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West 12 Health Centre
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For all joint & muscle pains, fibromyalgia, arthritis, rheumatic pain, frozen shoulder & headache. Also Clinical Pilates & Personal Training
For all joint & muscle pains, fibromyalgia, arthritis, rheumatic pain, frozen shoulder & headache. Also Clinical Pilates & Personal Training

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They found strong evidence regarding the following management approaches:

1. Nonnarcotic medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) improve short-term pain, function, or both.

2. Corticosteroid injections provide short-term improvements in function and pain.

3. Hyaluronic acid injections are no better than placebo for improving function, stiffness, and pain.

4. Physical therapy improves function and decreases pain in mild to moderate hip osteoarthritis.

And moderate strength evidence for the following:

1. Postoperative physical therapy improves early function more than no physical therapy.

2. Glucosamine sulfate is no better than placebo for improving function, reducing stiffness, and decreasing pain.

3. Practitioners may use intravenous or topical tranexamic acid to reduce blood loss associated with total hip replacement surgery.

4. No clinically significant differences in patient-oriented outcomes for anterior vs posterior approaches in total hip replacement.

From Dr. Derek Griffin Physiotherapy

What key messages should we be giving to patients with pain. Here are some ideas from a recently published review on pain. All clinicians should read this excellent review, one of the best that I have read in a long while.

1. NOCICEPTORS HAVE A SURVEILLANCE ROLE-THEY MONITOR FOR CHANGE (THEY DO NOT CARRY "PAIN").

"The main task of nociceptors appears to be to detect and signal homeostatic threats and only when the threat requires conscious action do we feel pain".

2. PAIN IS ALWAYS REAL BUT CAN BE OVERPROTECTIVE-THE SYSTEM IS DESIGNED TO ERR ON THE SIDE OF CAUTION.

"The detector must be very sensitive; no threats should be missed, and it is better for survival with many false alarms than a few missed ones."

3. OUR INDIVIDUAL EXPERIENCES ALL HINGE ON CONTEXT.

"It is how the person perceives the total situation – including nociceptive input, other sensory inputs, social context, previous experiences, expectations, mindset, and so forth – that will determine what is learned and the subsequent pain-related behaviour"

4. WE WILL EXPERIENCE PAIN WHEN THERE IS A PERCEIVED NEED FOR PROTECTION.

"Pain is felt (the alarm bell rings) whenever a homeostatic threat is considered sufficiently serious by our bodily surveillance systems. To reach an optimal conclusion, many kinds of information must be evaluated".

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Great information from Greg Lehman regarding biomedical explanations for pain.

"Every system in your body is influences by pain. When you have pain you move
differently, you can feel tight, you can feel your bones are out of position, you might be weaker, your balance can change and how you move can change.

You've probably also been told that you have:

- bad posture
- weak glutes
- tight hips
- altered muscle firing patterns
- bones/joints out of place
- muscle knots or scar tissue
- muscles imbalances

...and you've probably done a lot of work to try to fix those things. For many people with injury and pain doing that work can be helpful. But surprisingly, many of the things that help one person can have nothing to do with the pain of another person." "Remember, pretty much every assumed dysfunction (posture, tightness, weakness) can exist in people without pain. "
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Another great post from Greg Lehman about the multidimensional nature of pain - biopsychosocial model essentially.

Pain is a response from your brain to a perceived threat.

"“Any information that convinces you and your brain that you might need protection or that increase your danger alarm can contribute to your pain. This is why we say pain i more about sensitivity than damage. Yes, damage can certainly be a factor in pain but it is not the only factor. And you don’t need damage to have ongoing pain. You and your nervous system can become sensitized. And this sensitivity can come from a number of areas in your life. Depression, anxiety, rumination, fear of movement, a low sense of control, the loss of meaningful activities or poor coping strategies are factors that might influence your sensitivity and ongoing pain.

While a number of factors can make you sensitive it also means that we have a number of ways to desensitize you. Sometimes you can address specific factors that might make you sensitive like addressing a fear of movement or changing the way in which you move. Other times, we can do general approaches that can help to get you healthier. Exercise, resuming hobbies, starting more physical activity or gonig out with your friends can be general strategies that essentially make you healthier and can help desensitize you. Ultimately, turning down that pain alarm system.”
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What manual therapy can and cannot do, by Diane Jacobs

1. You cannot change any tissue or structure (for the better) from the outside of someone else's body (if you are a manual therapist): but you can do harm

2. All pain is perception, perceived as sensation

3. We cannot measure pain, only pain behaviour.

4. There is no direct predictable correlation between degree of tissue damage and degree of pain.

5. There are no pain fibres or pathways. There are, however, lots of nociceptive-capable neurons that signal danger.

6. There are many kinds of C-fibres. Many of them are
C-tactile low threshold that signal pleasurable sensation.

7. Peripheral neurons travel inside nerves. Nerves have their own problems with being physical, and a lot of danger signalling can be because of nerve physiology, not tissue damage, even when there has been absolutely no tissue damage (tunnel syndromes).

8. “We don't treat anatomy, we treat physiology”
(David Butler 2003)

9. Nociceptors fire tonically all the time. The brain normally inhibits them at the spinal cord level, successfully, through descending modulation and local inhibition. Except when it fails to. Or when it facilitates instead of inhibits.

10. Descending modulation has to do with substances made by brainstem nuclei. (These nuclei respond to context.)

11. Our work should be to help people figure out how to help their own brains stay on top of the game; make the right stuff to send down the spinal cord to inhibit nociception, be non-nociceptive ourselves, and encourage movement, because movement helps the brain and nerves stay healthy.

12. Sensory rehabilitation should precede motor rehabilitation.

~Diane Jacobs 2016

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You cannot outrun a bad diet!

"According to The Lancet global burden of disease reports, poor diet now generates more disease than physical inactivity, alcohol and smoking combined.

In the past 30 years, as obesity has rocketed, there has been little change in physical activity levels in the Western population. This places the blame for our expanding waist lines directly on the type and amount of calories consumed. However, the obesity epidemic represents only the tip of a much larger iceberg of the adverse health consequences of poor diet."

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I was talking with a colorectal surgeon/colleague the other day who seemed somewhat dismayed by the rising colon cancer rates in young adults. See, in western medicine we are consumed with treatment. Causes tend to be evasive. So the cancer shows up and we treat it.

I am not the least bit surprised by the colon cancer rates rising. The American Institute for Cancer Research and the World Health Organization labeled red meat a class 2a carcinogen and processed meat a class 1 carcinogen. While we have decreased average red meat consumption we have increased poultry and processed meats. And the decrease is probably from rising vegetarians, but your average person (majority of people) is eating close to 1/2 pound of meat a day! Much of this meat is processed and then grilled. This changes bowel bacteria, increases TMAO, heterocyclic amines, heme iron induced oxidation, new-5-GC, Advanced Glycated End products, etc. meanwhile we average a dismally low fiber intake.

Dr. Dennis Burkitt documented that Ugandans living in London had same colon cancer rates as Anglo Saxons but in Uganda colon cancer was never seen. The difference: fiber. Huge amounts of fiber in the traditional diet kept native Ugandans free of the typical diseases of western society.

That being said, this excellent study comparing native Africans compared to Africans land caucasians living in cities, suggests that the increased colon cancer is more about avoiding the noxious contents of meat. https://www.ncbi.nlm.nih.gov/m/pubmed/10235221/

I will tell you one thing for sure, colon cancer isn't rising because of rising intake of fruits and veggies. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3045642/

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"Spinal manipulation modestly improves pain and function in acute low back pain, a new systematic review and meta-analysis has found. Results were published online April 11 in JAMA.

"The principal conclusion of this review was that SMT [spinal manipulation therapy] treatments for acute low back pain were associated with statistically significant benefit in pain and function at up to 6 weeks, that was, on average, clinically modest," lead author Paul G. Shekelle, MD, PhD, from the West Los Angeles Veterans Affairs Medical Center, California, and colleagues write.
Citing a Cochrane Review, the authors note that the amount of benefit was about the same as for nonsteroidal anti-inflammatory drugs (NSAIDs)."

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Is Paracetomol for Acute Low Back Pain and Osteoarthritis a cheap fix of a waste of resources?

"Many of us have the humble paracetamol pill in the cupboard at home, and reach for it when we experience pain. But recent research shows that paracetamol does not provide more pain relief than a placebo pill in low back pain and osteoarthritis [1].

A more detailed way of explaining this is that paracetamol does not provide extra pain relief for low back pain and osteoarthritis beyond the effects associated with taking a pill, even if the pill has no specific treatment effect that we know of (i.e. placebo). But paracetamol does not cost a lot of money and is a relatively safe medicine. So is it still worthwhile to keep some in your cupboard and take it if you have low back pain?"

"...we have an opportunity to educate patients about both the clinical and cost outcomes that say that paracetamol is no better than placebo. Indeed, because acute low back pain generally has a favourable recovery [4], the recommended first line treatment of advice and reassurance without the addition of paracetamol, should be sufficient for most patients."

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"Please hear us, the most important part of any therapeutic interaction is feeling heard. Too many people have answers for us before they even know us or our pain. We have seen the face you make when we want to tell you our stories, and the way that you want to cut us off because there’s limited time in the clinic. Remember that feeling like we’re an active participant in decision making, and that we have likes, dislikes and preferences, even in the face of pain is critical to us getting better. Listening is a skill – and one that we need to practice, not just in the clinic, but in our everyday interactions with people.

Know you can’t FIX us

Please don't say you know exactly what's wrong with us and can fix us. We've been to so many people who've made such claims, and none of them could. Tell us pain is complex and that we'll figure out the way forward TOGETHER, as equal partners. When we’re in pain, we really want to believe you, that you do have all the answers, because life gets really big and heavy when everything hurts. Disappointment hurts too. Stick with the science, help us to understand the complexity, and make sense of our stories, and we’ll all do much better in recovering from persisting pain.

Please be a Human

Pain is a human experience. As much as you can, treat me as a friend. You don’t need to “be” my friend, but compassion is sadly lacking in pain care. Pain is hard, for both the person in pain and the person trying to treat them. If we can recognize the humanity in one another we'll all be better off, on both sides of the equation."
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