See the help page for answers to common customer questions!
If you’re a woman smoker “of a certain age” with a history of neck & back pain in a tough job with a crappy boss, you are totally screwed. Neck pain city!
Being a woman is an especially clear risk factor for neck pain, and no one has a clue why. (And now every woman reading this is now thinking, “Fantastic: as if being a woman in this world wasn’t challenging enough, now this?” I wish it wasn’t true, but it is literally one of the only things we know for sure.)
Also, if you often “feel tense,” your risk of developing neck pain is more than 4 times higher than someone who never feels tense — the conclusion of Huysmans 2012 one of the most intriguing studies I stumbled on.
Another interesting one: Paksaichol et al found computer display position (too high, too low) is definitely not actually a risk factor for neck pain, a classic example of failed common sense. So I’ve been wrong about that for 20 years.
I’ve updated my neck pain book with a much more detailed discussion.
Recently the (Australian) Association of Massage Therapy published a review of massage research that reeks of industry boosterism. Although it contains some perfectly good information, there’s also a conspicuous failure to acknowledge the poor quality and limitations of most of the evidence. In several cases they’ve made too much of the conclusions of junky reviews of thin science that provide faint praise for massage at best. Rather than reporting such evidence as damning, or at least an absence of evidence, it is applauded and cited in a way that, to most readers, just makes massage therapy look good and science-y.
That was my first impression. For much more detailed and specific impression, I’m linking to Nick Ng of Massage & Fitness Magazine, who quickly produced a more balanced review of some of the papers featured prominently in the AMT’s review… while I was off getting dental work done and writing a review of my new MacBook Pro, because I frankly needed a break from pain and therapy science. 😉
Today I have a little good-news science to offer, about reducing systemic inflammation with structured chillin’ (meditation and such). The optimism may surprise some readers, if you tune in for the curmudgeonly debunking.
I think the paper is fairly credible: a 2016 qualitative review of 26 randomized controlled trials of the biological effects of mind-body therapies like Tai Chi, Qigong, yoga, and meditation identified “mixed effects” on inflammation (CRP, IL-6, stimulated cytokine production, yada yada yada), and more consistent results for “genomic markers.”
“Mind-body therapies and control of inflammatory biology: A descriptive review”
Based on this evidence, it seems likely — not proven, but likely — that these activities are meaningfully good for you, and probably helpful for some kinds of chronic pain.
This study is the basis for some encouraging thoughts that I’ve recently injected into The Tyranny of Yoga and Meditation! Because of the inflammation connection, I’ve also cited it in Chronic, Subtle, Systemic Inflammation.
“Before you diagnose yourself with depression or low self esteem, first make sure you are not, in fact, just surrounded by assholes.”
not Freud or Gibson, but Notorious d.e.b. (@debihope)
Depression is probably risk factor for chronic pain (Thompson), and it can definitely feed back into the problem (Elbinoune), and yet, as Dr. James Coyne put it, “depression is actually often actually misdiagnosed IED (Inappropriate Environment Disorder).” And this applies equally to anxiety, I suspect. For instance, we know that macaques with low social status are treated very harshly and it has measurable effects on their immune systems (Snyder-Mackler): they are inflamed, they get more infections. Fascinating. And clearly their problem is that they are just surrounded by asshole macacques.
This is the kind of thing I mean when I cautiously counsel people to do their best to solve problems in their lives as a very basic defense against pain. I would never want to minimize the seriousness of mood disorders, but sometimes what looks like a mood disorder really is “just” a disheartening, stressful situation — and many crappy situations can be changed, sooner or later.
By the way, that charmingly acerbic quote about being “surrounded by assholes” appears to be routinely misattributed to William Gibson or Freud; QuoteInvestigator.com concluded the origin is actually a Tweet by @debihope. Nice one.
There have been so many site updates lately, dozens in January alone, that it’s tough to choose one to focus on for the blog. But the results of this late 2016 study (Herzog et al) blew my mind more than anything else I’ve read recently. If I’m judging by WTF-factor, this item wins hands-down.
I already knew MRI is misleading — everyone knows that, if they know anything about medical imaging and back pain. But it may be worse than I thought…
secret shopper” treatment — cooked up forty-nine distinct “findings.” Sixteen were unique; not one was found in all ten reports, and only one was found in nine of the ten. On average, each radiologist made about a dozen errors, seeing one or two things that weren’t there about missing about ten things that were.
That’s a lot of errors, and not a lot of reliability. The authors clearly believe that some MRI providers are better than others, and that’s probably true, but we also need to ask the question: is any MRI actually reliable?
I’ve seen some startling examples of imaging shenanigans personally, like that one time a radiologist missed literal loose screws — two of them — embedded in my wife’s back. I found them myself. And I’ve heard of many more. I’m not blaming radiologists (I think), because detecting clinically significant things with magic machines is a super hard problem to solve (signal detection theory and all that). But Jebus! For all my cynicism, what Herzog et al found was way worse than I would have predicted. Clearly we need to take all MRI “results” with a brick-sized grain of salt. MRI has now been added to my growing list of examples of unreliable diagnostic methods.