Pain And Perception

I read an interesting article in BBC News Health a couple of weeks ago. It reviewed 2 recent studies on pain. The first was published in The Journal of Pain by Atsuo Yoshino et al. Subjects were shocked with an electric current whilst they were shown pictures of sad, happy or neutral faces. Photos of an emotional face usually provoke the same emotional response in the person viewing the picture. Although the electrical stimulation was the same in all cases, subjects felt more pain when looking at sad faces.

The second study was conducted by Marion Hofle et al. in Pain. The researchers asked the subjects to place one of their hands under a screen. On the screen, they played a video of a hand being pricked by a needle, poked by a cotton bud or just left alone. The subjects perceived the hand on the screen as their own.  A painful or non-painful stimuli was applied simultaneously to the video. Viewing the needle prick increased the unpleasantness ratings of the stimulus.

As these studies have shown, negative emotional states and negative expectation seem to increase pain and so the mind plays an important role in the experience of pain. As a physiotherapist, dealing with pain is a daily occurrence and I can remember qualifying as an acupuncturist over 10 years ago…I was desperately keen to use my new skill on anyone that was willing to try and worked hard at convincing anyone that was hesitant to try! With those that were initially hesistant…possibly due to a slight needle aversion, I quickly noticed their exaggerated responses to acupuncture. I can remember several occasions when I would gently touch them with a finger or with the plastic guide tube that surrounds the needle and they would jump and shout “ouch”…to which I would reply “relax, we haven’t started yet!” I’ve now learnt from those experiences and no longer feel the need to convince everyone to have acupuncture…no matter how great I think it is!

John Milton was right in Paradise Lost…“The mind is its own place, and in itself can make a heaven of hell, a hell of heaven.”

An Integrated Approach To Low Back Pain Improves Results

An article in Medical News Today reviews a study in The Journal of Alternative and Complementary Medicine on the treatment of low back pain. A combined program of complementary and conventional therapies was found to be more helpful than the usual care provided by the primary care physician. The benefits of the program were a decrease in pain and an improvement in function. The complementary therapies provided included physiotherapy, acupuncture, massage, mind-body techniques, chiropractic and nutritional advice. Healing in Motion in St Albans aims to treat musculoskeletal disorders using a holistic, integrated approach.

Metal On Metal Total Hip Replacements Unsafe?

A BBC Newsnight and British Medical Journal investigation has prompted a lot of discussion regarding metal on metal total hip replacements. Lately, a study has found that the metal components rub against each other causing small particles to break away into surrounding tissues. This leads to elevated blood levels of metal ions such as cobalt and chromium. The clinical significance of this is still unknown. The Medicines and Healthcare products Regulatory Agency (MHRA) have stated that annual blood tests should be conducted to check levels of cobalt and chromium. If levels are high, an MRI scan should be carried out to see if the prosthesis requires revision.

A recent technology overview conducted by the American Academy of Orthopaedic Surgeons (AAOS) has concluded that metal on metal implants are at greater risk of revision than replacements with different bearing surface combinations. This has come as a bit of a surprise as it was hoped that sturdy metal on metal implants would outlast metal on plastic implants. It was also noted that larger femoral head components are at higher risk than smaller ones and older patients also incur a greater likelihood of requiring another operation.

A previous technology review had found that hip resurfacing is more likely to need revising than total hip arthroplasties (THA). The size of the head is inversely related to the risk of revision. However, the Australian registry has suggested that younger men have less risk of revision with resurfacing than they do with THAs. This is interesting because research published in this month’s The Journal of Bone & Joint Surgery (British Volume) shows that the 10 year survival rate for a Birmingham hip resurfacing (BHR) is 89.1% for women and 97.5% for men. Mr AJ Shimmin et al. conclude that “BHR provides good functional outcome and durability for men, at a mean follow-up of ten years. We are now reluctant to undertake hip resurfacing in women with this implant”.

All this definitely provides food for thought and it’s well worth doing some research and having a long chat with your surgeon before deciding what sort of hip prosthesis to have.

Acupuncture Awareness Week

This week the British Acupuncture Council is launching the very first Acupuncture Awareness Week and their website is full of useful information. Of all the treatments I use, acupuncture is by far the one that most clients are curious about. Acupuncture has been used in China for over 2000 years. Fine needles are inserted into the skin to stimulate the body. Obviously, the needles are sterile and disposed of after use. Acupuncture can help with all sorts of muscle or joint pains like back pain for instance. The most common question is; how does it work? Let’s use back pain as an example (the following information was provided by the British Acupuncture Council).

"Acupuncture can help back pain by:

• Providing pain relief - by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Zhao 2008).
• Reducing inflammation - by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007;Zijlstra 2003).
• Improving muscle stiffness and joint mobility - by increasing local microcirculation (Komori 2009), which aids dispersal of swelling and bruising.
• Reducing the use of medication for back complaints (Thomas 2006).
• Providing a more cost-effective treatment over a longer period of time (Radcliffe 2006;Witt 2006).
• Improving the outcome when added to conventional treatments such as rehabilitation exercises (Ammendolia 2008; Yuan 2008)."
• Releasing tight bands in muscles

Following research into the effects of acupuncture on low back pain, the National Institute for Health and Clinical Excellence (NICE) now recommend that GPs offer a course of 10 sessions of acupuncture as a first line treatment for persistent, non-specific low back pain.

Hypermobile Sportsmen Are More Injury Prone

Hypermobility can simply be described as joints bending and stretching further than normal. For instance, knees or elbows that bend backwards, a little finger that can bend backwards past 90 degrees, a thumb that can be bent to touch the forearm, etc.

An article in Reuters has summarised research that proves that hypermobile sportsmen are more prone to injury. Not only are they more likely to get injured but the injuries they sustain tend to be more serious. This could be due to a mix of factors such as weaker ligaments and soft tissue, and to poor joint positioning.

The likelihood of injury could be remedied by working on joint positional awareness and by muscle strengthening and coordination exercises to support the joints.

Acupuncture Helps Reduce Stress

An article in today’s Mail Online reviews research carried out on the effects of acupuncture on stressed rats. The results show that acupuncture can reduce the levels of a protein linked to stress. Apparently this is the first study to show molecular proof of the benefit of acupuncture on stress.

Exercise Encourages Healthy Eating

Researchers have recently postulated that exercise may help encourage healthy eating! How? By changing the structure and function of the brain! The result of which is an enhanced inhibitory control. What this means in layman’s terms is that we no longer have to succumb to the temptation or lack of restraint that causes our over indulgence in food.

So, in addition to increasing our metabolism and burning more calories, exercise also improves our diet. What are you waiting for?

Yoga and Stretching Ease Back Pain

Something I read with interest in the news this week. A large randomised controlled trial in the US has shown that both yoga and stretching can lead to better function and decreased symptoms from chronic low back pain. Although this was no surprise to me, it’s always good to have evidence to back up our practice…I believe they call it evidence based practice…

 If you would like to read the entire article, please follow the link below:

Largest US Yoga Study to Date Finds Yoga Eases Back Pain