PainSci summary of Taylor 2017?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★★?5-star ratings are for sentinel studies, excellent experiments with meaningful results. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
This paper tells the story of a patient who had “sciatica” for thirty-five years and was misdiagnosed many times until *finally* getting not only a definitive diagnosis but a cure. He had a narrowed artery (arterial stenosis causing “claudication,” the pain of impaired circulation). That’s it! Not even a difficult a diagnosis in the end, really. There were some pretty glaring clues there that got ignored by a lot of people who should have known better.
Not only was he misdiagnosed many times over more than three decades, he was misdiagnosed *fashionably*: that is, each misdiagnosis neatly fit a paradigm in physical therapy, better than it fit his symptoms. This carried on right up to and including the present day fascination with psychosocial factors and sensitization (which served him no better than any of the other paradigms had).
Interestingly, the patient’s belief that something ‘was actually wrong’ had remained with him throughout the journey. This, of course, had been explained away to him (more recently) by current research and evidence-based thinking on central sensitization and pain.
Just fascinating. The authors thoughtfully explore the implications of this rather shameful episode (definitely aimed at pros, some jargon, but readable enough for anyone — and behind a paywall, unfortunately). The bottom line? *Good diagnostic skills are never out of fashion.* Or shouldn’t be, anyway!
There are criticisms of this paper from a couple of my favourite experts and writers, pointing out [in a letter to the journal](sci-hub.tw/10.2519/jospt.2017.0207) that one of the “fashionable” paradigms impugned here, the biopsyschosocial model, “includes the considerations [the “bio” part] that eventually cured the patient’s pain.” I like the criticism *and* I like the authors’ response — I see only healthy debate here
Accuracy disclaimer: It’s always possible that a case study like this has been misrepresented to make a point. Maybe it didn’t really go down this way. But based on my own professional, I think things like this definitely do happen (and based on my personal experience, I know they do). I am referring both to fashionable misdiagnosis in general, and to problematic overemphasis on psychosocial factors and sensitization in particular. The omission of the “bio” from the “biopsychosocial” model should not happen in theory, but it certainly does in practice.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
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?
These two articles on PainScience.com cite Taylor 2017 as a source:
- PS Trigger Points & Myofascial Pain Syndrome — A guide to the unfinished science of muscle pain, with reviews of every theory and self-treatment and therapy option
- PS 28 Surprising Causes of Pain — Trying to understand pain when there is no obvious explanation
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.
- Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain: Systematic Review and Meta-analysis. Paige 2017 JAMA.