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Transcranial direct current stimulation (tDCS) is a form of non-invasive brain stimulation that delivers low intensity direct current stimulation to the brain through electrodes applied to the skin over the target area. It has been found to modulate cortical excitability at the target site leading some researchers to investigate it as a possible treatment for chronic pain…
Unfortunately, the authors of a new British Medical Journal editorial conclude that it is:
Not recommended; early promise is fading fast as trial methods improve.
The null hypothesis strikes again! Bummer. (Null hypothesis primer: in plain English, the null hypothesis says, “Most ideas turn out to be wrong.” And therefore most weakly positive results will turn out to the product of bias and wishful thinking. Read more about the null.)
In light of this uncertainty, I suggest that we should not be explaining trigger points as muscle knots, but rather that they are simply soft tissue sore spots of an unknown origin!
STSSOAUO doesn’t exactly roll of the tongue, but I like the sentiment: by all means, let’s (please) start regularly conceding our ignorance of the nature of this beast. Every book on the subject still reads like it’s a nearly-solved mystery, with just a few details to be filled in, which is just a tad overconfident.
And yet I don’t really have any beef with the term “trigger points.” Everyone acknowledges that there’s a painful phenomenon, and we have to call it something. Mystery points? Sufferin’ spots? Humility matters more than the label.
Filed under “Pain is Weird.”
The Salt Spring Island terrain in the video is gorgeous, and in my backyard. (I’ve spent a bunch of time on that island.) You can’t beat yoga under an arbutus tree!
Contrary to everything scientists might have feared exposing their irrationality, their humanity, even their craftiness and hot tempers, makes the public more receptive to the revelations of science, not less. People can not only take the truth about science, they actually prefer it.
~Michael Brooks, The Secret Anarchy of Science
I’ve know some crafty, hot-tempered scientists. Hell, it seems to go with the territory!
Harriet Hall translated a French article on placebo by Jean Brissonnet for ScienceBasedMedicine.org, calling it “the best explanation of placebo that I had ever read.” (I was quite involved editorially, and in particular spent a bunch of time on producing shinier, translated diagrams.) I’m not quite sure it’s the best placebo explanation I’ve ever read, but on the other hand I can’t point to a better one, and it is certainly chock-a-block with historical context, effectively cited science, and little gems of clarity on this tricky topic. For example:
There are many arguments against its use in healthcare practice. Do we have the right to fool the patient? Do we have the right to act without his consent? Can we risk permanently damaging the doctor/patient relationship if the patient finds out that he has been deceived? A better understanding of the phenomenon makes such questions obsolete. To the extent that the “placebo effect” is only a contextual effect that doesn’t depend on the use of an inactive object, it can and should be used in healthcare practice. It can probably be used instead of a prescription in certain functional diseases, and it certainly can potentiate the effect of prescribed drugs in many cases.
The gist of the article is that what we usually refer to as “the” placebo effect is a category of phenomena, many of them clinically meaningless, and we truly need to learn and use more precise terminology. It’s not just word-nerd nitpickery! Speaking only of “placebo” is about as useful as saying only “furniture” when you mean “chaise longue” or “credenza” or “futon.”Placebo, Are You There?
Does swearing reduce pain? @^#@%, yeah! And so does saying “ow!” according to a new study. And of course it’s not really surprising, given what we know about pain (it’s weird and thoroughly brain-tuned). It probably doesn’t have much relevance to chronic pain. But it’s interesting, and fun.
In our study, saying “ow” increased pain tolerance by about 20%. One may speculate that benefits in real life may, perhaps, even be larger. There, vocalisations are typically less measured. That is, people are likely to say “ow” and other things more forcefully and can do so continuously without the somewhat unnatural breaks that were introduced for standardisation in our study.
Less measured and more forceful indeed.
Naturopathic doctor training does not hold a candle to medical training, as I’ve explained before (see Chiropractor, Naturopath Training Way Less Than Doctors). It’s nice to have some insider confirmation of that now. Britt Marie Hermes is a naturopathy apostate, and she’s telling her story on her own new blog, NaturopathicDiaries.com and in a new series of guest posts on ScienceBasedMedicine.org, starting with an exposé of her training (which I was particularly proud to help publish). It’s cringe-inducing.
Given my journey through naturopathic medical school, I can provide strong evidence and testimony of the quality and quantity of training at Bastyr University. I base what follows on my academic transcript, course syllabi, course catalog, and the student clinician’s handbook in addition to my personal experiences. It should come as no surprise to readers of ScienceBasedMedicine.org that naturopathic training is not as the profession presents. I’ll say it anyway: naturopathic education is riddled with pseudoscience, debunked medical theories, and experimental medical practices.
~Britt Marie Hermes, ND Confession, Part 1: Clinical training inside and out
Alice Sanvito, massage therapist, in a new article about the difference between nociception and pain:
When we live with chronic pain, it can dominate our lives and dramatically alter the way we live, like an obnoxious cab driver who insists on taking us where HE wants to go rather than where WE want to go.
Googling your symptoms is as unavoidable as it is unwise. We almost literally cannot help ourselves. I imagine there is a modern epidemic of reckless, panicky self-treatment based on really bad Internet-powered self-diagnosis — something I am acutely aware of every time I hit my magic “publish” button. (With great power…)
The Flemish government is acutely aware of it too, which is why they commissioned a couple of (hilarious) public service announcements about it, one that’s pure sketch comedy, and one about their clever delivery method: the clever monkeys used Google’s own advertising program to target people searching for common symptoms!
Confession: reading about many kinds of symptoms actually makes me swoon. I get dizzy and queasy. It’s not really a hypochondriac effect — I don’t really start worrying about having the symptoms. It’s more like the way some people can’t handle the sight of blood. I just can’t handle the idea of many symptoms.