RichardMcIlmoyle,DC

@thomaskffmn @GregLehman In any trial of an intervention it’s typically the mean that’s reported. There are some that respond, some that get worse. Same in practice. The research with interventions should really guide what we try first, or do what has worked in the past for that person.

@GregLehman Hard to believe some research when people’s experiences are so different than what the research says.

Good luck Zach. Manual therapy is often considered “low value” care and doesn’t get recommended in our systematic reviews. Yet, we often see it helping many on an individual level. We need to reconcile this

@camtudor @DrZoffness 2/2 understanding that the pain experience is ALWAYS influenced by multiple factors is the important part. Which would also lead us down the road of how much suffering is linked to your pain experience. The hangover will likely cause you greater suffering in different contexts

@camtudor @DrZoffness I think what’s missing in the exploit the pain experience is that the physiological trigger of nociception is interpreted through a Biopsychosocial lens. The BPS framework is for the clinician, not the patient. The goal of the interaction is to make sense of their experience. 1/2

My headache after 5 tequila shots and a dodgy kebab isn’t because I’m unemployed and need my dad to be proud of me. Pain science is losing its way in its clinical application because of a tendency amongst its keenest academic proponents to insist that pain is ALWAYS biopsychosocial. Yes, but the weighting of its component parts (bio/psych/social) varies enormously and is largely indeterminate at the clinical level. It can range from significant to irrelevant. To broadcast that ALL pain is ALWAYS biopsychosocial is to infer a sense of certainty that we don’t have. It may be a valid model to fuel interdisciplinary debate. But for many patients it simply doesn’t align with their experience. Just because a patient has chronic knee pain doesn’t mean we should jump to “explain their pain” as being largely driven by their depression, fear of the scan, stress, or lack of exercise. Pain is hard. We should be humble and recognise how much we don’t know. Claiming with certainty that we understand it doesn’t reflect the reality of our current knowledge.

⏰ Happening NOW in the Wildrose Ballroom: Rising Tides: Collaborative Learning, Care Planning and Treatment Lifts Us All with @maleablemind at #PainAB2024.

Meet our extraordinary speakers at the 18th Annual Conference! 🎤✨ ⁠⁠Secure your spot at painab.ca/annualconferen…. ⁠⁠#PainAB2024 #PainSocietyofAlberta @maleablemind @suesobeyfawcett @JasonWBusse @MargieMcNeely @Linda_E_Carlson @ElenaLopatin @drivonnehernan @DrAlbino

@Retlouping 😆😆😆

McKenzie exercises trying put disc herniations back in the disc 😂

Orthopedic Truths: Part 3 Labral "tears" of the shoulder are incredibly common. Especially superior or SLAP tears. If you're over 40-50, odds are that you have one. It's rarely the cause of pain. They're not even tears per se. The easiest way to find an excuse to operate on a shoulder in adults is to get an MRI. Labral tears in adults are usually just age-appropriate changes. Do not assume it is the cause of your pain. Labral tears in kids are different animals. Adults are not kids... even though they may act like them ;-). There are different types of labral tears. All the above assumes no recent dislocation due to trauma. Adults can still get traumatic anterior or posterior labral tears that result in instability- or dislocations. There is a good reason to fix those tears if the shoulder remains unstable. Superior or SLAP "tears" do not cause gross instability in adults. I don't even like the phrase tears here. "Tearing" implies trauma or injury. Age-appropriate changes are just that. A few SLAP tears now and then in adults might, repeat, might hurt... An adult might occasionally want surgery for a superior labral tear, but this should be a very rare event. The vast majority of the time, it is not the cause of your pain. When fixing a rotator cuff tear in an adult, we often find superior labral "tears" and ignore them—aside from removing loose, frayed tissue. There's a reason why we ignore them. Actually repairing SLAP tears in adults is not recommended. We have alternatives if need be. Why? The tissue is of poor quality. It can lead to significant stiffness. Despite having a superior labral tear, you can continue to lift weights and play tennis or pickleball, etc. Determining the cause of pain in a shoulder can be challenging. The decision-making that goes into how to treat the many issues we see in a typical adult MRI can also be challenging. It can be challenging for you to forget or unsee your MRI result. As usual... these topics are far more complicated than they appear at face value...

In most of our previous episodes, we have had experts talk about chronic pain in adults, but what about chronic pain in children? There is a high number of children suffering from pain, but what resources are available for children? One organization is @KidsInPain (SKIP).

@tmorello @macklemore Had to put it here for y’all to see n’ hear. HIND’S HALL #FreePalestine 🇵🇸 #HandsOffRafah

@daspainbrain @head_like_egg Congratulations Dave. I was pondering the same as @sirileknes ...."early career?" 😆

What is Pain and Why Does it Matter? Early Career Award to @head_like_egg #CanadianPain24

@Tash_Stanton "obtuseness" 😆 never before seen as a symptom in a case summary. Made my morning Tash. Thanks

Differential diagnoses needed. MOI unknown. 42 year old female. No current meds. Has travelled to USA, Europe in the past 2 months, most recently Northern Territory Australia. Other symptoms: lethargy, reduced range of motion, obtuseness.

A tip for Physios from a folk singer

Are you attending the Pacific Pain Forum 2024 Conference? If not, it's time to secure your ticket - pacificpainforum.ca/register/

@Retlouping @DrJN_SportsMed 😆😆

@DrJN_SportsMed It’s levator ani innit 😂

Don’t get me started, i’m in a bad enough mood as it is

@SarahHaagPT @SandyHiltonPT @SanDiegoSummit Late night arrivals from Victoria. See you for coffee in the morning!

@SandyHiltonPT @SanDiegoSummit Also a tad bumpy coming from Chicago. Not due to weather, just an overtired toddler. 😂 See you soon!

@AsafKlaf Interested, but first curiosity is what was the reasoning for non-LBP disc herniations to be surgically repaired? Did I misread that?

Interesting new observational longitudinal study of n=300. Compared to individuals without back pain, in individuals after lumbar disc herniation, MRI findings (disc degeneration, fat infiltration and reduced cross section) ,and inflammatory biomarkers in the blood were ASSOCIATED with development of chronic pain with some large effect sizes for disc degeneration and fat infiltration (OR 1.86-2.18). This is a very good methodology, and I think if others will employ it, we will see the same kind of results over and over again. Link: sciencedirect.com/science/articl…

Amazing paper by @FadelZeidan + colleagues reporting that mindfulness REDUCES CHRONIC PAIN via non-opioidergic neurological processes🧠 TL/DR: Mindfulness can be an EFFECTIVE INTERVENTION for chronic pain (not pseudoscience). 👏😃🔥 nature.com/articles/s4138… #MedTwitter #MedEd

Knee joint distraction results in MRI cartilage thickness increase up to 10 yrs after treatment ncbi.nlm.nih.gov/pmc/articles/P… in these young end-stage knee OA patients,KJD treatment results in significant short-term cartilage regeneration in the MAC, effects still be seen after 10yrs

@GregLehman @bretcontreras Enjoyed listening to it!

First Movement Optimism Podcast just dropped this morning with guest Bret Contreras (@bretcontreras ). Get it where you get your podcasts!