This website is for both patients and health professionals. It is always addressed to patients, but professionals appreciate clear, readable, jargon-free information just as much as patients do. Key features here for professionals:
Doctors too? Yes, doctors read this website. Over the years, many physicians have given me a thumbs up for my science-based approach to the subject matter, and they often write with helpful corrections as well. One of my co-authors, Dr. Tim Taylor, is a physician and pain specialist. I also correspond constantly with several of the physicians at ScienceBasedMedicine.org, where I am the assistant editor (which is quite educational, I can tell you).
PainScience.com is primarily about conservative manual and physical therapies for muscle pain, low back and neck pain, and repetitive strain injuries, especially in the lower leg. I focus on the importance of neurobiological mechanisms of pain, such as sensitization. I constantly chip away at the therapeutic dinosaur of the postural-structural-biomechanical model of pain.
I get deep into plausibility and evidence for etiologies and treatments, clinical reasoning, and diagnostic logic. I focus on the importance of neurobiological mechanisms of pain, such as sensitization, and I constantly chip away at the therapeutic dinosaur of the postural-structural-biomechanical model of pain. I always consider the role of placebo and non-specific effects of therapeutic interactions, and I bet heavily on the null hypothesis in testing treatment claims.
I don’t offer detailed reference information: there are excellent texts for that. So, for instance, I do not systematically describe special orthopedic testing for any condition or provide detailed differential diagnosis charts, but I will translate and explain the implications of a scientific paper about the reliability of a test.
Despite the scope of this one-man show, it’s not a medical publishing empire. My own training and expertise is limited,3 and I am careful to respect my own limits. I particularly avoid pathology-driven chronic pain and invasive treatment methods.
Patients find it difficult to find good help for many kinds of chronic pain problems. Diagnostic wild goose chases are common. Most pain problems slip into a gigantic crack in the medical system between hospital orthopedics and rheumatology. For everything else, we simply don’t much about know why people hurt, and keep hurting. Often we can offer our patients no better than educated guesses. And there is controversy about virtually every kind of thinking and therapy.
PainScience.com tries to make sense of it all. Everything written here was written for love of the topic — I am a musculoskeletal medicine and pain science geek.
Please accept my apologies for all the criticism. I often criticize practices that cannot be supported by science. What gives? And who do I think I am? “It seems a poor way to run a business,” commented one irritated massage therapist. “Do you really think it’s smart to criticize your potential customers?” I think it’s smart to be true to my nature, attracting and earning the trust of the readers I respect — the critical thinkers. We can get nowhere in health care without healthy, vigorous debate. I don’t think that’s “negative.”
Not everyone in medicine can be constantly making calculations about the value of the information. You’d go crazy. But if you are in a subspeciality field … you not only need to know what people know but how they know it. You have to regularly question everything and everyone.
James Lock, MD, Chairman, Dept of Cardiology, Boston Children’s Hospital
This classic, elegant experiment found no connection between leg length and back pain. Like most of the really good science experiments, it has that MythBusters attitude: “why don’t we just check that assumption?” Researchers measured leg lengths, looking for differences in “lower limb length and other disproportion at or around the sacroiliac joints” and found no association with low back pain. “Chronic back pain is thus unlikely to be part of the short-leg syndrome.” Other studies since have backed this up, but this simple old paper remains a favourite.
So what’s special about this footnote? You don’t have to take my word that the source is relevant — readers can easily link to the original source material, and check the relevance and quality of the reference. The presentation is attractive and useable. Under the hood, custom tech makes it a snap for me to publish richly cross-referenced, “interactive” bibliographic data — better technology and higher standards for publication than most scientific journals.BACK TO TEXT