In this episode, Sandy and Cory take a look at this popular publication from 2019 proposing an "Enactive Approach" to pain. There's a lot to cover in this paper as it takes us through a history of pain science up to the Biopsychosocial model at which point it proceeds to point out some flaws in the model. GASP! Take a listen as the discussion unfolds. An enactive approach to pain: beyond the biopsychosocial model. Peter Stilwell & Katherine Harman. Phenomenology and the Cognitive Sciences. 18, pages637–665(2019). doi: 10.1007/s11097-019-09624-7. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade

Pain Science and Sensibility

052 Beyond the BPS Model?

The gang is all here (except Greg) for another festive dump of holiday cheer! Happy Holidays everyone!!!

2020 PT Podcast Network Holiday Extravaganza

Pain flare-ups are one of the most frustrating things for patients and clinicians alike. Are they normal? Who gets them? Why is it important to know their prevalence? What are Sandy and Cory's thoughts on dealing with them?  All this and more in episode 50! Prevalence, Severity, and Correlates of Pain Flares in Response to a Repeated Sit-to-Stand Activity: A Cross-sectional Study of 14 902 Patients With Knee and Hip Osteoarthritis in Primary Care. Søren T Skou, Dorte T Grønne, Ewa M Roos. J Orthop Sports Phys Ther. 2020 Jun;50(6):309-318. doi: 10.2519/jospt.2019.9125. Epub 2019 Sep 6. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade

050 Pain Flare-Up

We are joined in this episode by Professor Lorimer Moseley AO for a casual chat about pain. Lorimer gave us his thoughts on recent and future clinical research and the translation of the evidence into the clinic.  Is there an expiration date for recovery from persistent pain? How can we enhance learning the things that matter? Was it a mistake to think that we could/should explain pain? Does Sandy work pelvic health examples into this conversation? Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade

049 Contemplating Possibilities and the Impermanence of Pain

 Do you use SI joint tests? What type of information do the tests give you? Should you be using them? These are just a few of the questions that arise in the discussion of this recent perspective paper. Join us for episode 48! Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Palsson TS, Gibson W, Darlow B, et al. Phys Ther. 2019;99(11):1511-1519. doi:10.1093/ptj/pzz108 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

048 The SI Joint Narrative

 Is it safe to exercise and lift heavy things for people with pelvic organ prolapse symptoms? Or put more bluntly, will lifting heavy weights make your lady bits fall out? Is lifting weight asking for trouble? That is the question that our guest this month is seeking to answer and Sandy and Cory sit down to ask some questions about her recently published cross sectional study that is a start to this research. There are some important implications of this and potentially some misconceptions that are driving current approaches. Please listen as we are joined by physiotherapist and PhD candidate, Lori Forner for this episode of Pain Science and Sensibility. Symptoms of pelvic organ prolapse in women who lift heavy weights for exercise: a cross-sectional survey. Forner LB, Beckman EM, Smith MD. Int Urogynecol J. 2019 Dec 7. doi: 10.1007/s00192-019-04163-w. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

047 Is It Safe For Women To Lift Heavy Things?

 These questions arise very frequently in rehabilitation. Should it hurt? Is it OK if it hurts? Will I set myself back if it hurts? Will I get better if it doesn't hurt? In this episode we examine a pair of articles that examine these questions. One article is an RCT that covers pain free vs. painful exercise in an acutely injured population, while the other is a systematic review and meta analysis of the approach in chronic pain populations. Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. Hickey JT, Timmins RG, Maniar N, Rio E, Hickey PF, Pitcher CA, Williams MD, Opar DA. J Orthop Sports Phys Ther. 2020 Feb;50(2):91-103. doi: 10.2519/jospt.2020.8895. Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis. Smith BE, Hendrick P, Smith TO, Bateman M, Moffatt F, Rathleff MS, Selfe J, Logan P. Br J Sports Med. 2017 Dec;51(23):1679-1687. doi: 10.1136/bjsports-2016-097383. Epub 2017 Jun 8. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

046 Is There an Advantage to Pain Free Rehab?

 A recent Cochrane review looked at studies of people with rotator cuff tears comparing those who had surgery with those who did not. What do you think they found? Did surgery provide benefit? Is it OK to go without surgery in these cases? Sandy and Cory discuss these findings and provide their clinical commentary in this episode of Pain Science and Sensibility. Surgery for rotator cuff tears. Karjalainen TV, Jain NB, Heikkinen J, Johnston RV, Page CM, Buchbinder R. Cochrane Database Syst Rev. 2019 Dec 9;12:CD013502. doi: 10.1002/14651858.CD013502. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

045 A Review of Surgery for Rotator Cuff Tears

This episode covers a recent paper that compares a popular and trending approach, Cognitive Functional Therapy, against a group treatment and exercise intervention. The primary outcomes were pain and disability. The results may surprise you. Join Sandy and Cory as they discuss the findings, what to make of them, and the clinical impact. Cognitive functional therapy compared with a group-based exercise and education intervention for chronic low back pain: a multicentre randomised controlled trial (RCT). O'Keeffe M, O'Sullivan P, Purtill H, Bargary N, O'Sullivan K. Br J Sports Med. 2019 Oct 19. pii: bjsports-2019-100780. doi: 10.1136/bjsports-2019-100780. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade

044 Cognitive Functional Therapy Vs. Group Therapy Plus Education

 In the last episode (42) a systematic review was discussed regarding the value of pre-operative measures in predicting pain post-operatively. In this episode, Dr. Henrik Vaegter, an author of that review joins us to discuss that research as well as several other fascinating topics regarding exercise and pain. In this interview we discuss topics of Exercise Induced Hypoalgesia, Conditioned Pain Modulation, and Temporal Summation of Pain, all of which are among the focus of Dr. Vaegter's research. What do the findings in these phenomenon tell us about how we should or should not address exercise in our patients with pain? Tune it to episode 43 for a very informative discussion! Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review. Sangesland A, Støren C, Vaegter HB. Scand J Pain. 2017 Apr;15:44-52. doi: 10.1016/j.sjpain.2016.12.002. Epub 2016 Dec 19. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

043 An Interview with Dr Henrik Vaegter

 In this episode Sandy and Cory discuss a systematic review which investigated what pre operative pain tells us about a person’s propensity for post operative pain. Is it predictive? If so, would changing it matter? The discussion gets into these topics and more. Are preoperative experimental pain assessments correlated with clinical pain outcomes after surgery? A systematic review. Sangesland A, Støren C, Vaegter HB. Scand J Pain. 2017 Apr;15:44-52. doi: 10.1016/j.sjpain.2016.12.002. Epub 2016 Dec 19. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

042 Does Preop Pain Predict Postop Pain?

 This study looked at pain score associations between people with "typical" and "atypical" bedtimes. Sandy and Cory discuss the topic of sleep and pain broadly as well. So, perk up and see if you can make through this episode without dozing off. Does bedtime matter among patients with chronic pain? A longitudinal comparison study. McHugh RK, Edwards R, Ross E, Jamison R. PAIN Reports. May/June 2019 - Volume 4 - Issue 3 - p e747. doi: 10.1097/PR9.0000000000000747. We also discussed this paper: Effects of sleep changes on pain-related health outcomes in the general population: A systematic review of longitudinal studies with exploratory meta-analysis. Afolalu EF, Ramlee F, Tang NKY. Sleep Med Rev. 2018 Jun;39:82-97. doi: 10.1016/j.smrv.2017.08.001. Epub 2017 Aug 18. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

041 Bedtimes and Pain: Can You Sleep It Off?

 In this month's episode we are examining more of a general health question. But it is one that is very relevant to people in pain. Much has been made of "Sitting is the new smoking" with some indications that the negative effects of sitting may not be able to be undone with exercise and activity. This study looked at that concept in particular. Join us for Episode 40. Sitting Time, Physical Activity, and Risk of Mortality in Adults. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. J Am Coll Cardiol. 2019 Apr 30;73(16):2062-2072. doi: 10.1016/j.jacc.2019.02.031. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

040 Does Activity Counteract Sitting?

 This paper, with results that many find very surprising, has started a bit of a buzz in the PT world. What do we make of the results? Can we trust the results? What does this mean in clinical practice? We were able to discuss these topics and more with the researchers themselves as Adrian Traeger and James McAuley were kind enough to share their time and help us navigate these new findings. Don't miss this episode! Effect of Intensive Patient Education vs Placebo Patient Education on Outcomes in Patients With Acute Low Back Pain: A Randomized Clinical Trial. Traeger AC, Lee H, Hübscher M, Skinner IW, Moseley GL, Nicholas MK, Henschke N, Refshauge KM, Blyth FM, Main CJ, Hush JM, Lo S, McAuley JH. JAMA Neurol. 2018 Nov 5. doi: 10.1001/jamaneurol.2018.3376. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

039 Pain Education in Low Back Pain

 Research on chronic pain tends to aim at identifying factors that are in deficit, or are the so called "risk factors" for those who develops chronic pain. In this episode, we discuss a paper that takes a different angle in looking at what factors do those people who are successfully living well with chronic pain share. The primary author is friend of the show, Bronnie Thompson, who has made guest appearances in previous episodes. Living well with chronic pain: a classical grounded theory. Lennox Thompson B, Gage J, Kirk R. Disabil Rehabil. 2019 Jan 11:1-12. doi: 10.1080/09638288.2018.1517195. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade 

038 Living Well with Chronic Pain

Join co-hosts Sandy Hilton and Cory Blickenstaff, physical therapists who are "in the trenches" practicing in unique settings on opposite sides of United States, as they discuss current research and topics of pain science. Listen in on occasional interviews of the prominent figures of pain science. Focus will be on making the information meaningful to practice in the clinic.

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Pain Science and Sensibility

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