Reading Guide for Professionals

What’s on PainScience.com for therapists and doctors?

PainScience.com is crafted for both patients and health professionals — a tricky balancing act. Most of the content is addressed to patients, but professionals appreciate clear and jargon-free writing just as much as patients do. Key features here for pros:

Citations and nerdy digressions are tucked away in sidebars and footnotes like this one1 — an extra “layer” of information for more knowledgeable readers.

A membership program gives my most serious readers access to the most advanced content: members-only sections scattered all over the site. For instance, while 80% of a huge, 35,000-word review of stretching science is free to all visitors, I’ve set aside a 3,500-word deep dive into several sub-topics for members only.
Ten extraordinarily detailed ebooks about several common, clinically challenging pain problems. Save 50% on a complete set of ebooks — collectively like a large, virtual, self-updating textbook — and free future editions for life. See the eBoxed set information page.
The largest private annotated bibliography of rehab, pain and injury science available anywhere.2

Doctors too? Yes, doctors read this website. Over the years, many physicians have endorsed my science-based approach to this subject matter (and they have often offered helpful corrections as well). I also stay in touch with several of the physicians at ScienceBasedMedicine.org, where I was the assistant editor for several years.

What kind of subjects are covered on PainScience.com?

The three major categories are (these are links to full indexes):

PainScience.com is primarily about conservative manual and physical therapies for muscle pain, low back and neck pain, headaches, frozen shoulder, and repetitive strain injury, especially in the lower leg (plantar fasciitis, shin splints, plantar fasciitis, iliotibial band syndrome, patellofemoral syndrome).

There’s quite a lot about massage therapy because of my history in that profession.

I constantly chip away at the conceptual dinosaur of the postural-structural-biomechanical model of pain, in many different ways.

Over time, I have been spreading out into a wider variety of more “medical” topics that intersect with pain. These days there’s more on the site about complex, strange, chronic, and multisite pain — problems like fibromyalgia. I focus on the importance of messy neuroimmunological and psychosocial mechanisms of chronic pain, such as sensitization, subtle systemic inflammation, and the role of mind.

I often get deep into the weeds of both the evidence and plausibility — a science-based medicine perspective — for aetiologies, treatments, clinical reasoning, and diagnostic logic. I bet heavily on the null hypothesis in testing treatment claims. I always consider the role of placebo, nocebo, and the non-specific effects of therapeutic interactions.

What’s not on PainScience.com?

Although PainScience.com is very large, I am but one man, and it is not actually encyclopedic in scope despite it’s reputation for being like a wiki for pain.

I don’t offer comprehensive reference information (there are excellent texts for that), and so there are many surprising omissions, dozens of topics I still hope to get to someday, and dozens more I never intend to. For instance, I will never systematically describe special orthopedic testing for any condition or provide detailed differential diagnosis charts … but I have done plenty of translating and explaining of the implications of a scientific paper about the reliability of such tests.

My own training and expertise is limited,3 and I am careful to respect my own limits and stay in my “lane.” I mostly avoid pathology-driven chronic pain — for instance, there’s not much here for multiple sclerosis patients — invasive treatment methods, and pharmacotherapies.

Musculoskeletal and rehab science nerdery

Patients find it difficult to find good help for many kinds of chronic pain problems. Diagnostic wild goose chases are common. Many painful problems slip into huge cracks in the medical system between orthopedics, rheumatology, and neurology. For everything else, we simply don’t much about know why people hurt, and keep hurting. Patients often cannot find anything better than educated guesses… if that. 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 nerd.

Some of my favourite sources

I spend a lot of time on PubMed, and I cite from the best sources whenever possible, like The Cochrane Collaboration and The New England Journal of Medicine and PLoS Medicine.

Just who do I think I am?

Many professional readers have been offended by my style over the years. Please accept my apologies for all the criticism I dish out. I routinely question common 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

My own top picks for professional readers

Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain. This article challenges the clinical paradigm that has dominated manual therapy for decades. If you only read one article on this website, please read this one.
Pain is Weird — Pain science reveals a volatile, misleading sensation that comes entirely from an overprotective brain, not our tissues. Although quite basic and not quite yet what it should be, many clinicians are not aware of most of this information and really, really should be.
38 Surprising Causes of Pain — Trying to understand pain when there is no obvious explanation
Does Fascia Matter? — A detailed critical analysis of the clinical relevance of fascia science and fascia properties. Fascia is hot hot hot right now, but despite all the conferences and fascia-fanaticism it’s just not clear that fascia matters. Find out exactly why.
Most Pain Treatments Damned With Faint Praise — Most controversial and alternative therapies are fighting over scraps of “positive” scientific evidence that damn them with the faint praise of small effect sizes that cannot impress. A short, sweet article about a simple idea that really simplifies a lot of debates about “what works.”
What Works for Chronic Pain? — A skeptical roundup of all the disappointingly small selection of effective chronic pain treatments (or the least bad ineffective ones)
Quite a Stretch — Stretching science has shown that this extremely popular form of exercise has almost no measurable benefits This is PainScience.com’s original “controversial” article. Stretching was one of the issues that got me writing. Chock full of myths … myths that you may still be passing on to your patients.
Chronic, Subtle, Systemic Inflammation — One possible sneaky cause of puzzling chronic pain. This is probably one of the geekiest articles on the site, as well as one of my favourites.
Placebo Power Hype — The placebo effect is fascinating, but its “power” isn’t all it’s cracked up to be.
A Deep Dive into Delayed-Onset Muscle Soreness — The biology & treatment of “muscle fever,” the deep muscle soreness that surges 24-48 hours after an unfamiliar workout intensity.
Trigger Point Doubts — Do muscle knots exist? Exploring controversies about the existence and nature of so-called “trigger points” and myofascial pain syndrome
Statistical Significance Abuse — A lot of research makes scientific evidence seem much more “significant” than it is.
14 Kinds of Bogus Citations — Classic ways to self-servingly screw up references to science, like “the sneaky reach” or “the uncheckable”.
Pain Science Reading Guide for Skeptics — A tour of PainScience.com for readers who have doubts and concerns about the validity and efficacy of popular treatments for injuries and chronic pain.

Notes

Grundy PF, Roberts CJ. Does unequal leg length cause back pain? A case-control study. Lancet. 1984 Aug 4;2(8397):256–8. PubMed 6146810 ❐
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.
Obviously it’s not PubMed or even PEDro (the Physiotherapy Evidence Database) — it’s not an institutionally run and funded database. However, what it lacks in sheer size it more than makes up for with charm, personality and focus. As far as I know, the PainScience.com bibliography is the single largest resource of its kind, with about 3500 citations to scientific papers. It’s a readable, annotated bibliography. Quickly get the gist of a paper, my take on its significance, and anything else that’s noteworthy and interesting. Much better than just reading abstracts!
Massage therapists in my part of the world are surprisingly well-trained for that profession — I did a three-year full-time program — but the quality of the education was dubious, and even three years was also still less than physical therapists and chiropractors (who in turn study much less than any physician). See more information about my credentials.