Wednesday, August 23, 2017

When Chronic Pain Is Not “Chronic Pain”: Lessons From 3 Decades of Pain.

Illustration of pain perception. Education, patient experience, patient satisfaction, patient education.

The current move in physical therapy toward the biopsychosocial management of chronic pain has led some interpreters to call for a less hands-on approach, as awareness of central sensitization leads to specific management trends and a move away from pathoanatomical considerations. The authors of this Viewpoint suggest that no approach, no matter how vocal and evangelistic its followers, would likely be any more certain than what preceded it. This Viewpoint poses the question, why, when we (as a profession) appear (according to the new physical therapy gurus) to have been so wrong before, do we appear to believe that we are right this time?

Compression Wrapping Shoulder Mobilization

A great way to mobilize a frozen or very peripherally sensitive shoulder is to use compression wrapping. In this video, taken from IASTM Technique 2.0 - I show how to use an EDGE Mobility Band to reduce perception of stretch and improve mobility rapidly without discomfort.

Compression Wrapping Shoulder Mobilization

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  • lectures
  • integration with your existing toolbox like neurodynamics, joint mobilization and more!
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The sale ends Sunday Aug 27 at midnight EST. Click below to learn and save!

Keeping it Eclectic...

WCPT Warns Against Predatory Journals & Events

WCPT has urged physical therapists to be vigilant against unsolicited emails featuring publication promises and speaking invitations, usually with excessive fees attached.
Publishing research and presenting at conferences are essential parts of high-quality scholarly exchange and education, but an increasing number of commercial journals and events are targeting health professionals. Awareness of ‘predatory’ journals and events is rising but physical therapists are reminded to scrutinise and reject approaches from unofficial journals and commercial conferences promising high-profile opportunities.
“It is an unfortunate reality that legitimate publishers and event organisers – such as WCPT and our Member Organisations – are finding themselves being copied and mimicked by rogue operators,” says WCPT Chief Executive Officer Jonathon Kruger.
Predatory journals often use spam emails to ask for contributions from a range of researchers and academics including physical therapists. They promise quick and prestigious publication, but do not offer the traditional services provided by reputable publishers, such as peer-review, editing, archiving and marketing. International events associated with predatory publishers are often held at the same times or close to legitimate events in attractive locations across North America, Western Europe, Japan and China. Conferences have been promoted with detailed programmes, but have been proven to use speaker biographies and photographs without permission, confirmation or prior contact.
South African dietician Elizabeth Fourie believes she was tricked into attending the two-day ‘11th Obesity and Endocrinology Congress’ in Australia, alleging that advertised speakers were absent, that research was not properly scrutinized, and that many papers had limited relevance to the theme. The scale of predatory journals, events and emails has recently increased, with some academics reporting that they are being spammed on a daily basis. Predatory conferences are now sadly considered ‘a cottage industry in scientific communication’ which exploits researchers and the need to publish and present at official, reputable events.
Junior researchers, academics and professionals who do not speak English as their first language are considered especially vulnerable, and are reminded that low-quality publications and events pose a threat to credibility, long-term professional standing and overall quality of care.

List of Predatory Journals

Tuesday, August 22, 2017

Non-pharmacological self-management for people living with migraine or tension-type headache: a systematic review

The objective of this study was to assess the effect of non-pharmacological self-management interventions against usual care, and to explore different components and delivery methods within those interventions. This was achieve through a systematic review of articles including people living with migraine and/or tension-type headache, and the impact of  non-pharmacological educational or psychological self-management interventions; excluding biofeedback and physical therapy.

The authors found a small overall effect for the superiority of self-management interventions over usual care, with a standardised mean difference (SMD) of −0.36 (−0.45 to −0.26) for pain intensity; −0.32 (−0.42 to −0.22) for headache-related disability, 0.32 (0.20 to 0.45) for quality of life and a moderate effect on mood (SMD=0.53 (−0.66 to −0.40)). We did not find an effect on headache frequency (SMD=−0.07 (−0.22 to 0.08)).

Assessment of components and characteristics suggests a larger effect on pain intensity in interventions that included explicit educational components (−0.51 (−0.68 to −0.34) vs −0.28 (−0.40 to −0.16)); mindfulness components (−0.50 (−0.82 to −0.18) vs 0.34 (−0.44 to −0.24)) and in interventions delivered in groups vs one-to-one delivery (0.56 (−0.72 to −0.40) vs −0.39 (−0.52 to −0.27)) and larger effects on mood in interventions including a cognitive–behavioural therapy (CBT) component with an SMD of −0.72 (−0.93 to −0.51) compared with those without CBT −0.41 (−0.58 to −0.24).

Overall the authors found that self-management interventions for migraine and tension-type headache are more effective than usual care in reducing pain intensity, mood and headache-related disability, but have no effect on headache frequency. Preliminary findings also suggest that including CBT, mindfulness and educational components in interventions, and delivery in groups may increase effectiveness.

Pain experiences of patients with musculoskeletal pain + central sensitization: A comparative Group Delphi Study.

Central sensitization (CS) is regarded as an important contributing factor for chronification of musculoskeletal pain (MSP). It is crucial to identify CS, as targeted multimodal treatment may be indicated. The primary objective of this study was therefore to explore pain experience of individuals with MSP+CS in order to gain a better understanding of symptoms in relation to CS from a patient perspective. The secondary objective was to investigate whether pain experiences of patients with MSP+CS differ from those of individuals with neuropathic pain (NP).

The authors conducted a comparative Group Delphi Study including patients with MSP+CS and neuropathic pain (NP). 13 guiding questions were used to gather information about sensory discriminatory, affective and associated bodily, mental and emotional phenomena related to the pain experience of patients. Descriptions were categorized using qualitative content analysis. Additionally, patients completed several pain related questionnaires.

Nine participants with MSP+CS and nine participants with NP participated. The Delphi procedure revealed three main themes: psycho-emotional factors, bodily factors and environmental factors. Descriptions of patients with MSP+CS showed a complex picture, psycho-emotional factors seem to have a considerable impact on pain provocation, aggravation and relief. Impairments associated with mental ability and psyche affected many aspects of daily life. In contrast, descriptions of patients with NP revealed a rather mechanistic and bodily oriented pain experience.

Patients with MSP+CS reported distinct features in relation to their pain that were not captured with current questionnaires. Insight in patient’s pain experience may help to choose and develop appropriate diagnostic instruments.

New Avenue for Parkinson’s Research?

In recent years the diabetes drug Exenatide had been a potential avenue for the management of Parkinson’s disease. Due to the small scale nature of previous initial investigations, larger studies were needed to demonstrate a proof of concept, and allow the potential treatment to progress to the next level. Now that has happened.

Dr Folynie, his team and esteemed colleagues, have published the results of the first ever randomised, placebo-controlled trial of exenatide as a potential disease-modifying drug in Parkinson’s disease. The study has been published in the Lancet and is titled “Exenatide once weekly versus placebo in Parkinson’s disease: a randomised, double-blind, placebo-controlled trial“. The study was a success as the team replicated the results of the initial, smaller scale clinical studies. The patients with Parkinson’s disease who were given exenatide had improvements in their off-medication motor scores.

It is still unclear if the drug affects the progression of the disease or if it simply offers symptomatic relief. This will be the direction of future investigation. For now, the drug remains unlicensed for the treatment of PD however it looks promising that this may change in the future.

[WEBINAR SPOTS STILL LEFT] Start a PT Practice Without Debt

When I was starting my own Cash Based PT Practice, I reached out to my good friend and colleague, Dr. Aaron LeBauer. He is my go to authority for all things #CashPT. We teamed up for the latest MMT Webinar scheduled for Aug 30th 8:30 pm EST.

What you're going to learn:
  • 3 Secrets to Creating Your Cash-Based Practice for Less Than $5,000
  • The Free & Low Cost Way to Get Started Building The Practice of Your Dreams
  • Why You Don't EVER Need to a Loan or Borrow Money... Again!
  • The EASY Way to Build a Successful Cash-Based Practice
  • How to Market and Fill Your Practice with Cash Paying Patients for Free
  • How You Can Escape Working 9-5 & Feeling Like You're Always Justifying Treatments
  • What is Possible for You in the Cash-Based Model.
  • Live Q&A: There will be time at the end for your questions.

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Keeping it Eclectic...