rid=4294949&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F12%2Fsnow-and-winter-and-cancer.html It snowing out. It snowed all night. It snowed since yesterday afternoon. It is supposed to keep snowing for a few more hours. Our street was just plowed. We couldn't tell where the yard ended and the street began. I now have to wait until my husband starts shoveling and using the snow blower. I can't shovel. I can't use the snow blower. Bummer.No its not a bummer. I will stay inside where its warm and get some work done. Its pretty to look at but I'll just stay here and hang out with the cat. Between my tennis elbow, lymphedema arm, and bad back, I'm not going anywhere until the snow removal process is complete. I had actually planned a work at home day today so this fits in just fine. My husband's office (USAF) said non essential civilian employees did not need to report so he is happy t... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4294949 Mon, 27 Dec 2010 11:47:00 +0100 4294949 http://www.medworm.com/index.php?rid=4251242&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F12%2Fpart-3-of-my-very-long-day.html Yesterday, I was supposed to be smart and stay home and work quietly and recover from my VERY long day. I was STUPID (worthy of capitals - and that was after I was a MORON because I forgot to pay the mortgage which I immediately rectified) because I didn't do what I was supposed to do.In the morning, I decided that since I had finished stamping the latest newsletter from my nonprofit job, I could put all 1700 of them in their 3 boxes on a two wheeled cart and get them into the car to drive them to the post office and then out of the car and into the post office. That wasn't so bad as I lightened the boxes by taking some newsletters out when I had to lift them in and out of the car and was not above dragging them. Next I decided that with my abundance of healthy feelings I was in good shape... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4251242 Sat, 11 Dec 2010 11:39:00 +0100 4251242 http://www.medworm.com/index.php?rid=4249209&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F12%2Frecovering-from-very-long-day.html Last night I returned home about 9 pm with back and hip pains, exhausted. I had PT in the morning and got to work. It was extremely busy there as many colleagues were in software training but I was relatively productive. Then I went to a small holiday party and had a good time. Finally when I got home, I took a pain pill and slept all night.Today I will take it easy and work from home and go to my pain support group for another small holiday party. The question - should I make brownies or not to bring with me. It will be a recovery day. That is my problem now I have to take it easy for the day - the price I pay for a long day.I am okay but very achy this morning. I took my thyroid pill and will wait until its been an hour so I can take a pain pill - I can tell this will be my requirement f... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4249209 Fri, 10 Dec 2010 11:36:00 +0100 4249209 http://www.medworm.com/index.php?rid=4245517&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F12%2Fi-am-faced-with-very-long-day.html Today I have a VERY long day - worthy of capitals. I have a 7am PT appointment, followed by work, followed by a Christmas party. I should be home by 8 or so. To many of you that is not a long day, never mind a VERY long day. For me, exhaustion will set in and tomorrow I will have to take it easy as a result.Basically, between all my ailments I have no ability to go out for more than a few hours at a time. Work is not that bad because I sit in a big, ergonomic chair and get up periodically to go to the restroom, printer, copier etc. I go home and I am tired. But I can't work two full days in a row. Tomorrow I will spend most of the day at home - except my chronic pain group (that I haven't been to in months). My life has changed. And won't unchange. Yesterday I successfully made by back, bo... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4245517 Thu, 09 Dec 2010 10:52:00 +0100 4245517 http://www.medworm.com/index.php?rid=4214521&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F30%2Fhow-to-transfer-research-into-practice-more-questions-than-answers%2F With a background in a health profession not known for its love of science, I suppose when I came across evidence based health care I felt a strong sense of relief. Here, at last, was a way to work out what to do when faced with the task of helping people with pain.  I was therefore a bit taken aback when I read a blog post on Science-Based Medicine here challenging my assumptions about the place of randomised controlled trials at the top of the evidence hierarchy (well, actually second from top – meta-analysis of RCT’s is at the top!).  It took a moment or two of serious pondering to come to terms with David Gorski’s critique of EBHC, and to accept that he has a point.  His point is that if RCT is at the top of the heap in evidence terms, it shouldn’t do so at t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4214521 Mon, 29 Nov 2010 18:31:43 +0100 4214521 http://www.medworm.com/index.php?rid=4183239&cid=t_103331_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F11%2Fstudy-reports-nurse-practitioner-angela-sarro-good-diagnosis-spine-surgeon%2F A new Canadian study being reported in a leading nursing journal is reporting that nurse practitioner Angela Sarro is just as good as spine surgeons indiagnosing the etiology of back pain. The study did not address the research question of whether the nurse practitioner’s operative outcomes were similar to a spinal surgeon’s. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=4183239 Fri, 19 Nov 2010 03:48:17 +0100 4183239 http://www.medworm.com/index.php?rid=4152303&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F11%2F10%2Frebuilding-work-identity%2F I love helping people return to work.  It’s got to be one of the most rewarding parts of pain management for me because not only is work important for health, it’s a major part of our day, and it’s a whole lot about individual identity.  So helping people reconstruct their sense of self to the point where they can go to an employer and say ‘I can do this for you’ with confidence is an enormous challenge. To feel confident enough to put yourself on the line to an employer despite chronic pain is a challenge.  It involves at least some of the following (and yes, this is mostly from my experience on this post!): Good self efficacy for managing pain - to the point where fluctuations in pain intensity can be taken with equanimity Strong knowledge of what you ca... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4152303 Wed, 10 Nov 2010 01:28:00 +0100 4152303 http://www.medworm.com/index.php?rid=4122034&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F10%2Fgimme-that-shot-please.html I go to the back doctor on Tuesday to discuss how my new back meds are working and what are the next steps which are sure to involve more needles. A few years ago I would never have asked for a needle. I still can't look at them. But I am becoming an avid fan of needles full of cortisone for my back pain. They have proved very helpful.But of course, just as I am starting to appreciate them, there is a new study which doubts their efficacy. (Damn these medical studies.) I think (as my little chemo brain dissects the article) that the problem is people come in with tennis elbow and other injury/overuse type issues and get a cortisone shot. Yes they get instant relief but then they also are prone to reinjury. This is opposed to waiting and taking it easy for 6 to 12 months. Well this makes se... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4122034 Sat, 30 Oct 2010 11:11:00 +0100 4122034 http://www.medworm.com/index.php?rid=4119590&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F10%2Fsometimes-i-need-to-ignore-what-they.html Next Tuesday I have an appointment with my pain doctor. I have been hoping he will deem me okay for another cortisone injection in my left hip - so I can walk with less pain. I have already had numerous injections in different areas. Sometimes just one injection works but other times it takes 2 or 3 in a specific area. If they don't work, we get to move on to the wonderful radiofrequency denervation which is NOT fun but is supposed to kill nerves. I have mixed feelings on this so far but I like the cortisone injections. They have done well for me so far. Then they come up with the theory that cortisone injections aren't as good as they thought they were - they have only been used since the 1940's so you think they would have had long enough to figure this out so far. I was concerned when I... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4119590 Thu, 28 Oct 2010 10:10:00 +0100 4119590 http://www.medworm.com/index.php?rid=4098493&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F21%2Fhow-to-translate-research-into-practice%2F Well, maybe that’s a misnomer for today’s post, but it does strike to the very heart of some of the more heated debates that I see when I browse the interweb. With all the conflicting research reports into all the various interventions for chronic pain (well, for anything really), how does a clinician decide when the time is right to start incorporating a new practice (such as working with acceptance or mirror therapy or laterality), or begin to phase out an old practice (like distraction or core stability or muscle imbalance)? This paper, one of a series of excellent papers in Best Practice & Research Clinical Rheumatology on the management of low back pain, discusses in a really accessible way, the various problems that face an earnest clinician who wants to ‘do the... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4098493 Wed, 20 Oct 2010 18:38:45 +0100 4098493 http://www.medworm.com/index.php?rid=4086533&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F21%2Fhow-to-translate-research-into-practice%2F Well, maybe that’s a misnomer for today’s post, but it does strike to the very heart of some of the more heated debates that I see when I browse the interweb. With all the conflicting research reports into all the various interventions for chronic pain (well, for anything really), how does a clinician decide when the time is right to start incorporating a new practice (such as working with acceptance or mirror therapy or laterality), or begin to phase out an old practice (like distraction or core stability or muscle imbalance)? This paper, one of a series of excellent papers in Best Practice & Research Clinical Rheumatology on the management of low back pain, discusses in a really accessible way, the various problems that face an earnest clinician who wants to ‘do the... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4086533 Wed, 20 Oct 2010 18:38:45 +0100 4086533 http://www.medworm.com/index.php?rid=4082343&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F19%2Fhow-did-that-happen-stories-of-returning-to-work%2F Yesterday I started to talk about returning to work with chronic pain. I mentioned that it’s often not the degree of importance an individual places on returning to work that engenders resistance – it’s more likely the lack of confidence the person has towards the process, the fear that this won’t work out and they will fail… A story or two might help detail some of the issues that people I work with encounter when they’re returning to work. Now I recognize that the people I see are possibly at the more complex end of the spectrum than many, so these stories might well be more extreme than what many clinicians see, but at the same time they illustrate where things go wrong. A note: vignettes used in this blog are composites of people I’ve worked wi... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4082343 Tue, 19 Oct 2010 05:21:29 +0100 4082343 http://www.medworm.com/index.php?rid=4082344&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F10%2F19%2Fworking-and-chronic-pain%2F If there is one aspect of chronic pain management that has received more attention than returning to work, I don’t know it! In 1995 when I started working at my current workplace, work was almost a dirty word. I was accused at one time of being a ‘Siberian workcamp’ Commandante because some people thought it was cruel to ‘force’ people with chronic pain into the workplace. Thankfully this attitude has changed over the years, and most people recognise that working when you have chronic pain, while difficult, is achievable and good for health. At the same time, returning to work with pain has never been especially easy and there are numerous issues to work through. Today is the first day I will discuss the practical aspects of returning to work with the current ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=4082344 Mon, 18 Oct 2010 18:37:07 +0100 4082344 http://www.medworm.com/index.php?rid=4074370&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F10%2Fi-am-not-alone-in-this-pain-business.html But first color me appalled about pink tire caps! Yes the little caps on your tire valves are available in pink from Tirecraft. Apparently 76 million Americans live in chronic pain. The word chronic means its not going way anytime soon. While its nice to know I am not alone, I find the results of the survey interesting.- 48 percent of respondents don't believe that proper treatment can ease chronic pain. - Did they even talk to their doctor? My husband always says to me that the doctor can never fix his sore shoulder, etc. But then he goes to the doctor, tells him about it, and they send him for PT and voila he is fine.- 41 percent believe pain is a normal part of aging, and 10 percent simply ignore the pain. - I'm all for ignoring pain as long as possible- 36 percent would refuse doctor-r... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4074370 Fri, 15 Oct 2010 10:25:00 +0100 4074370 http://www.medworm.com/index.php?rid=4003336&cid=t_103331_122_f&fid=36582&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSharpBrains%2F%7E3%2FNKbWYNHx4yA%2F Welcome to the XL edi­tion of Sci­en­tia Pro Pub­lica (or, since we are trying to speak English, the 40th edition of “Science for the People”), the rotating blog car­ni­val that show­cases the finest sci­ence, med­ical and envi­ron­ment writ­ing pub­lished in the blogosphere. Quick now — ask a question, any question, that comes to mind. Chances are someone in this excellent roster of science bloggers has anticipated it and provided an answer below. Enjoy! About ourselves Why do I feel better after I exercise (pic: brainblogger) Can thoughtful blogging and reading build brain reserve and delay dementia What’s the borderline between high and low functioning — autism research examples Can we learn to multi-task more effectively Should you mind your brain About our bo... SharpBrains blogs http://www.medworm.com/rss/comments.php?id=4003336 Mon, 27 Sep 2010 11:53:43 +0100 4003336 http://www.medworm.com/index.php?rid=4001783&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F09%2Fthis-will-be-adventure.html Last night we had a family dinner and went to a restaurant where we sat in a big wooden booth. My back did not like that. I was in a lot of pain when we left. Today, can I take it easy? No. A town fair and I am organizing a booth. I will be there this morning and again this afternoon. Then a surprise birthday party this evening. Ow, ow, ow, ow, ow. I'll bring my pain drugs with me all day. (Source: Caroline's Breast Cancer Blog) Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=4001783 Sat, 25 Sep 2010 11:46:00 +0100 4001783 http://www.medworm.com/index.php?rid=3921093&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F09%2F01%2Fmeasuring-changes-during-graded-exposure-acceptance-treatment%2F I have been pondering about the best way to monitor ‘Matt’s progress during graded exposure therapy for his avoidance of activities involving back movement. I introduced you to Matt yesterday. He’s a ‘man’s man’, a real bloke who, for the past four years since he had surgery for a prolapsed disc, has avoided things like mowing the lawns, making the bed, fishing and whitebaiting and even golf. Yesterday I described how we went through 100 photographs of activities of daily living, and of these, Matt identified 67 of the photographs as things he wouldn’t do because of his concern about both the impact on his pain and the ‘strain’ on his back. I have used a simple count of the number of photographs a person decides is in the ‘avoided... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3921093 Tue, 31 Aug 2010 19:35:59 +0100 3921093 http://www.medworm.com/index.php?rid=3915308&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F31%2Fgraded-exposure-in-the-real-world%2F Well, not exactly the real world – yet – just the clinic. A man I’m working with is very worried about his back.  Some years ago he had a discectomy and his surgeon told him he needed to be ‘very careful’ with his back – and so he has.  No bending, twisting, lifting for this man!  He’s given up some of his favourite things like fishing and whitebaiting and even golf because of this worry, although when I talk things through with him he’s not exactly sure what might happen if he ‘disobeyed’. Let’s call him Matt for wont of a better name (and yes, as usual, details have been changed to ensure confidentiality), and he’s a fairly ‘blokey’ man who loved his fishing, diving, and taking off for days in his conv... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3915308 Mon, 30 Aug 2010 21:02:47 +0100 3915308 http://www.medworm.com/index.php?rid=3915309&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F30%2Fexposure-in-vivo-for-kinesiophobia%2F In this study, the authors firstly looked at outcomes of graded exposure and whether anxiety, depression and catastrophising moderated these.  While anxiety was found to influence outcome generally (leading to poorer outcomes for those who were more anxious), catastrophising was found to have a more complex relationship.  Graded exposure was effective for low and moderate catastrophising, but for those with high catastrophising the results were far less spectacular.  And depression? Made little difference to outcome at all. After finding that high levels of catastrophising influenced outcome, the next step in this study was to examine those people who made a good deal of changein disability  and compare them with those who made much less change in disability.   For this part of the s... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3915309 Sun, 29 Aug 2010 19:33:53 +0100 3915309 http://www.medworm.com/index.php?rid=3915257&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F08%2Fpaying-price.html Today I am paying the price. Yesterday I had fun. I got together with a college friend. She runs half marathons and I don't so she is probably in better shape than I but that, of course, didn't stop me. I went to visit her yesterday. She went for a run before I got there so she should have been tired. We hung out on the rocks behind her house on the lake. Then we went for a little hike - 3-4 miles through the woods and got caught up on marriages and old friends. After a brief shopping stop, we decided to cool off by floating around her lake on tubes. After successfully flipping from my back to my stomach on the tube and staying dry, I was over confident and assumed I could handle tubing. I erroneously attempted to navigate off the tube and onto the rocks. On my first try, I stayed mostly o... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3915257 Sun, 29 Aug 2010 11:56:00 +0100 3915257 http://www.medworm.com/index.php?rid=3899658&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F25%2Fdrawing-pain%2F The pain drawing has to be one of the more ubiquitous assessment tools around. There are many versions of outlines of naked bodies on which a person can scribble, colour, and write to indicate to treatment providers exactly where they feel their pain, and to a certain extent, some of the sensory features of that pain. But – how many of us use that drawing for anything other than ‘Oh so that’s where you feel it?’ Schott, in this truly interesting paper, discusses pain maps – not a term I’d come across before – and traces the history of pain maps as well as discussing some of the problems with it – and concludes that pain maps can contribute something quite unique to our understanding of the person’s experience, but at the same time, ackn... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3899658 Wed, 25 Aug 2010 03:05:42 +0100 3899658 http://www.medworm.com/index.php?rid=3896119&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F24%2Finformation-is-to-behaviour-change-as-spaghetti-is-to-a-brick%2F I’m a great fan of books like ‘Explain Pain’. This delightful publication by David Butler and Lorimer Moseley gives accurate information about pain, particularly chronic pain, in an accessible format for both patients and clinicians, and I’ve used it often with people I’m seeing. I’m also a fan of helping people to understand what we do (and don’t) know about pain to give them more awareness of their ability to influence their own body. But as anyone who has worked in chronic pain management knows, telling someone something doesn’t always make an enormous difference – and here’s a case in point.  Before I go on, any cases I refer to on this blog are a compilation of several people and details are altered to protect confidentiali... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3896119 Mon, 23 Aug 2010 19:35:10 +0100 3896119 http://www.medworm.com/index.php?rid=3891826&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F23%2Fwho-drops-out-of-cbt-for-chronic-pain%2F Wouldn’t it be wonderful if everyone we saw was ready for self management and committed to putting everything in place? Wouldn’t it be even better if we could tell who was and who wasn’t going to drop out? Then we could focus treatment on people who were ready for treatment, and help those who are not ready prepare to get ready (or manage their situation differently). Unfortunately, it’s one of those areas that is not well-researched, even though it’s a very important part of our clinical planning and can affect up to 60% of people initially enrolled in a cognitive behavioural approach to pain management. Over the years I’ve worked in pain management, I’ve seen several different approaches for establishing whether people should be included or not. ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3891826 Mon, 23 Aug 2010 09:14:55 +0100 3891826 http://www.medworm.com/index.php?rid=3876912&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F18%2Fexercise-questions%2F If there is one finding that has remained pretty solid over the past 10 – 15 years, it’s the one that says being active is a good thing for managing chronic pain.  I’m not sure how many papers I’ve read where ‘exercise’ and some form of cognitive behavioural approach have been found to produce improvements in disability, mood and even pain – and the benefits are often maintained for 12 months or more.  But we have a problem, Houston.  The problem is this – many of these studies treat ‘exercise’ in much the same way as ‘interdisciplinary pain management’ – a black box that no-one really knows exactly what goes on in there, but hey it works. This is a real problem when we come to put the research findings to wor... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3876912 Tue, 17 Aug 2010 19:36:07 +0100 3876912 http://www.medworm.com/index.php?rid=3868932&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F16%2Fhow-well-do-we-really-communicate%2F In this study, Habit 4 and the total score were used to measure the quality of the interactions, and scoring was rated by one clinician who had been recently trained in the system, while a second clinician re-rated a random sample of 16 videos independently. Inter-rater reliability was 0.835 (CI 0.600; 0.939). Patients also completed a set of questionnaires about their experience, and several biographical details such as age, duration of pain and so on. What did they find? Firstly, the providers included chiropractors, physiotherapists and doctors, and a total of 21 clinicians were included.  79 encounters were rated.  There were no real differences between the various professions, and patient variables such as gender, educational level and social class weren’t associated with any ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3868932 Mon, 16 Aug 2010 00:03:49 +0100 3868932 http://www.medworm.com/index.php?rid=3854774&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F08%2F11%2Fis-reassurance-reassuring%2F Having started yesterday’s post by discussing health anxiety, and pointing out that one of the things people do to cope with their anxiety about their pain is to seek reassurance, I thought it might be useful to go back to a paper published a couple of years ago by Linton, McCracken & Vlaeyen (2008).  In this paper, the authors reviewed the concept of reassurance and see whether it is, in fact, reassuring. What is reassurance anyway? We talk about it as if we know what we mean, and it’s even part of most guidelines for managing acute low back pain – but what is it? In this paper, the authors refer to the Oxford dictionary definition where reassurance is defined as ‘‘. . .removes the fears or doubts of (pain/illness); to comfort’’. As they point out, “Re... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3854774 Tue, 10 Aug 2010 18:43:41 +0100 3854774 http://www.medworm.com/index.php?rid=3790897&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F07%2Fthink-before-you-eat.html Someone pointed this article out to me. It makes me pack my own snacks for a professional sports game. If you read it, you will note that in Chicago, where the scores were good, they inspected when the stadiums were closed. Also, in FL where all the stadiums did poorly, apparently the state has stringent inspections. But regardless, I am not sure I want to eat at any of them. It makes me reconsider a lot of restaurants in general.When we go out to eat, we assume that food is prepared correctly. We assume the basics - the ice machine is clean, they are not using the same knife and cutting board to chop raw chicken and a prepared sandwich. And that the food is cooked and stored correctly. The whole idea of it is EEEWWW! I do like my own cooking and know that I may not always be up to restaur... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3790897 Mon, 26 Jul 2010 10:23:00 +0100 3790897 http://www.medworm.com/index.php?rid=3780533&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F07%2Fmedical-school-decoder-ring.html There is a project afoot to allow normal people to understand doctor-speak without going to medical school. Its called the Open Notes project but I think it really should be the Medical School Decoder Ring project. I'm all for it.One of my favorite activities while hanging around pre and post surgery is to read my own medical file. Usually I understand most of it but not all. I have asked the doctors and nurses around to translate. Sometimes I get a copy to take home and then start googling all the words and phrases. But even with that, it doesn't always make sense. For example when the doctor writes 'patient denies' to the non doctor, it means you denied sneaking out after bedtime. To the doctor it means you said you don't have shortness of breath (or SOB). They might have written 'patien... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3780533 Thu, 22 Jul 2010 10:16:00 +0100 3780533 http://www.medworm.com/index.php?rid=3767338&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F20%2Fwhat-do-people-really-do-about-their-back-pain-an-on-line-survey-reveals%2F There are many studies describing the way treatment providers fail to follow clinical guidelines for managing acute low back pain – and because there are inconsistencies between various guidelines for chronic low back pain, it’s not surprising that people with back pain (whether acute or chronic) get a little confused about what to do.  Of course, if you use a popular search engine or two you’ll be able to find loads of sites on the internet that put forward their ideas of how to manage, and the quality of these sites is pretty variable.  So when a group of Australians carried out an online survey asking what people did when they had back pain, you can guess there was a pretty wide range of strategies used. In February 2009, 1001 participants who met the inclusion crite... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3767338 Tue, 20 Jul 2010 05:53:25 +0100 3767338 http://www.medworm.com/index.php?rid=3754108&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F15%2Fonline-self-management-works-for-some%2F Given that you’re reading this, I suspect that the thought of an on-line approach to managing pain wouldn’t take a terrible stretch of the imagination. The idea is certainly appealing – after all, there are many, many people with chronic low back pain in the community, and not nearly so many clinicians specialised (or even interested!) in helping people to learn to live well despite their pain. Along with the practicalities of getting the message across to as many people as possible, there is some evidence that people are prepared to reveal more about themselves and their health problems via computer than face-to-face (Williams, Freeman, Bowen, et al. 2000). In this well-described study, participants were recruited to either receive written material about back pain (the N... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3754108 Wed, 14 Jul 2010 19:43:20 +0100 3754108 http://www.medworm.com/index.php?rid=3823006&cid=t_103331_113_f&fid=38494&url=http%3A%2F%2Fcuretogether.com%2Fblog%2F2010%2F07%2F14%2Fjust-released-%25e2%2580%2593-curetogether-guide-to-back-pain%2F . . You are a part of this. It’s a new kind of health book that puts real-world data before authority, and teaches you how to make better decisions for your health. Inside, you’ll find 7 insight-filled sections to help you navigate your way through Back Pain. Download your copy here, or read on for more details. . The Story Health books are usually written by experts who offer authoritative information about conditions, symptoms and treatments – people who usually don’t live with the condition themselves, but nevertheless tell you what you should do because they know best. This book is different. It’s based on the real-world experiences of patients. Our approach is not to tell you what to do, but to give you the hard data and the education to help you make your own decisions �... The Collective Well blogs http://www.medworm.com/rss/comments.php?id=3823006 Wed, 14 Jul 2010 19:41:45 +0100 3823006 http://www.medworm.com/index.php?rid=3753915&cid=t_103331_113_f&fid=38494&url=http%3A%2F%2Fcuretogether.com%2Fblog%2F2010%2F07%2F14%2Fjust-released-%25e2%2580%2593-curetogether-guide-to-back-pain%2F . . You are a part of this. It’s a new kind of health book that puts real-world data before authority, and teaches you how to make better decisions for your health. Inside, you’ll find 7 insight-filled sections to help you navigate your way through Back Pain. Download your copy here, or read on for more details. . The Story Health books are usually written by experts who offer authoritative information about conditions, symptoms and treatments – people who usually don’t live with the condition themselves, but nevertheless tell you what you should do because they know best. This book is different. It’s based on the real-world experiences of patients. Our approach is not to tell you what to do, but to give you the hard data and the education to help you make your own decisions �... The Collective Well blogs http://www.medworm.com/rss/comments.php?id=3753915 Wed, 14 Jul 2010 19:41:45 +0100 3753915 http://www.medworm.com/index.php?rid=3750314&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F14%2Fways-to-ask-about-sensitive-topics%2F I teach postgraduate courses in pain and pain management.  Many of my students are experienced general practitioners who often ask me “how do I talk to people with pain about psychosocial issues without them thinking I’m telling them their pain is ‘all in the head’?” It can be a pretty sensitive topic for the person with unexplained pain that doesn’t go away because to somehow suggest (a) they’re not coping with their situation or (b) they have some psychological problem can seem uncaring or even that the person’s pain is ‘imaginary’. The psychosocial ‘yellow flags’ are widely known, but even after a decade or more of exposure to what the ‘yellow flags’ are, there is much confusion and misconception.  Tod... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3750314 Tue, 13 Jul 2010 19:32:03 +0100 3750314 http://www.medworm.com/index.php?rid=3747009&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F13%2Fold-beliefs-die-hard-case-conceptualising-coping-with-a-flare-up%2F We know about neuroplasticity – how the brain so wonderfully remodels connections continuously.  We also know how hard changing habits can be.  The underlying premise of the cognitive behavioural approach to coping with chronic pain is that people can learn new ways of viewing their situation and develop new responses, and in doing so, start to live well again.  The process is not easy! Before I go further, I want to reassure readers that the case presentation I’m going to discuss is a fiction – based on several real patients, but with details altered to protect identity. One of the most difficult aspects of coping with chronic pain is that the pain doesn’t remain at a constant level.  It fluctuates in intensity, it can remain high for varying periods, it can dr... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3747009 Mon, 12 Jul 2010 19:35:48 +0100 3747009 http://www.medworm.com/index.php?rid=3737262&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F07%2Fhow-am-i-supposed-to-keep-up.html As a relatively average American (well maybe slightly different than average due to my medical crap), how I am supposed to keep up with all the latest medical news. This morning alone I found.1. Glucosamine is no help for lower back pain.2. Fish oil may help prevent breast cancer.3. Diet cola drains calcium in womenI found these in just a couple of minutes. But this is representative of the amount of medical news found daily. Some of it is unfounded - for example the fish oil study is not yet proven and based on a single study and needs more research. We get bombarded by medical news and those of us to whom it might apply feel we have to read it and ask 'does it apply to me?'. The sheer amount news is difficult to keep up with. So we resort to the path of least resistance and start ignorin... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3737262 Thu, 08 Jul 2010 09:33:00 +0100 3737262 http://www.medworm.com/index.php?rid=3730120&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F07%2F10-things-you-really-oughta-know-about-chronic-pain%2F …with apologies to the therapists in the Special Interest Group who first raised this topic! Something I’m acutely aware of after working in pain management for a while is the number of assumptions that I hold about what people ‘should’ know about pain…sometimes I can be quite rightly accused of leaping waaaaaaay ahead of what people are ready for in terms of new information! So it’s time to summarise the ’10 things you really oughta know about chronic pain’ In My Humble Opinion. 1.  Pain is a biopsychosocial experience, that it’s “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage” and what that means in real terms.  I think it’s imp... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3730120 Tue, 06 Jul 2010 19:37:30 +0100 3730120 http://www.medworm.com/index.php?rid=3726801&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F07%2F06%2Fwho-looks-for-treatment-when-they-have-back-pain%2F I’m not a primary care clinician. The people I see with pain have long-term, chronic, persistent pain that has been around for ages. I think the shortest time someone might have had pain before I see them is 4 months! The average is something like more than 4 years. But I AM interested in who is likely to ask for treatment for their pain because while the people I see may be ‘experienced’ in the ways of being a patient, not everyone who has a back pain looks for treatment.  And I wonder whether people who seek treatment at one point in time might carry on seeking treatment each time they have trouble with their pain. When I came across this paper by Ferreira, Machado, Latimer and colleagues, I was really interested in what they found out from their review of papers datin... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3726801 Mon, 05 Jul 2010 19:32:48 +0100 3726801 http://www.medworm.com/index.php?rid=3721936&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F07%2Farticle-i-had-to-read-whats-causing.html I am glad they can tell me what is causing my back pain through ESP. Actually the title is a misnomer there is a new tool for doctors, the EMG, to diagnose causes of back pain. They should have titled it something along the lines of 'A New Tool for Diagnosing Back Pain". I have been told that surgery is not an option for me but perhaps something could be learned through an EMG... I will ask my pain doctor at my next office visit.I do have a basic idea of what is causing my back pain - degenerating disks which cause nerve pain in all sorts of areas in my back. The goal is to follow the new areas of pain around my back and treat them and then go on to the next area with more treatment. For the rest of my life. I am so excited - another medical procedure involving needles every couple of mont... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3721936 Fri, 02 Jul 2010 09:52:00 +0100 3721936 http://www.medworm.com/index.php?rid=3721721&cid=t_103331_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F07%2F02%2Fadvice-to-rest-in-bed-versus-advice-to-stay-active-for-acute-low-back-pain-and-sciatica%2F Cochrane Review: Advice to rest in bed versus advice to stay active for acute low-back pain and sciatica The Skinny: Aims to determine the effects of advice to rest in bed or stay active for patients with acute low-back pain (LBP) or sciatica.  Moderate quality evidence shows that patients with acute LBP may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed; patients with sciatica experience little or no difference between the two approaches. Low quality evidence suggests little or no difference between those who received advice to stay active, exercises or physiotherapy.  More research is required. Filed under: Clinical Governance, Current Awareness, Evidence Based Practice, Primary Care Tagged: Back... Fade Library blogs http://www.medworm.com/rss/comments.php?id=3721721 Fri, 02 Jul 2010 09:10:18 +0100 3721721 http://www.medworm.com/index.php?rid=3707025&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F29%2Fphysical-and-organisational-ergonomic-interventions-so-far-not-effective%2F A million years ago (truly, ask my daughter if I’m that old!) I completed several papers in postgraduate ergonomics, primarily physical and organisational ergonomics rather than cognitive, and for a while there I could recall the NIOSH lifting equation and even discuss biomechanics with some confidence. Sad to say, over the years, my familiarity with those mathematical concepts has rather fallen away, but with an ongoing interest in work and workplaces, I’m still trying to keep up-to-date with the literature on the effectiveness of these interventions. My frustration with ergonomics grew as I started to realise how limited biomechanical modelling that I used was by comparison with the real work of real people in a real workplace.  All of those ‘reals’ add up to mes... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3707025 Mon, 28 Jun 2010 19:43:58 +0100 3707025 http://www.medworm.com/index.php?rid=3679891&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F06%2Fhighly-regarded-medical-journal-parade.html I opened the Sunday paper this morning and found a copy of Parade Magazine which is covering cancer in America. I do not consider Parade Magazine to be a source of hard core news but every so often it surprises me. I have read the majority of it already (its an easy read and I had a case of insomnia so have been up for a bit already) and found some interesting information. First of all they talk about how there are 12 million cancer people in America and many face long term issues that I am all too familiar with: fatigue, pain, cognitive impairment (a/k/a chemobrain), depression and anxiety, and other cancers. 25% of the people lucky enough to get cancer, are even luckier and get it a second time. (Its all a matter of attitude here.) I say cancer is the gift that keeps on giving. They also... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3679891 Sun, 20 Jun 2010 10:06:00 +0100 3679891 http://www.medworm.com/index.php?rid=3678648&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F06%2Fchronic-word-i-dislike-as-much-as.html The CDC has a whole set of programs to define chronic diseases. Wikipedia defines chronic disease as:'In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between. As an adjective, chronic can refer to a persistent and lasting medical condition. Chronicity is usually applied to a condition that lasts more than three months. The opposite of chronic is acute.The definition of a disease or causative condition may depend on the disease being chronic, and the term chronic will often, but not always appear in the description: * Chronic fatigue syndrome ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3678648 Sat, 19 Jun 2010 10:38:00 +0100 3678648 http://www.medworm.com/index.php?rid=3652628&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F06%2Fanother-failed-attempt-to-be-normal.html Yesterday I was foolish. I tried to be normal. Now some of you may think that would be a real stretch as what I consider normal, others may consider far from normal but the point is I tried to pretend I have a normal body. I worked all day and then skipped my walk (egad!) because it was raining and I ran out of time before going to my networking meeting. It was a good meeting and I met lots of nice people and brought home Ben & Jerry's for my husband. But in pretending that I was normal, I stood on my feet for an hour and a half. I came home and sat down and took pain meds and ended up going to bed early simply because I needed to lie down.Today I am going to go for a walk this morning - sometimes that helps to loosen up my back. After that I need to go to work and then get a manicure & pe... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3652628 Fri, 11 Jun 2010 10:04:00 +0100 3652628 http://www.medworm.com/index.php?rid=3645072&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F09%2Fgroup-based-cbt-for-pain-in-primary-care%2F I briefly discussed yesterday the content of this six-session group-based cognitive behavioural approach for chronic pain, delivered in the community. Today I want to look a little more closely at the way the programme was delivered and how the findings might differ from what happens in New Zealand. To refresh your memory, this is a study of around 700 people with sub-acute or chronic ‘troublesome’ low back pain, recruited via their GP, who were randomised into two groups – while both groups received ‘advice’ in the form of ‘The Back Book’, the CBT group also received the CBT programme, while the other group were able to seek their ‘usual care’. The programme was delivered to groups of roughly 8 participants by a single therapist, and t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3645072 Wed, 09 Jun 2010 00:03:57 +0100 3645072 http://www.medworm.com/index.php?rid=3641009&cid=t_103331_87_f&fid=36941&url=http%3A%2F%2Fwww.mazecordblood.com%2Fblog%2F%3Fp%3D521 Here’s a simple article from the MedicinePlus website; a list of helpful hints for preventing back trouble during pregnancy (Source: Cord Blood News) Cord Blood News blogs http://www.medworm.com/rss/comments.php?id=3641009 Tue, 08 Jun 2010 11:02:55 +0100 3641009 http://www.medworm.com/index.php?rid=3641350&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F06%2F08%2Fgroup-based-cbt-for-troublesome-low-back-pain%2F These two papers have created a bit of a storm in the health news recently – a six-session CBT group programme for chronic low back pain that not only provides good outcomes, but is also cost-effective?  Unbelievable!  And it’s not delivered exclusively by any specific health professionals.  AND it’s delivered in primary care! My take on this study is, much like others, very positive.  I think it’s wonderful that an intervention that has been used for years in secondary and tertiary health care has been successfully translated into primary care.  It seems to have used a pragmatic study methodology, and pretty fairly represents the kind of person that, at least in New Zealand anyway, misses out on pain management of this kind unless they’re funded by ACC (... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3641350 Mon, 07 Jun 2010 19:35:11 +0100 3641350 http://www.medworm.com/index.php?rid=3629837&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F06%2Fi-jinxed-myself.html Yesterday I said everything was feeling okay. I jinxed myself. Well by the end of the day yesterday, my back was killing me, my arm was feeling funny, and I didn't sleep well last night. Wah! I took a pain pill last night and tried to get comfortable to sleep. There is nothing more infuriating than going to bed and listening to your spouse fall asleep in less than five minutes and an hour later you are still listening to him. Then I woke up around 3 and was awake until 4 and then around 5 and then I got in another tiny snooze. Add in a few hot flashes and a headache and I feel just ducky today. I think I will just go with the 'I'm fine and ignoring everything but might be a touch crabby'. But I'll go work by myself for the day so I don't have to risk being a crabby co-worker.Actually thoug... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3629837 Fri, 04 Jun 2010 10:09:00 +0100 3629837 http://www.medworm.com/index.php?rid=3617917&cid=t_103331_111_f&fid=39123&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fnursingcomments%2Ftdtc%2F%7E3%2FrtAauhpKLb8%2F           The sciatic nerve is the largest nerve in the human body.  Its diameter is about the size of a human finger.  Sciatica actually refers to pain resulting from irritation of the sciatic nerve.  Typically the pain is felt from the low back to behind the thigh and radiating down below the knee.  Further, sciatica usually affects one side of the body.  The term is a symptom caused by a disorder occurring in the lumbar spine.  The pain varies – it can be dull,  burning, sharp or accompanied by intermittent shocks of shooting pain beginning in the buttock traveling downward into the back or side of the thigh and/or leg.  Then, sciatica normally extends below the knee and may be felt in the feet.  Sometimes it is characterizes by tingling and numbness.  Trying to... Nursing Comments blogs http://www.medworm.com/rss/comments.php?id=3617917 Tue, 01 Jun 2010 13:10:38 +0100 3617917 http://www.medworm.com/index.php?rid=3599554&cid=t_103331_113_f&fid=38494&url=http%3A%2F%2Fcuretogether.com%2Fblog%2F2010%2F05%2F25%2Fmarijuana-better-than-chiropractic-for-back-pain%2F For the interactive version of this infographic and some statistical geekery, click here. When your back hurts, is your first thought, “Where’s the marijuana?” I’m guessing not. But Back Pain is the #2 condition at CureTogether, with 1188 people reporting their experiences, and this is their collective wisdom. If you look at the infographic above, the most popular and effective treatments reported are on the top right – hot packs, physical therapy, stretching, exercise, massage. The top left quadrant shows below-average usage, but above-average effectiveness, so presumably if more people tried these, they would be helped (marijuana, Oxycodone, yoga, and Pilates). Those in the lower-right quadrant have above-average usage but below-average effectiveness, so pre... The Collective Well blogs http://www.medworm.com/rss/comments.php?id=3599554 Tue, 25 May 2010 17:17:10 +0100 3599554 http://www.medworm.com/index.php?rid=3581811&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F05%2Fits-just-side-effect.html I hate side effects. What is the side effect of a three hour nap? Waking up at 4 am.Yesterday went okay as 12 needles worth of fun can be. I got to the hospital and had an hour to wait because I was early so my husband wouldn't be late for work. Normally I would go eat some breakfast but I couldn't eat. I sat in the lobby and knitted and watched CNN.Finally I motivated to check in and went down to the surgical area. I changed into a lovely gown and coordinated robe that make us all look like other clones... Then the fun began. They had to put in an IV. I have wimpy veins. They have limited options as I have lymphedema arm which is not allowed to be used for IV's, blood pressures, etc. I made a point to drink two glasses of water before my cut off time because it can help with your veins. B... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3581811 Thu, 20 May 2010 09:51:00 +0100 3581811 http://www.medworm.com/index.php?rid=3581551&cid=t_103331_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F05%2F20%2Forganising-quality-and-effective-spinal-services-for-patients-a-report-for-local-health-communities-by-the-spinal-taskforce%2F Title: Organising quality and effective spinal services for patients: a report for local health communities by the Spinal Taskforce Skinny: Report  intended to assist the NHS in developing and delivering effective spinal services, creating a set of productive services that deliver quality, timely and clinically appropriate care that meets patients’ needs and expectations. It looks at the effective organisation of spinal services for a wide population to support those planning and commissioning services across an SHA, PCTs and clinical and managerial teams within provider units. The document describes the main types of patients being referred for spinal treatment and advises on how to organise services to meet the needs of these groups, paying particular attention to quality, clinical ou... Fade Library blogs http://www.medworm.com/rss/comments.php?id=3581551 Thu, 20 May 2010 04:32:13 +0100 3581551 http://www.medworm.com/index.php?rid=3570038&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F05%2Fwould-you-want-to-know.html Science is at the stage where now they can promise all sorts of things by analyzing your DNA. (This always makes me think of a cross between Igor in Dr. Frankenstein's lab with bubbling beakers and a weird 1950's black and white sci fi movie where they are trying to find martians among the residents of a normal neighborhood. But I digress.) So do you want to know? Do you really want to know that you are more likely to get cancer or any number of other life threatening or changing ailments? Really? Are you sure? To me its kind of like knowing that you are going to die in a car accident in a certain number of years. Wouldn't you live with a feeling of doom? I think we all know now that we are going to go at some point but I don't know that we want to know when or how ahead of time. I was sur... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3570038 Mon, 17 May 2010 10:36:00 +0100 3570038 http://www.medworm.com/index.php?rid=3568065&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F05%2Fsecret-mission.html Today I am off on a secret mission. My sister and a friend are doing the Avon 40 mile walk for breast cancer this weekend. I called them to cheer them on (and annoy them) several times yesterday. This morning, I will call again just when they should be starting. But what my secret mission is that I plan on calling them from the first mile marker where there is a cheering station and will walk with them for a bit. They don't know this which is why it is a secret mission. But since they are computerless (and slept in a tent last night) I can write about it here and they won't know until afterward.Yesterday they both asked me if I can join them at the closing ceremonies which are way the hell on the other side of Boston and involves standing around. This is closer and a shorter excursion that... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3568065 Sun, 16 May 2010 09:34:00 +0100 3568065 http://www.medworm.com/index.php?rid=3566792&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F05%2Fgood-nights-sleep.html Yesterday was a tough day. I was not feeling well - mostly from lack of sleep and lots of back pain. I worked at one job and then met a friend for a walk. I am not sure how I got through that walk but I came home and alternated preparing dinner with sitting on the couch and took a pain pill. Then I went to bed early on top of that.Last night I made a deal with my husband that he would make sure the (damn) alarm clock would not go off this morning. I actually slept for nearly 10 hours. At one point I woke up to feel the cat walking on me. This means he was hungry. Well, I was sleepy so I played possum and he gave up and went some place else. Sometimes he comes and checks to see if we are awake and will get up and give him food.Today, so far, so good, but it is only 730 am and I am still lyi... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3566792 Sat, 15 May 2010 11:35:00 +0100 3566792 http://www.medworm.com/index.php?rid=3564177&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F05%2Fday-of-mistakes.html Yesterday was a day full of mistakes. I had the best of intentions but as you know the road to hell is paved with good intentions. I started off by volunteering at the annual conference for the regional direct marketing association. I love to do it every year. I think this was my fourth year. I usually go on the Wednesday and stay through the evening dinner and then go back on Thursday morning early and stay for the day. I get to learn what is going on in the marketing world and talk a lot of people I rarely see. I made two mistakes. Mistake number one was to think that I could be up on my feet on Wednesday afternoon and then again on Thursday. Mistake number two was to have to leave to go to Walter's doctor appointment. So my back was very sore for trying to be on my feet (and be a normal... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3564177 Fri, 14 May 2010 10:11:00 +0100 3564177 http://www.medworm.com/index.php?rid=3549592&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F10%2Fact-ing-well-living-well%2F For some time I’ve been learning more about ACT – Acceptance and Commitment Therapy (normally pronounced ‘act’, not A – C – T).  While I have to admit that I have been flummoxed by relational frame theory, a behavioural theory of human language and cognitionthat underpins ACT (go here for a tutorial that may enlighten somewhat), there are some very simple principles that ACT employs that I’ve found useful in my own life – and in the lives of people I work with. Over the next few days I want to outline a bit more about ACT and how I use it within pain management – I’ll be referring to journal papers that explore the use of ACT in pain management, but a lot of what I’ll cover comes more from my own experiences with moving fro... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3549592 Sun, 09 May 2010 23:33:21 +0100 3549592 http://www.medworm.com/index.php?rid=3538365&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F05%2Fit-can-be-yours-as-well-for-20-and-mere.html Yes, you too can have a healthy balancing ankle for the mere investment of a $20 copay and ten minutes twice a day. No stress, no strain, no surgery! Yesterday I went to see my ankle surgeon. I thought because of the state of my ankle after twisting and falling a few weeks back (when I attempted to be a healthy person) that I had no choice but ankle surgery to heal up. The surgeon talked to me and then she tried bending my ankle around under this funky xray machine where she could move my ankle and take pictures of it. It was kind of cool, but I digress. She said the ligaments are fine and surgery would do nothing. But my balance is off. I admit to neglecting the balance exercises I had been given - I have so many damn exercises I forgot them - but apparently they are the key to my healthy... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3538365 Thu, 06 May 2010 10:15:00 +0100 3538365 http://www.medworm.com/index.php?rid=3534070&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F05%2Foff-to-see-ankle-surgeon.html Today I am off to work and then I see the ankle surgeon to find out about scheduling surgery. My ankle is not better. It is not getting better. In fact it is swollen again. Its not going away. The question the doctor had was 'if it was in a state where I can live with it' and the answer is no. I am sick of it. So today I will find out about scheduling when it can take place. I know it won't be until at least another month because my next back procedure is the 19th and it will have to be at least 2 weeks after that. But it will finally be scheduled and dealt with and I can move on and deal with other ailments. It will be nice to have something get better and go away as opposed to chronic things that just seem to hang on and get worse (like my back) or just never go away (like cancer).My app... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3534070 Wed, 05 May 2010 10:11:00 +0100 3534070 http://www.medworm.com/index.php?rid=3534135&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F05%2F05%2Fdead-bodies-cant-feel-pain-or-why-biomechanics-and-ergonomics-havent-reduced-back-pain%2F I know, it should make sense: reduce the biomechanical load on the body bits and pain/injury should reduce, right?  I mean, the maths adds up, cadaver experiments ‘prove it’, it has ‘face validity’, there is a whole industry based on the idea of  ‘safe lifting’ and injury prevention – physical ergonomics works, doesn’t it? Well, sad to say, this very recent paper (this week’s BMJ no less!) by very respected researchers in the field has once again found that the evidence is at the most low to moderate that “physical and organisational ergonomic interventions were not more effective than no ergonomic intervention on short and long term LBP and neck pain incidence/prevalence”. Not only does this finding fly in the face of co... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3534135 Tue, 04 May 2010 19:39:57 +0100 3534135 http://www.medworm.com/index.php?rid=3502968&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F04%2Fwhat-is-wrong-with-me.html Now someone did make a point yesterday in a comment that they didnt understand what the needles in my back were for but hoped it was not for cancer related issues. So what is wrong with me? (And I am not consulting my husband on this as he will have other diagnosis not normally found in the medical profession). Basically I am okay breast cancer wise. I have my annual mammogram/surgeon/bloodwork/bone density coming up in a few weeks which will stress me out but should give me some reassurances. I will probably also switch from Tamoxifen to an aromatase inhibitor. The bone density check is to get another update on my bones because thyroid medicine is hard on one's bones as is Tamoxifen and aromatase inhibitors. They will continue to watch my bones for the duration that I am on an AI because ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3502968 Sun, 25 Apr 2010 10:54:00 +0100 3502968 http://www.medworm.com/index.php?rid=3501692&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F04%2Fmore-reassuring-articles.html I have to stop reading. That's it. Why read this stuff other than to drive myself crazy? First, we have all the articles floating around about cancer recurrence rates and all sorts of lovely statistics, never mind the news reports about people who die from cancer. Then apparently I need to be concerned about side effects from the anti inflammatories I take for my back. It doesn't look like I am going off them any time soon. And I guess I am supposed to either be saving my money to pay for a knee replacement in the future. Something nice to look forward to - but its not cancer so I guess I should be happy. My right knee has had meniscal tears twice and I have a partially torn ACL as a result of ice skating and skiing. (I should add that no one knew I tore my meniscus the first time, it was ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3501692 Sat, 24 Apr 2010 10:40:00 +0100 3501692 http://www.medworm.com/index.php?rid=3499292&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F04%2Fday-after.html Wednesday afternoon I was happy. My back did not hurt. I cooked dinner, went for a walk, stood, cooked, all sorts of complicated things. Then the day after the good day began... Yesterday morning I was driving to work and decided my back was hurting so I took half a pain pill as I needed to drive and work (things that I don't do after a whole pain pill). However my back continued to hurt so I took another half a pill at lunch, left work 45 minutes early, and came home to put ice on my back and more pain meds. My upper back was not happy because it had 12 needles stuck in it. It just felt like it had been punctured 12 times. My middle back was not happy (I have no idea why, perhaps it was in sympathy for my upper back) and caused severe pain so I had to resort to my lovely lidocaine patches... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3499292 Fri, 23 Apr 2010 10:31:00 +0100 3499292 http://www.medworm.com/index.php?rid=3494521&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F04%2Fmental-note-to-self-it-pays-to-ask.html Yesterday I got to spend quality time at the hospital. I had a back injection scheduled for 930 am but had to go with my husband first thing in the morning, which means I got there at 715. I did plan to visit a friend who works there, another friend who volunteers there, have breakfast, and get my bloodwork that is scheduled for two weeks from now done. The advantage to getting my blood work done ahead means that the doctor will have the results when I see her an hour later.First stop blood lab - where the only blood work in the system for me was for a single test which is very odd. Usually my oncologist wants a full set of blood work before I see her. The blood lab thought it was odd as well and said we should check with the doctor first but it was too early to call the doctor's office. T... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3494521 Thu, 22 Apr 2010 10:12:00 +0100 3494521 http://www.medworm.com/index.php?rid=3490843&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F04%2Fim-not-only-one-who-is-confused.html It is nice to know that the doctors and pathologists are often confused as well. Or do they just share their confusion with us patients? At any rate, it turns out medical tests are not necessarily black and white. I am sure there are safeguards and double checks built in to the system. I personally know that when I had a confusing pathology report on a recent test, my doctor discussed it with at least one other doctor. I know I discussed it with three of my doctors.Now today I am off for another lovely back injection (can't wait - NOT). The actual injection is painful briefly but the results should heal that lovely spot in my back that jumps up to a pain level of 8 out of 10 if I stand or walk for more than ten minutes or so. (This morning it is twinging because I was bad yesterday and wal... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3490843 Wed, 21 Apr 2010 10:02:00 +0100 3490843 http://www.medworm.com/index.php?rid=3436380&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F04%2Fbut-i-was-just-trying-to-act-like.html Yesterday, I was doing my normal things - laundry, cooking, went for a walk, a little gardening, etc. I try not to let my health interfere with my daily activities. I usually just ignore the aches and pains and keep on going. If I did let them interfere I would be sitting in the corner, doing nothing with my life. But often by the end of the day, my back is killing me and my ankle is telling me I did too much again. I was doing laundry and cooking - my parents were coming for dinner and I like to create - so I was on my feet a good portion of the day. But I did sit down and take some breaks to help my back rest. I was almost done with laundry and had three full laundry hampers lined up, waiting for my husband to bring them upstairs. I could have moved them but I attempted to step over them... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3436380 Sun, 04 Apr 2010 14:13:00 +0100 3436380 http://www.medworm.com/index.php?rid=3433133&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F04%2Foh-joy-another-big-needle-scheduled.html Yesterday I went to see my pain doctor's physician assistant to learn what else we can do for my back. I have decided that physician assistants can be very useful and this one was too. But when he walked into the room, I almost asked him if he was out of high school yet. He was a bit young. But we did have a good discussion about my back and he explained things, like why I can have degenerating disks in my lower back but have pains in my upper back. This is called inflamed facet joints. These little bitty joints run along each side of your spine. If they get inflamed they hurt. They hurt a lot. Then we talked about my bursa pains in my hips. There was lots of ouching from me as the way to determine if something is inflamed is to push on it and find out what hurts. So the plan of action is ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3433133 Fri, 02 Apr 2010 11:12:00 +0100 3433133 http://www.medworm.com/index.php?rid=3399200&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F03%2F24%2Fefficiency-pain-management%2F I can’t remember a time when people working in health were told ‘Go and spend as much as you like to help people get well’ – in fact, in over 20 years I can only recall being told ‘there is less money in the kitty, we need to look for efficiencies, tighten your belts’! So it’s no surprise to me that once again, no matter where you look in the world, health professionals are being told to look at ways to be more efficient.   I don’t have a problem with this – if I’m a patient I want to know I can be treated quickly and effectively so I can get back to being a person and not a patient.  What I do have a problem with is when, in the urgency to save money, problems in health care are given a quick fix solution without taking a look... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3399200 Tue, 23 Mar 2010 18:32:54 +0100 3399200 http://www.medworm.com/index.php?rid=3378436&cid=t_103331_87_f&fid=36050&url=http%3A%2F%2Fblisstree.com%2Flive%2Frelationships-love-on-the-front-burner%2F My biggest relationship problem is that I rarely understand the problem. Instead, I develop back pain. I’m not a particularly reflective person. I’m constantly in motion (except when I’m watching “House”). In relationships, this usually means that I’m doing something for my boyfriend – cooking, or attempting to improve his footwear choices. I rarely take a moment to sit and think about the relationship in any context. I’m always trying to make something better: My apartment, my body, my skin, my gnocchi. This isn’t necessarily a bad habit, but it’s a terribly effective way to block out thought. When you’re in a relationship, you’re supposed to take time to think about how you feel and what you want. I never do that. Instead, I receive signals fro... Breastfeeding 1-2-3 blogs http://www.medworm.com/rss/comments.php?id=3378436 Thu, 18 Mar 2010 16:47:11 +0100 3378436 http://www.medworm.com/index.php?rid=3374351&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F03%2Fwords-take-two.html I posted yesterday about how I don't like certain words to describe cancer and dealing with a diagnosis. A comment in reply did point out that some people actually feel empowered by them. This is a reminder that every one is different and every cancer is different. Just because I don't like something doesn't mean everyone else doesn't. And what works for me doesn't work for others. Well, doh! Otherwise, I am doing okay. I am still dilemmaing about my ankle - surgery or no. Sometimes its fine and sometimes it hurts. Like right now while lying in bed. I am undecided. I heard back from the lymphedema lady and will be going back in to see her. Puffiness in my hand isn't a good thing and its been happening fairly regularly. My back is having good days and bad days. Today I am making a positive ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3374351 Wed, 17 Mar 2010 10:23:00 +0100 3374351 http://www.medworm.com/index.php?rid=3362552&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F03%2Fexercises-can-be-dangerous.html Every day I get down on the floor and do my back exercises twice a day with a big exercise ball, then I do my arm exercises standing up, and then I stand on the balance board and balance disk and do my ankle exercises. Well, yesterday I seem to have been lacking that key trait that can be very helpful in life - coordination. As I was getting down on the floor to start my back exercises, I twisted and jolted my back simultaneously in a distinct lack of adeptness and my back gave a nasty jolt which continues to this moment. No I wasn't doing my exercises I was getting ready to do my exercises.I have no idea what I did. I have pain meds. It is bearable with drugs. My thought is if it still continues Monday, I will call the doctor. No this is nothing to do with the injection I received on Thur... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3362552 Sat, 13 Mar 2010 11:47:00 +0100 3362552 http://www.medworm.com/index.php?rid=3359195&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F03%2Fnicely-non-eventful-day.html Well, it wasn't completely non-eventful but it was not traumatic or stressful, mostly. My husband delivered me to the hospital for my injection. As planned I was there early and had time for breakfast - yogurt and banana - before heading for my appointment. I told the nurse (both nurses remembered me - I think I am a frequent patient or something) before hand that I was hoping to avoid the previous outcome where the back of my leg hurt and I left in a wheelchair. The injection itself is okay. They clean off your lower back and then inject a pain killer so you don't feel the needles. This can cause a little discomfort but not really. Then they stick in a big needle full of steroid which can produce amazing amounts of pain down the back of your leg and across your hip that goes away in about... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3359195 Fri, 12 Mar 2010 11:26:00 +0100 3359195 http://www.medworm.com/index.php?rid=3327258&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F03%2Fhows-my-stress-level.html Well, honestly, its not very good. I had a discussion on this with my therapist yesterday. She suggests that I talk about my stress as it helps relieve it. I am stressed a little still about my husband and the cat. However they both seem to be improving - the cat is developing a little gut from all the canned food he has eaten in the past few days. Trader Joe's tuna for cats, two cans a day. Oink.I'm stressed about:- lymphedema. It needs to be gotten under control and determined whether it can be controlled and what treatment I will need. Regardless, it never really goes away and I will have to be more careful for life.- ankle. My ankle is not getting better. I am still working on it and will for a few more weeks but it seems clearer and clearer that surgery (or a life with a painful ankle... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3327258 Wed, 03 Mar 2010 11:32:00 +0100 3327258 http://www.medworm.com/index.php?rid=3322604&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F03%2Fleg-bone-is-connected-to-hip-bone.html I can't remember the rest of this but you know how it goes the back bone is connected to the hip bone, blah, blah, blah. Last week the lymphedema nurse told me I should consider getting ankle surgery to prevent falling. I started thinking about this. My ankle isn't really getting better. I might wait another month before calling instead of waiting until my appointment in May. No I don't want more surgery but it hurts generally all the time. I just ignore it and go about my life but pain sucks. And is draining. And is stressful.However, I have to talk to the doctor again. If I have the surgery, I think it was six weeks in a cast and six weeks in a boot. If I am in a cast, I don't know if my back and lymphedema arm can deal with crutches so I need to find out if a walking cast is an option. ... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3322604 Tue, 02 Mar 2010 11:16:00 +0100 3322604 http://www.medworm.com/index.php?rid=3316227&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F02%2Fwe-are-what-we-eat.html I did some reading again. I try to limit myself to trashy novels, the daily newspaper (especially the comics) and the closed captioning on the TV at the gym but sometimes I do expand to news sources and the internet...So I learned a few new things. First of all if you have pain, there is a good chance that the new fancy drugs, aren't going to help you. Gee thanks. I do take one of those and thought it was helping. Well at this point I am going to keep taking it for now. Then I read that people in pain such as fibromyalgia (which I have not been told I have but believe that some of my pains in my back are referred neurological pain because it is treated that way) should change their diets and avoid all sorts of different things and eat other things. I learned that the majority of American's... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3316227 Sun, 28 Feb 2010 13:45:00 +0100 3316227 http://www.medworm.com/index.php?rid=3314779&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2010%2F02%2Fattempt-to-be-less-whiney.html I was thinking (sorry I know I shouldn't) and reread my recent posts and decided that I have been rather whiney recently, possibly even more than normal, if that is possible. Today my goal (and my husband will cheer when he hears this) is to be less whiney. Admittedly my life has had its ups and downs recently and I am attempting to deal in a sane manner. I am glad to say that my husband is clearly on the road to improvement, which is important because one of us needs to be healthy. But my health is still struggling. Again. My ankle is not happier. The physical therapist nurse I saw on Monday about my arm suggested I step up my exercises of my ankle to see about rehabbing it or just have the surgery and not wait because I really should be concerned about falling. Feel the cheery rays of su... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=3314779 Sat, 27 Feb 2010 11:58:00 +0100 3314779 http://www.medworm.com/index.php?rid=3311709&cid=t_103331_105_f&fid=38964&url=http%3A%2F%2Fdrwes.blogspot.com%2F2010%2F02%2Foccupational-sciatica.html Ever note lower back pain that radiates down your leg after standing at a cath lab or operating room table?Timothy Sanborn, MD, director of cardiology at our institution shared his experience with this occupational hazard in a recent editorial (pdf) from Catheterization and Cardiovascular Interventions and offers an interesting non-invasive remedy short of laminectomy: hyperextension of the lower back using McKenzie exercises (video). It's helped him.-WesMusings of a cardiologist and cardiac electrophysiologist. (Source: Dr. Wes) Dr. Wes blogs http://www.medworm.com/rss/comments.php?id=3311709 Thu, 25 Feb 2010 21:39:00 +0100 3311709 http://www.medworm.com/index.php?rid=3302673&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F24%2Flow-back-pain-unfit-just-not-doing-much-or-something-else%2F For as long as I’ve been working in pain management (and probably well before), I’ve heard patients being described as ‘deconditioned’. From what we know about the effects of staying in bed because of illness or injury, it makes sense to think that if a person does very little they will become unfit. Common sense really. And from this assumption an industry of gym programmes and fitness initiatives have been instituted as an integral part of back pain rehabilitation. Now before my physiotherapy colleagues start to lynch me, I’m not saying that these programmes should be banished into outer darkness because ‘reactivation’ has been shown to be effective in the recovery from back pain – but maybe it’s effective for quite a different reason... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3302673 Tue, 23 Feb 2010 18:31:00 +0100 3302673 http://www.medworm.com/index.php?rid=3294832&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F22%2Fpeople-with-high-risk-factors-for-disability-get-more-biomedical-information%2F For a couple of years now, the focus of researchers on factors that identify ‘high risk’ of ongoing disability has turned from patients and onto providers. I’ve written before that health provider’s own beliefs about pain, particularly pain-related anxiety and avoidance, can change the advice they give. This can lead to less ‘reassurance’ about remaining active despite an episode of acute low back pain, and more advice to ‘use pain as a guide’. Occupational therapists with high levels of pain-related anxiety and avoidance beliefs can issue more equipment and advise patients to use compensatory movement patterns than those who don’t. As a result I was really interested in another paper exploring communication patterns between doctors and... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3294832 Sun, 21 Feb 2010 18:33:10 +0100 3294832 http://www.medworm.com/index.php?rid=3276109&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F02%2F16%2Fheres-looking-at-us%2F This study looks at the use of the Pain Attitudes and Beliefs Scale with GP’s, or primary care providers.  The PABS was originally developed for physiotherapists, and aimed to identify whether a primarily biomedical view was held, or a biopsychosocial model.  The aim of the study was to firstly evaluate the test-retest reliability of the tool, then in a second study, to establish whether it measured change after the practitioners were given a two-hour presentation on the ‘modern management of acute low back pain’, including material about the biopsychosocial approaches. The presentation on managing acute low back pain covered a review of 4 main topics: trends in disability, including the role of iatrogenic factors; the role of work in maintaining health; current guidel... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3276109 Mon, 15 Feb 2010 18:37:50 +0100 3276109 http://www.medworm.com/index.php?rid=3216665&cid=t_103331_111_f&fid=36048&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAHeartyLife%2F%7E3%2F_qh6E05HZSM%2F The warnings have been out for years now: heavy backpacks are NOT good for your child’s back. And, while parents may be concerned about it, not much seems to be happening in lessening the overall load that’s being carried around. Yet another study has come out that has found that heavy backpacks compress the spinal discs and increase spinal curvature – even if the backpacks are worn properly. And when they’re worn only on one shoulder, as most kids tend to do, the damage is even worse. The results of this study were published in a recent issue of the journal Spine. The authors of the study say that the vast majority of students in the United States (up to 90%) carry backpacks to and from school. On average, the backpacks weigh the same as about 10% to 22% of the chi... A Hearty Life blogs http://www.medworm.com/rss/comments.php?id=3216665 Thu, 28 Jan 2010 14:44:55 +0100 3216665 http://www.medworm.com/index.php?rid=3176015&cid=t_103331_122_f&fid=35055&url=http%3A%2F%2Fsarasotaneurology.com%2F2010%2F01%2F15%2Fjama-reports-prp-not-effective-a-poorly-designed-study%2F In conclusion, PRP is a highly effective medical treatment for ligament, tendon, muscle and other knee/shoulder injuries as well as lower back pain. Even patients with post-operative knee pain or shoulder pain can benefit from PRP therapy.  Outcomes are entirely dependent on the preparation and handling of the blood, equipment used and experience as well as skill of the treating physician. Additional information on PRP can be found at PRP Stops Pain. Excellent clinical study references can be found by clicking here. (Source: Sarasota Neurology) Sarasota Neurology blogs http://www.medworm.com/rss/comments.php?id=3176015 Fri, 15 Jan 2010 14:20:35 +0100 3176015 http://www.medworm.com/index.php?rid=3164084&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2010%2F01%2F12%2Ftwo-tools-for-screening-risk-start-back-tool-and-orebro-musculoskeletal-pain-screening-questionnaire%2F This study asked 244 patients seen in eight GP practices in the UK to complete the two questionnaires, plus a number of other questionnaires – unfortunately these are not listed in this paper, although they are included in a previous paper (Hill, Dunn, Lewis et al, 2008). Correlations and discriminant analyses were carried out, and the results detailed in this paper. Only 53% of the patients actually completed the questionnaires. That’s probably quite good in terms of usual response rate, but a little low for the purposes of being able to make effective generalisations. The correlations between the SBT and OMPSQ are reported as being ‘excellent’ or rs=0.80. The subgroups, however, differed a little. Although qualitatively they ‘looked’ the same – i... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=3164084 Mon, 11 Jan 2010 20:30:27 +0100 3164084 http://www.medworm.com/index.php?rid=3136617&cid=t_103331_111_f&fid=36048&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAHeartyLife%2F%7E3%2FRZOwa-VXi0s%2F Anyone who has experienced chronic lower back pain knows that there are many treatments to try, but it may be difficult to find one that works for your specific problem. Transcutaneous electric nerve stimulation (TENS) is technique that many doctors and physiotherapists have been using to treat pain, including lower back pain. It’s a painless procedure that uses electrical currents to try to interrupt the pain signals from reaching the brain. Electrodes from the TENS machine are placed around or on the painful area and the machine is then turned on. Electrical currents are sent through the electrodes and into the body tissue. The currents don’t cause any pain, but some people do feel a bit uncomfortable. Now, new guidelines, published at the end of December 2009 in the journal ... A Hearty Life blogs http://www.medworm.com/rss/comments.php?id=3136617 Fri, 01 Jan 2010 10:26:14 +0100 3136617 http://www.medworm.com/index.php?rid=3126551&cid=t_103331_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2009%2F12%2F29%2Fquality-in-primary-care-2009-vol-17-no-6%2F This article looks at the barriers which interfere with understanding and optimising expectations in back pain management in primary care. The article reviews literature relating to expectations, back pain patients’ and doctors’ expectations and sources of unmatched expectations. Contact the library for a copy of this article Posted in Current Awareness, Journals Tagged: Back Pain, Expectations, Primary Care (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3126551 Tue, 29 Dec 2009 16:19:48 +0100 3126551 http://www.medworm.com/index.php?rid=3089224&cid=t_103331_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2009%2F12%2F14%2Fannals-of-rheumatic-diseases-2010-vol-69-no-1%2F contents page Fade Fave: Magnetic resonance imaging for low back pain: indications and limitations Fade Skinny: This review summarises the indications for Magnetic Resonance Imaging in Low Back Pain and calls for improved education of patients and health professionals in the limitations of this investigation. (NHS Athens is required to access this article online) Posted in Athens Password, Current Awareness, E-Journals Tagged: Athens Password, Current Awareness, E-Journals, Low Back Pain, Magnetic Resonance Imaging, MRI (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=3089224 Mon, 14 Dec 2009 19:30:33 +0100 3089224 http://www.medworm.com/index.php?rid=2934799&cid=t_103331_111_f&fid=36048&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAHeartyLife%2F%7E3%2Fp7wOC8Hk-Wk%2F At 100 years old, some people may be grateful to be alive, but life for Helen Daniels of Poughkeepsie, NY, was difficult because of back pain from osteoporosis. Her osteoporosis (thinning of the bones) had led to fractures in her spine, making it difficult to walk. But thanks to a minimally invasive surgical procedure called balloon kyphoplasty, Ms. Daniels is now walking again. According to this article, 100-Year-Old Woman Gets Relief From Debilitating Back Pain After Minimally Invasive Spine Surgery, balloon kyphoplasty is a procedure where: a needle and tube are used to create a small pathway into the fractured bone. Orthopedic balloons are inserted and then inflated inside the fractured bone in an attempt to restore vertebral body height and correct angular deformity. Inflation of the ... A Hearty Life blogs http://www.medworm.com/rss/comments.php?id=2934799 Wed, 28 Oct 2009 10:53:20 +0100 2934799 http://www.medworm.com/index.php?rid=2927454&cid=t_103331_122_f&fid=35055&url=http%3A%2F%2Fsarasotaneurology.com%2F2009%2F10%2F25%2Fregenerative-medicine-platelet-rich-plasma-provides-joint-pain-relief%2F As a neurologist who sees many patients with neck, back and various joint pains, I practice an area of medicine known as neuro-orthopedics. As such, I treat patients for their pain without surgical intervention. Many patients with neck, back and joint pain (knee pain, shoulder pain, elbow pain, etc.) can be successfully treated without invasive surgery and the many risk that go along with this. With surgery there is also a prolonged recovery time and need for extensive rehabilitation. The area of medicine that applies to successfully treating patients without surgery or use of narcotic medications is known as regenerative medicine. In this field, platelet rich plasma is injected into the affected joint, tendon, ligament or soft tissue area that has pain and is failing to heal completely. T... Sarasota Neurology blogs http://www.medworm.com/rss/comments.php?id=2927454 Sun, 25 Oct 2009 21:00:24 +0100 2927454 http://www.medworm.com/index.php?rid=2899171&cid=t_103331_136_f&fid=39026&url=http%3A%2F%2Fcarolinemfr.blogspot.com%2F2009%2F10%2Fcant-come-up-with-title.html I am not sure how to title today's post - Ending Years of Denial, Off to be Labeled, or Volunteering Again. Today (and tomorrow and Sunday), I am off to the Thyroid Cancer Survivor's (hence the label - I hate that word) Association's annual conference which is being held in the Boston area for the first time (ending the denial). I will be a volunteer - which means I will sit at a table talk to people about things that I don't really know about. I will also get to attend some sessions on fun topics such as 'Long term survivorship' (I better be in that club after 28 years even if I hate the word), 'Coping with Multiple Health Issues (maybe I could write that one), or 'Ask A Doctor: Managing Thyroid Cancer for those diagnosed before 18 or as Young Adults' (I may be too old for that one). I am... Caroline's Breast Cancer Blog blogs http://www.medworm.com/rss/comments.php?id=2899171 Fri, 16 Oct 2009 10:47:00 +0100 2899171 http://www.medworm.com/index.php?rid=2883228&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F12%2Facceptance-in-chronic-pain%2F It’s a truism that no-one really wants to have pain (and if they do, we probably need to ‘talk’!).  Accepting pain may be equated with ‘giving up hope’ or ‘giving in’ – perhaps acceptance is thought to be about resignation rather than acknowledgement.  In any event, very few of the people I work with seem to be ready to acknowledge the reality of having pain and at the same time being aware of the ability to also experience joy, peace, fun and all the other good things in life. I’m not entirely surprised by this when I consider the way we’re raised to believe that: (1) pain is bad and must be avoided (2) doctors are all-powerful and can fix anything if only they try hard enough (except the common cold – but we can take ant... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2883228 Sun, 11 Oct 2009 19:26:01 +0100 2883228 http://www.medworm.com/index.php?rid=2876119&cid=t_103331_111_f&fid=36048&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAHeartyLife%2F%7E3%2FogkR_5JP2YI%2F If you have lower back pain that has been triggered within the year, don’t despair. There’s a good chance that you may recover and not be left with chronic back pain. Researchers in Australia found that 35% of people with chronic lower back pain will recover within nine months while 41% will recover within one year. The results of their study was published in the on-line journal, BMJ. The study involved 400 patients who were followed throughout the year by telephone interviews. The patients were asked about pain levels, what they were and weren’t able to do, and if they had returned to their previous level of work. An additional finding was that those who didn’t recover as quickly often had taken prior time off word because of lower back pain, had high disability le... A Hearty Life blogs http://www.medworm.com/rss/comments.php?id=2876119 Thu, 08 Oct 2009 14:57:01 +0100 2876119 http://www.medworm.com/index.php?rid=2862759&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F10%2F06%2Fself-care-or-medical-care-for-low-back-pain-what-patients-want%2F This study is an old one, dating from 1999, but there’s no reason to believe the findings differ too much from what we’d find today. It was conducted by Saunders, VonKorff, Pruitt and Moore, based mainly in Seattle, and looks at the extent to which specific patient attitudes and beliefs about medical care and self-care for back pain predict future healthcare use. The study design involved a five year follow-up of patients who had attended Group Health Cooperative of Puget Sound.  All patients were primary care patients, so unlike many studies, these people were not necessarily seen in a tertiary hospital setting. There were three groups of patients: the first group of around 1200 were recruited in 1989 and 1990, and were adult primary care patients with back pain, interviewed ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2862759 Mon, 05 Oct 2009 18:29:27 +0100 2862759 http://www.medworm.com/index.php?rid=2823996&cid=t_103331_90_f&fid=36413&url=http%3A%2F%2Fwww.dcscience.net%2F%3Fp%3D2262 Conclusions: SMT is unlikely to result in relevant early pain reduction in patients with acute low back pain." Admittedly, the trial was quite small (104 patients, 52 in each group) so it will need to be confirmed. but the result is entirely in line with what we knew already. It also adds to the evidence that the recommendation by NICE of SMT by chiropractors constitutes their biggest failure ever to assess evidence properly. If NICE don’t amend this advice soon, they are in danger of damaging their hitherto excellent record. Despite the moderate tone and accuracy of what Holt said on TV, the New Zealand Chiropractors’ Association made a formal complaint. That is what they like to do, as I learned recently, to my cost. It is so much easier than producing evidence. Quite ... DC's goodscience blogs http://www.medworm.com/rss/comments.php?id=2823996 Wed, 23 Sep 2009 00:00:21 +0100 2823996 http://www.medworm.com/index.php?rid=2820618&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F22%2Fmore-on-anxiety-and-pain-pain-related-anxiety%2F It seems obvious that something unpleasant is something to be avoided – and if we’re meant to avoid it, we’re likely to be just a little bit afraid of it. Yesterday I talked about health anxiety in general, and today I want to touch on a specific sub-group of health anxiety – pain-related anxiety. Many people will be familiar with pain-related anxiety and avoidance, the model of so-called ‘fear avoidance’ that is a compelling explanation for how so many people become deactivated and disabled when they have persistent pain. It might be a surprise to some that the term ‘fear avoidance’ is actually not technically correct! There are two parts to the phenomenon: fear (or really, pain anxiety) and avoidance. It’s possible to be fearful or an... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2820618 Mon, 21 Sep 2009 19:37:13 +0100 2820618 http://www.medworm.com/index.php?rid=2814557&cid=t_103331_122_f&fid=35055&url=http%3A%2F%2Fsarasotaneurology.com%2F2009%2F09%2F20%2Fcymbalta-savella-new-hope-for-fibromyalgia-patients%2F The FDA has approved two additional medications specifically for the treatment of fibromyalgia symptoms. The first drug to ever be approved for fibromyalgia treatment was Lyrica. Lyrica was developed as an anti-seizure medication and has FDA approval for this and treatment of painful diabetic neuropathy. Since its initial release, the FDA approved its use for symptomatic treatment of fibromyalgia. Cymbalta was the second drug to be FDA approved for the treatment of fibromyalgia. This has been a tremendous addition to treatment of this disabling condition. The most recent medication approved for FM treatment is Savella. Prior to the FDA approval of these three medications, there were no proven effective treatments for fibromyalgia. What is fibromyalgia? Fibromyalgia (FM) is a syndrome of di... Sarasota Neurology blogs http://www.medworm.com/rss/comments.php?id=2814557 Sun, 20 Sep 2009 23:55:25 +0100 2814557 http://www.medworm.com/index.php?rid=2800711&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F16%2Fthe-myth-of-core-stability-part-2%2F Following on from yesterday’s post about core stability, today I want to look at training, back pain prevention and rehabilitation as it relates to core stability. Motor learning moves from conscious attention to make certain movements through to movements that are basically over-learned or automatic. There are considerable differences in how a beginning learner carries out a movement from the way an accomplished or proficient person carries out the same movement – think about how we first learned to drive a car (complete with tongue poking out and bunnyhops!) through to the relatively automatic way we drive to and from work today! Motor learning is specific – so if we want to get good at typing, we need to actually type rather than lift weights. This has important implic... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2800711 Tue, 15 Sep 2009 19:27:55 +0100 2800711 http://www.medworm.com/index.php?rid=2796834&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F15%2Fthe-myth-of-core-stability%2F Fads come and fads go, and no more so than in managing back pain. One of the more durable fads has been the plethora of exercises to ’strengthen the core’. I’ve been searching for a good review of the literature on core stability, and surprisingly found one in a journal I rarely read: Journal of Bodywork & Movement Therapies. Eyal Lederman has written an extensive critical review of the use of core stability in back pain rehabilitation, and although there is a lot of material covered in the review, it is summarised nicely and the reference list alone is worth getting the article! The basic premise of core stability was a finding that in people with chronic low back pain, there are changes in motor control of the trunk muscles. Along with some of the other underlying b... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2796834 Mon, 14 Sep 2009 19:27:27 +0100 2796834 http://www.medworm.com/index.php?rid=2790270&cid=t_103331_90_f&fid=36413&url=http%3A%2F%2Fwww.dcscience.net%2F%3Fp%3D2222 In July 2008 I wrote an editorial in the New Zealand Medical Journal (NZMJ), at the request of its editor. The title was  Dr Who? deception by chiropractors.  It was not very flattering and it resulted in a letter from lawyers representing the New Zealand Chiropractic Association.  Luckily the editor of the NZMJ, Frank Frizelle, is a man of principle, and the legal action was averted. It also resulted in some interesting discussions with disillusioned chiropractors that confirmed one’s worst fears.  Not to mention revealing the internecine warfare between one chiropractor and another. This all occurred before the British Chiropractic Association sued Simon Singh for defamation.  The strength of the reaction to that foolhardy action now has chiropractors wond... DC's goodscience blogs http://www.medworm.com/rss/comments.php?id=2790270 Sun, 13 Sep 2009 16:00:43 +0100 2790270 http://www.medworm.com/index.php?rid=2762156&cid=t_103331_151_f&fid=36896&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FSuboxoneTalkZone%2F%7E3%2F_8WoDtll8Rw%2F Today I received a call from a patient who has been taking Suboxone for about six months, asking for help with a pain issue.  Before getting into the specific details I’ll mention something that I have mentioned many times before; some people do very well on Suboxone maintenance for opiate dependence, and others do less well.  Some people take their daily morning dose of Suboxone and then live life almost as non-addicts, rarely even thinking about opiates as they go about the business of life.  But others will remain in an addictive relationship with opiates.  The Suboxone bails them out of jams, or even prevents the jams from happening in the first place.  They don’t spend all of their money on oxycodone or heroin, and in most cases they will manage to avoid taking opiate agonist... Suboxone Talk Zone blogs http://www.medworm.com/rss/comments.php?id=2762156 Thu, 03 Sep 2009 04:34:08 +0100 2762156 http://www.medworm.com/index.php?rid=2752229&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F09%2F01%2Ftake-the-pain-away-and-the-other-problems-go-too%2F There are some days I despair that the biopsychosocial model will EVER take hold in the died-in-the-wool medical interventionist strongholds. This quote from a discussion with a colleague might help you join in my pity party…The conversation is about a case of a young woman with 18 month history of neck pain post-MVA, she has been to pain management and ‘while this has helped her understand and manage her pain better, the pain persists to the point that she is becoming increasingly frustrated, with deterioration in her work, personal and social environment.’ In my discussion with my colleague, he stated that ‘…the reasons that the patient is frustrated is that she still has pain.  Take that away (if it is possible) and the other problems go too.’ He wen... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2752229 Mon, 31 Aug 2009 21:24:14 +0100 2752229 http://www.medworm.com/index.php?rid=2741624&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F28%2Fwhat-is-self-management-in-chronic-pain%2F Self management. It’s term we use very often in pain management, but do we really agree about what we’re talking about? Maybe self management is different things to different people, maybe even different things to different people at different times! But if we don’t talk about what we’re aiming for, especially if we’re in a team that don’t talk – we’re bound to run into trouble. Self management has been defined by academics in several ways, which doesn’t help, but all the definitions seem to include concepts of wellbeing, activities that the person with the health condition does, and encounters with the health system. The Institute for Healthcare Improvement states that self management includes three things: care of the body and manag... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2741624 Thu, 27 Aug 2009 19:44:09 +0100 2741624 http://www.medworm.com/index.php?rid=2730384&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F25%2Fsafety-behaviours-do-they-maintain-kinesiophobia%2F Let me start by saying this post is conjecture, but based both on observing patients, and after reading an interesting paper on ’subtle avoidance and safety behaviours relevant to social anxiety’. First some definitions: I hope you’re all familiar with the term ‘kinesiophobia’, or ‘fear of movement’ – it’s the fear and avoidance of movements that an individual believes will hurt or harm them. Safety behaviours: are strategies that may be used to reduce the anxiety of carrying out a behaviour – and are usually ‘logically’ linked to the underlying belief about the movement.  For example, using ’safe lifting techniques’ can be a safety behaviour in someone who is fearful of bending; taking a deep breath in an... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2730384 Mon, 24 Aug 2009 19:29:17 +0100 2730384 http://www.medworm.com/index.php?rid=2720002&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F21%2Ffunctional-capacity-evaluations-my-take-on-them%2F Functional capacity evaluations There are many forms of functional assessment available.  These range from a series of structured activities carried out in the home or work environment over a period of days or weeks to those that are carried out in a very precise manner in a clinic and often under the supervision of an occupational therapist or physiotherapist.  Both commercial (ie standardised and franchised) ‘Functional capacity evaluations’ (FCE) are available, as well as semi-structured or individualised assessments. The term functional capacity evaluation has been criticised, because it can suggest that it is able to assess ‘capacity’ or ‘can do’, while most commentators believe that functional assessments can only assess what a person ‘will do’ (e.g. Battie & Ma... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2720002 Thu, 20 Aug 2009 19:16:43 +0100 2720002 http://www.medworm.com/index.php?rid=2685387&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F08%2F10%2Fmore-about-acupuncture-press-needles-as-a-placebo%2F Slightly tangential to my normal topics, I located this article today on a placebo procedure that may work for acupuncture. Many people will be aware that in acupuncture, it’s really difficult to truly conduct a double-blind trial where both the person receiving and the person giving the treatment are unaware of which is the ‘active’ treatment. In fact ongoing criticism of many studies such as those reviewed in Cochrane reviews (and the recent post I made of Ernst’s review of 32 Cochrane reviews) is that in giving the ‘placebo’ treatment, the comparison is not really between acupuncture and placebo acupuncture, but it is instead of acupuncture with ’something else’, and in doing this, much of the ‘active’ component of acupuncture ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2685387 Mon, 10 Aug 2009 08:08:26 +0100 2685387 http://www.medworm.com/index.php?rid=2657926&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F07%2F31%2Fseeing-people-progress%2F A quick post this morning before I search for some Friday funnies! I saw a few patients this week after having had just over a fortnight off work – and you know how sometimes working in pain management can seem unrewarding, progress can be incredibly slow, one step forward, two sideways… Well here are some progress reports from some of the people I’ve been seeing (names and details changed to protect identities). Hypnosis for intermittent phantom pain First up is a man with a 10 year history of below knee amputation. He wears a prosthesis, is fit and active, and until late last year was working full time. Over the latter half of last year he developed intermittent severe stabbing phantom pain (prior to this he had phantom sensation with some stump pain but never phantom p... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2657926 Thu, 30 Jul 2009 19:39:40 +0100 2657926 http://www.medworm.com/index.php?rid=2513398&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F25%2Fsplish-splash-hydrotherapy-for-chronic-back-pain-is-pretty-good%2F This study measured outcome immediately at the conclusion of the treatment period, so didn’t control for these very influential factors. I’ll bet that over the next couple of months, there will be a rise in the prescription of hydrotherapy under supervision by a physiotherapist, with this study being cited as a good reason for doing so. I mean, this is a study published in a well-established peer-reviewed and very influential journal. But hold on folks – how good is this study really? Would you want to draw conclusions from this? Dundar U, Solak O, Yigit I, Evcik D, Kavuncu V. (2009). Clinical effectiveness of aquatic exercise to treat chronic low back pain: a randomized controlled trial. Spine, 34 (14), 1436-1440 (Source: HealthSkills Weblog) HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2513398 Wed, 24 Jun 2009 19:11:19 +0100 2513398 http://www.medworm.com/index.php?rid=2513405&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F18%2Fif-we-can-get-rid-of-the-pain-is-it-worth-knowing-about-psychosocial-factors-in-acute-back-pain%2F In this study, (and I won’t go into the details of the design) a group of around 900 people seeing their GP for a first visit for acute low back pain under ACC funding, provided their responses to the Orebro Musculoskeletal Pain Questionnaire.  This is a widely used questionnaire designed to identify those people at risk of developing ongoing problems with their back pain, and has been used in New Zealand (and many other places in the world) as a screening tool to determine the need for early intervention. In this study, the findings showed that the factors present at the time of the first visit for back pain, as identified in the scores on the OMPQ, were associated with the eventual overall cost of the claim.  Now the association wasn’t a linear one, there was some variabili... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2513405 Wed, 17 Jun 2009 19:28:47 +0100 2513405 http://www.medworm.com/index.php?rid=2473435&cid=t_103331_97_f&fid=36415&url=http%3A%2F%2Fwww.dcscience.net%2F%3Fp%3D1718 Jump to follow-up Peter Dixon is a chiropractor. He is chair of the General Chiropractic Council (GCC). He was also a member of the hotly-disputed NICE low back pain guidance group that endorsed (you guessed it) the use of chiropractic, a decision that has led to enormous criticism of the standards of the National Institute of health and Clinical Excellence (NICE). As a consequence largely of the decision of the British Chiropractic Association (BCA) to sue Simon Singh for defamation, there has been an unprecedented interest taken in the claims made by chiropractors in general. Peter Dixon has a problem because something like 600 individual complaints about unjustified health claims have been sent to the GCC. Even when a web site does not claim to be able to benefit things like asthma and ... DC's Improbable Science blogs http://www.medworm.com/rss/comments.php?id=2473435 Sat, 13 Jun 2009 19:17:33 +0100 2473435 http://www.medworm.com/index.php?rid=2469806&cid=t_103331_130_f&fid=34938&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEvidenceInMotion%2F%7E3%2FsJSr6XfWCPw%2Fan-extreme-risk-of-drugs.html Not sure if a physical therapist was ever involved  in treating Danny Gans' chronic back pain.Another potential risk when one relies on medications to "treat" chronic back pain.  Was Danny educated on all his options?  Were all the risks of those options shared with him?~Selena (Source: MyPhysicalTherapySpace.com) MyPhysicalTherapySpace.com blogs http://www.medworm.com/rss/comments.php?id=2469806 Wed, 10 Jun 2009 14:41:09 +0100 2469806 http://www.medworm.com/index.php?rid=2464478&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F09%2Fself-management-follow-up-a-focus-group-study%2F In this study, the focus group participants were only those who had received the stepped care approach. The groups were moderated by an external facilitator, and a simple open-ended semistructured discussion was conducted. Members of the research group were also present to code responses. Although the questions were not specifically about the relationships that people had formed with the care manager or GP, the groups are reported to have raised this relationship often during the course of the discussion. Typically the participants were less than happy with the pain management they had received from their GP, and much more satisfied with the pain management provided during the self management programme. Now, the key differences between the two approaches are summed up as these: time acces... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2464478 Mon, 08 Jun 2009 19:04:31 +0100 2464478 http://www.medworm.com/index.php?rid=2463309&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F06%2F08%2Fmore-pain-sites-over-time-greater-risk-of-work-disability%2F It struck me today, as I spent a little time with two people who have been returned to Pain Management Centre for a review of their progress, that something we don’t do very well is help people distinguish between an acute or new problem and what might be a flare-up of the old chronic problem. And by ‘we’ I mean all health providers. Ok, so that the problem is there is not really so surprising – after all, helping clinicians work out that chronic pain doesn’t respond to acute pain management is quite a change of focus (from short-term cure to long-term management), but I guess I hadn’t really thought through how to help people deal with new pain problems as they arise. Let me illustrate what I mean. Gary (not his real name, and other details are also dis... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2463309 Mon, 08 Jun 2009 04:42:58 +0100 2463309 http://www.medworm.com/index.php?rid=2774804&cid=t_103331_130_f&fid=38947&url=http%3A%2F%2Frealpt.blogspot.com%2F2009%2F06%2Fif-we-know-we-shouldntwhy-do-we-still.html Ihave posted several articles on the overuse of imaging in musculoskeletal care (find them here, here, here, and here). Now we have another study from the Archives of Internal Medicine making not only that statement but going as far as speculating that this is related to financial gain, improved patient satisfaction, and potential for more harm that good.In a news release from Musculoskeletal Report, the study found:Patients were more likely to undergo imaging tests if their primary care physician worked in large practices and if the doctor was offered patient satisfaction-based financial incentives. Practices with clinical quality-based incentives, however, were less likely to order advanced imaging tests for low back pain patients in the absence of clinical red flags.Additionally, the ar... Evidence Based Rehab blogs http://www.medworm.com/rss/comments.php?id=2774804 Wed, 03 Jun 2009 15:25:00 +0100 2774804 http://www.medworm.com/index.php?rid=2452542&cid=t_103331_97_f&fid=36415&url=http%3A%2F%2Fwww.dcscience.net%2F%3Fp%3D1593 Jump to follow-up The first post was NICE falls for Bait and Switch by acupuncturists and chiropractors: it has let down the public and itself. That was followed by NICE fiasco, part 2. Rawlins should withdraw guidance and start again. Since then, something of a maelstrom has engulfed NICE, so it’s time for an update. It isn’t only those who are appalled that NHS should endorse voodoo medicine on the basis of very slim evidence who are asking NICE to rethink their guidance on low back pain. Pain specialists are up in arms too, and have even started a blog, ‘Not Nearly as NICE as you think …‘, to express their views. Equally adverse opinions are being expressed in the Britsh Medical Journal. A letter there is signed by over 50 specialists in pain medicine. It ... DC's Improbable Science blogs http://www.medworm.com/rss/comments.php?id=2452542 Wed, 03 Jun 2009 07:20:28 +0100 2452542 http://www.medworm.com/index.php?rid=2442238&cid=t_103331_130_f&fid=34938&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEvidenceInMotion%2F%7E3%2FXvD5Y7tlV_I%2Fimplementing-evidence.html  A policy change to clearly outline defined care, based on some level of evidence, should be viewed positively.  I'm completely horrible with geography, but I believe the United Kingdom began an initial step toward defining the care options for people with low back pain this month.  It is a bit difficult for me to easily understand politics or the medical systems in other countries, but this change did appear to have reasonable evidence to support the options for care.The next day, crap hit the fan.  The public had its own perception.  Since painkilling jabs (routine facet joint injections) were not included in the options for care, this was interpreted as cutting corners and costs.  Granted, sure, costs were being cut but the rationale was because of the lack of cost effectiveness.... MyPhysicalTherapySpace.com blogs http://www.medworm.com/rss/comments.php?id=2442238 Fri, 29 May 2009 19:57:16 +0100 2442238 http://www.medworm.com/index.php?rid=2441449&cid=t_103331_97_f&fid=36415&url=http%3A%2F%2Fwww.dcscience.net%2F%3Fp%3D1542 Conclusions Relative to “best care” in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months. In other words, none of them worked very well. The paper failed to distinguish between manipulation by physiotherapists, chiropractors and osteopaths and so missed a valuable chance to find out whether there is an advantage to employing people from alternative medicine (the very problem that this NICE guidance should have dealt with) Steve Vogel, another member of the guidance development group, is an osteopath. Osteopathy has cast off it... DC's Improbable Science blogs http://www.medworm.com/rss/comments.php?id=2441449 Fri, 29 May 2009 18:09:14 +0100 2441449 http://www.medworm.com/index.php?rid=2442920&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F28%2Fthe-gap-between-pain-management-and-returning-to-work%2F One of the most satisfying experiences I have in my job is seeing someone who has been off work for ages finally return to work.  It’s like seeing the person open up and bloom again.  I often see people who have been off work for several years – most of them don’t have jobs to return to, and most of them have experienced a couple of attempts to return to work that have, for some reason or another, failed.  Often pain is given the blame for this, and the remedy is thought to be ‘develop pain management skills’ – and I guess in part that’s true.  But not completely. There is a difference between using pain management skills at home, where for the most part, activities can be picked up and put down as needed, and at work where other demands are pr... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2442920 Wed, 27 May 2009 20:58:01 +0100 2442920 http://www.medworm.com/index.php?rid=2442922&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F26%2Fovercoming-pain-david-halls-new-book%2F Every now and then you run into someone who makes a real impact on you – Dave’s one of those people.  I met him in Sydney at the International Association for the Study of Pain World Congress in 2005 (take a look here at the information on the next one), and we’ve intermittently kept in touch by email ever since.  David is one of these almost relentlessly energetic people – he looks fit, healthy and balanced.  You’d never guess that he’s experienced chronic neck pain and has had to learn how to become ‘CAPABLE’ so he can live this good life. His book (and pain management programme by the same name) is called Overcoming Pain, and it’s available from his website at the very reasonable price of Aus$25 + postage.  It’s all about t... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2442922 Tue, 26 May 2009 08:14:51 +0100 2442922 http://www.medworm.com/index.php?rid=2441450&cid=t_103331_97_f&fid=36415&url=http%3A%2F%2Fwww.dcscience.net%2F%3Fp%3D1516 First the MHRA lets down the public by allowing deceptive labelling of sugar pills (see here, and this this blog). Now it is the turn of NICE to betray its own principles. The National Institute for Health and Clinical Excellence (NICE) describes its job thus “NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health.” Its Guidance document on Low Back Pain will be published on Wednesday 27 May 2009, but the newspapers have already started to comment, presumably on the assumption that it will have changed little from the Draft Guidance of September 2008. These comments may have to be changed as soon as the final version becomes available. The draft guidance, though mostly sensible, has two re... DC's Improbable Science blogs http://www.medworm.com/rss/comments.php?id=2441450 Mon, 25 May 2009 15:24:25 +0100 2441450 http://www.medworm.com/index.php?rid=2774806&cid=t_103331_130_f&fid=38947&url=http%3A%2F%2Frealpt.blogspot.com%2F2009%2F05%2Fmore-evidence-of-acupunctures-lack-of.html Acupuncture (sticking needles at specific points to a certain depth in the skin) is not an effective treatment for chronic low back pain. This may sound surprising as the media has jumped all over a new study that supposedly shows that acupuncture is more effective than "usual care". Unfortunately - as the media usually does - they've misinterpreted the results of the study. In fact the study showed that there is no difference in the effectiveness between "fake" and "real" acupuncture. Meaning, there is no effect of acupuncture.Steven Novella over at Science-based Medicine does a masterful job of explaining this in detail. Please visit his post on this study to become enlightened by logical and scientifically based thoughts and discussion - as opposed to hype.Jason L. Harris (Source: Evide... Evidence Based Rehab blogs http://www.medworm.com/rss/comments.php?id=2774806 Wed, 20 May 2009 16:13:00 +0100 2774806 http://www.medworm.com/index.php?rid=2405513&cid=t_103331_111_f&fid=36048&url=http%3A%2F%2Ffeeds.b5media.com%2F%7Er%2Fb5media%2FAHeartyLife%2F%7E3%2FfuoTx3qWJCU%2F Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root. Let’s see if this makes any difference to those of us who know how painful life is with a painful lower back. ~~~~ Image: iStock.com Share and Enjoy: Post from: Blisstree New Guidelines to Treat Low Back Pain (Source: A Hearty Life) A Hearty Life blogs http://www.medworm.com/rss/comments.php?id=2405513 Thu, 14 May 2009 01:54:50 +0100 2405513 http://www.medworm.com/index.php?rid=2406267&cid=t_103331_165_f&fid=37959&url=http%3A%2F%2Fhealthskills.wordpress.com%2F2009%2F05%2F14%2Ftalking-about-psychosocial-issues%2F A couple of days ago I wrote about how to raise psychosocial issues with someone who has pain, hopefully without that person thinking you’re saying it’s ‘all in your head’. I thought today I’d cover some more about ways to find out about psychosocial factors, with some simple questions you can reword to fit your style. My first point is repeated from last time – it’s not about ’cause’ and trying to identify whether psychosocial factors are ‘causing’ the pain problem. Not only is this unhelpful because often the patient is very sensitive to any suggestion that they’re ‘not coping’ or ‘making the most of it’ or even ‘faking’, it’s also not accurate.  Most pain problems do start ... HealthSkills Weblog blogs http://www.medworm.com/rss/comments.php?id=2406267 Wed, 13 May 2009 19:23:29 +0100 2406267 http://www.medworm.com/index.php?rid=2405801&cid=t_103331_130_f&fid=34938&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEvidenceInMotion%2F%7E3%2F8C8fvXhHRGY%2Flights-camera-action.html News... is it all about being IN the news or CREATING the news?  I suppose it depends on the content of the news.I was completely impressed with a string of articles Google Alert fed me last week.  A reporter for Deseret News focused some health articles on low back pain, incontinence and physical therapists.  The "series" all started on May 7th with the topic for Saturday's Deseret News/Intermountain Healthcare Hotline.  This wasn't just a lone announcement.  There was also an article published about incontinence and low back pain.  The news didn't stop there... on May 8th there was another article published about low back pain.  Amazingly, another article about chronic back pain and physical therapists was published on May 9th!  It won't be ending there either.  On the 15th an... MyPhysicalTherapySpace.com blogs http://www.medworm.com/rss/comments.php?id=2405801 Wed, 13 May 2009 17:40:16 +0100 2405801