Detailed guides to painful problems, treatments & more

What’s New on

New featured articles, updates to articles, recent blog posts, and noteworthy new scientific papers

See also the about page, complete articles index, and sitemap.

I have been expanding and upgrading this website for 20 years now, and full-time since 2010. Useful new references are added almost daily. I am always working on an endless list of improvements, and corrections and mea culpas are always the highest priority items. This page lists everything that’s new or changed lately … or just Google for content that’s new in the last month or year. ~ Paul Ingraham, PainSci Publisher

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The 10 newest featured articles on (out of 234)

  1. Does Pandiculation “Reset” Muscle Tone? » Jan 2023
  2. The Tibiofibular Joint and Knee Pain » Feb 2022
  3. Ozone Therapy for Pain » Dec 2021
  4. Mind Over Pain » Sep 2021
  5. What Works for Chronic Pain? » Jun 2021
  6. Counterstimulation, Counterirritation, and Gate Control » Jun 2021
  7. Autonomous Sensory Meridian Response » Jun 2021
  8. Neurodynamic Stretching » Jun 2021
  9. The Science of Pain-Killers » May 2021

The last 60 updates to featured articles and tutorials

Like good footnotes, update logging sets apart from most other health websites and blogs. It’s fine print, but important fine print, in the same spirit of transparency as the editing history available for Wikipedia pages. I log any change to articles that might be of interest to a keen reader.

Current Update Stats — 60 updates to 34 articles & books in 157 days, breaking down into 28 major updates, 16 medium, 15 minor. That’s every 2.6 days in recent history; there have been 1644 updates since comprehensive logging started in mid-2016 ?Comprehensive update logging started in the summer of 2016. Prior to that, I only logged major updates for the most popular and controversial articles. (about one every other day) … plus very roughly ten thousand more since the early 2000s. See the complete update archives.

showing of 60 recent updates

LSep 21The Complete Guide to Low Back Pain — Rewritten, back pain as an overuse injury — Like-new re-write. Before: simplistic and old-school by my 2023 standards. After: not very scientifically rigorous, but much more informed and wide-ranging speculation. And kinda fun.
SSep 20Marijuana for Pain — Added a citation to Gedin on the role of placebo, poor blinding, and media buzz.
SSep 18Ten Trillion Cells Walked Into a Bar — Added a fresh citation (first note) about the number of cells we have: roughly thirty trillion, according to a new paper.
SSep 7Opioids for Chronic Aches & Pains — Edited. Made several minor clarifications, most notably emphasizing that opioids are indeed effective for some kinds of chronic pain (despite being surprisingly ineffective for so many others).
MSep 2Trigger Point Doubts — Added a very substantial (bloated?) new footnote, in which I (finally) provide my best guesses for “what really happened” in a trigger point therapy success story. There’s also a blog post.
MAug 30A Deep Dive into Delayed-Onset Muscle Soreness — A variety of modest improvements to the sections on active recovery, particularly the evidence.
LAug 27The Complete Guide to Low Back Pain — New chapter, treating rib subluxations.
LAug 27The Complete Guide to Low Back Pain — New chapter, rib subluxations — Not just a new chapter, but a particularly huge one, based on interesting new science, with plenty of value. (PainSci Members can also read this in a recent blog post, “Extra, extra! Extra floating ribs are way more common than anyone knew.”)
LAug 26Chronic, Subtle, Systemic Inflammation — Rewritten, psychologically triggered neuroinflammation — Significant revision of all neuroinflammation content.
LAug 26Chronic, Subtle, Systemic Inflammation — Rewritten, neuroinflammation dysfunction — Significant revision of all neuroinslammation content.
LAug 26Chronic, Subtle, Systemic Inflammation — Rewritten, neuroinflammation with subtle triggers — Significant revision of all neuroinflammation content.
LAug 26Chronic, Subtle, Systemic Inflammation — Rewritten, sickness behaviour — Significant revision of all neuroinflammation content.
LAug 26Chronic, Subtle, Systemic Inflammation — Rewritten, neuroinflammation intro — Significant revision of all neuroinflammation content.
SAug 25The Complete Guide to Patellofemoral Pain Syndrome — Science update, strengthening — Added an important footnote with a bunch of detail about exactly what kind of strength training was tested by Hansen et al..
LAug 24Quite a Stretch — New section, stretching for hypertrophy.
MAug 2338 Surprising Causes of Pain — Added small new section about foreign objects, inspired by a good new example (a bullet embedded in someone's hand for decades before it started to hurt).
LAug 21The Complete Guide to Patellofemoral Pain Syndrome — Science update, new strengthening evidence — After almost a decade without a meaningful update, new evidence from Hansen et al has forced a rewrite of this chapter!
LAug 20The Complete Guide to Low Back Pain — New chapter.
SAug 4Quackery Red Flags — Added new section: “Are we intuitive about our health? Hell no! On animals and the limits of self-care.”
LJul 11Vulnerability to Chronic Pain — Added new section, “Drink less alcohol.”
LJun 25Water Fever and the Fear of Chronic Dehydration — New section, “The fountain of youth is probably not your kitchen faucet.”
LJun 25Vulnerability to Chronic Pain — Added new section, “Don’t worry about … lots of other things.” More about wellness “optimization.”
LJun 17The Complete Guide to Trigger Points & Myofascial Pain — New content, sarcomere chapter — Added an interesting sidebar about how we can actually lose sarcomeres. And I finally added two very complex new diagrams of muscle structure and sarcomere function — a project I avoided for years, because it was really hard! But also very important for this subject matter.
LJun 1538 Surprising Causes of Pain — Two new main sections about pollutants and food additives, radiculopathy (especially multiple-level radiculopathy), plus a new appendix about how “Pain demands an explanation.” Miscellaneous revision and editing.
LJun 15Chronic, Subtle, Systemic Inflammation — New section.
MJun 13The Double-Edged Sword of Imaging to Diagnose Pain — Added two new short sections: “Patients are part of the medical incompetence equation,” and “When should you imaging be considered?”
SJun 13Speculation-Based Medicine — Added several examples of treatments that were popular long before they were proven to be ineffective.
MJun 12Medical Errors in Perspective — Editing and several new links and footnotes to shore up the thesis and put it in context.
LJun 11Ten Trillion Cells Walked Into a Bar — Added two short new sections about muscular hydrostats, bipedality, and variations in spinal posture — some riffs on the theme of “standing up” that seemed like a long overdue way of making this weird article more relevant to the rest of the website (which is always was, but it’s quite a bit clearer now). I also did some general editing … and was a little freaked out by how much useful work there was to do on this ancient page.
MJun 11Spinal Fracture Bracing and Fixation — Revised the introduction and put the topic more in context, relating to it to other topics on the site. Eventually this is going to become part of a larger article about the “medical impulse to stop or limit movement”: bracing in general.
SJun 11We Are Full of Critters — This article does not need many updates, but today I added a short section: “Why an article about cells on a pain website?” Because it is a bit odd.
MJun 10How Many Muscles Are In the Human Body? — Small new section, “There’s even more? Sarcomeres are basically ‘micro muscles’ … and there are many trillions of those.”
MJun 8Vulnerability to Chronic Pain — Added a short new section, “The basics versus wellness ‘optimization’: a cautionary tale.”
SJun 8Confirmation Bias — Added a small new section about confirmation bias as a driver of both cherry-picking and nitpicking of studies.
LJun 6Does Posture Matter? — Added content — Added much more information about stability cushions, mostly imported from a minor old article and improved.
MJun 5Does Posture Matter? — Science update — Added two citations: one about the reliability of lumbar curvature assessment; and a thoroughly annotated one to the paper that sparked the “cells phone usage causes horns” idea (Shahar). There’s basically a whole blog post in that footnote!
LJun 5Does Posture Matter? — Rewriting and editing — Many small and medium improvements. I mostly worked on recommendations for changing posture. I also threw out the article's summary and started over, and the new one is 10x better. (A new summary doesn't sound like much, but crafting really good summaries in incredibly challenging. And ChatGPT really just cannot do it like I can do it. 😉)
MJun 5The Trouble with Chairs — Editing. Top-to-bottom content tidying and tuning. It’s uncomfortably rare for me to just throughly re-read one of my own articles. It took two full hours just to go through it carefully fixing minor issues along the way and taking notes on more substantive updates I’d like to do.
SJun 5The Complete Guide to Low Back Pain — Science update, posture — Cited Schmidt on lordosis assessment reliability (there is none).
SJun 3Reassurance for Massage Therapists — Filled out the extro a little. Just a bit more detail and context.
LMay 31Chronic, Subtle, Systemic Inflammation — New section.
MMay 31The Complete Guide to Low Back Pain — Edited, directional preference chapter — Numerous minor corrections and improvements. Added ‘focalization’ as a clearer alternative to ‘centralization.’ Added two images. There's also now a blog post version of this chapter for PainSci members, and an audio version of the chapter embedded here.
MMay 30Vitamin D for Pain — Added a tiny new section about vitamin D as a possible therapy for statin-associated muscle soreness. Also removed the position statement on vitamin D and COVID. It was more interesting in 2020, but since then the relationship between vitamin D and COVID has become a big nothing burger, and it’s beyond the scope of this article in any case.
SMay 29The Complete Guide to Low Back Pain — Small additions — Post-publication editing and polishing, most notably a couple more citations about MDT efficacy, and an interesting point about the implications of centralization’s origin story.
SMay 28Reviews of Pain Professions — Added several images. Obviously just a minor update, but in this context some visual cues are quite helpful. A few minor edits while I was here.
MMay 27Does Posture Matter? — Improvements, posture article conclusion — This was just a reiteration of a few keys points for a long time. Now it’s more colourful rant and battle cry — death to posturology!
LMay 27The Complete Guide to Low Back Pain — New chapter, McKenzie Method® of Mechanical Diagnosis and Therapy® (MDT)
LMay 26Mind Over Pain — New section, resilience rant — Added a section about the overuse and abuse of the idea of “resilience,” from a 2021 members-only post now made public.
MMay 26Mind Over Pain — Science update, confidence cure section — Cited and critically analyzed that big new study of cognitive functional therapy (Kent) — more on this to come, but the process of citing it widely on PainSci has begun.
SMay 26Mind Over Pain — Many minor adjustments, overview of all mind-over-pain ideas — I remember crafting this summary extremely carefully back in 2021. But it’s amazing how steadily my ideas evolve — especially on this topic in the last two years — and I saw a need for a whole bunch of edits. The idea that you could create something like this and leave it alone is kind of laughable.
LMay 24What’s New on — An update to the updates page?! It’s so meta! It’s not going to happen often, but I just finished improving the whole update-logging system in several ways. Most of the upgrades are "under the hood," but there is now much better filtering for the update list, and the foundations have been laid for more improvements in the future.
MMay 22Neurodynamic Stretching — Added a lovely anecdote about a dramatic success with neurodynamic stretching.
SMay 20The Complete Guide to IT Band Syndrome — Improvements, knee pain diagnosis — Added information about pain referral from the hip joint, plus some other minor clarifications.
LMay 19Vulnerability to Chronic Pain — Added new section, “Health and luck: the non-modifiable risk factors.”
LMay 19Cognitive Behavioural Therapy for Chronic Pain — Added a substantial new section, “What about conventional treatment with a psychological spin?” And it will get more substantive, because there’s more to do on that topic. I also cited Johnsen on CBT for depression, added a note about the tendency of all psychological therapies to get gaslighty, and some clarifications and a link in defense of acceptance and commitment therapy.
MMay 19Placebo Power Hype — Added a new conclusion: “Placebo enthusiasm cannot be curbed.”
LMay 16The Complete Guide to Low Back Pain — New chapter, centralization and directional preference.
LApr 28Chronic Low Back Pain Is Not So Chronic — Rewrite and major upgrade. The previous reassurance-is-good-for-back-pain slant has been replaced with a much more nuanced perspective on the relationship between back pain and psychological factors. And there are useful new sections on risk factors.
SApr 22Cramps, Spasms, Tremors & Twitches — Cited a case study about mistaking Parkinsonian dystonia for a knee injury.
SApr 19How Many Muscles Are In the Human Body? — Corrected a minor error: capillaries are not muscular. Hat tip to reader M.C. for reminding me of that.

The last 20 blog posts

Blog posts are smaller and more ephemeral than the articles in PainSci’s main library. I blog about many topics as I work on books and permanent articles. There are 1099 posts dating back to 2010.

  1. Stretching to … build muscle? It works, but there’s a catch! 🔈 » Sep 22, 23
  2. Cannabis hype control » Sep 19, 23
  3. Follow-up: The details of that strength training protocol that didn’t work for knee pain 🔈 » Sep 14, 23
  4. More study not always needed » Sep 12, 23
  5. Can neck massage stimulate the vagus nerve? For better or worse? (Member Post) 🔈 » Sep 7, 23
  6. Joint lube still useless 🔈 » Sep 5, 23
  7. What do I REALLY think happened with that massage success story? 🔈 » Sep 1, 23
  8. Should you exercise when you’re still sore from the last workout? 🔈 » Aug 30, 23
  9. Bullet stuck in a hand for decades before being noticed » Aug 23, 23
  10. Strengthening for painful knees performs poorly in a new trial 🔈 » Aug 22, 23
  11. Infection aches versus normal chronic pain » Aug 17, 23
  12. If we’re genetically programmed to hurt, why bother trying to control anything? 🔈 » Aug 12, 23
  13. Extra, extra! Extra floating ribs are way more common than anyone knew (Member Post) 🔈 » Aug 9, 23
  14. Are we intuitive about our health? Hell no! On animals and the limits of self-care 🔈 » Aug 4, 23
  15. Sign me up for mild muscle pain? The statins dilemma 🔈 » Aug 1, 23
  16. Slow exhalations: are they a meditative breathing upgrade? 🔈 » Jul 20, 23
  17. Muscles and brains get healthier together 🔈 » Jul 18, 23
  18. New “positive” studies rarely change the bottom line (e.g. massage for exercise soreness) 🔈 » Jul 13, 23
  19. Does debunking back pain myths work? » Jul 9, 23
  20. Kooky misogynistic beliefs about gait and fibromyalgia 🔈 » Jul 7, 23

The last 20 bibliography items with beefier summaries

Many scientific papers added to the bibliography are boring and utilitarian, but some are much more interesting, like small blog posts about the science — like the recent highlights are listed here. The are roughly 4000 more items in the whole bibliography, ~700 of them more substantively annotated.

  1. Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. Weisman et al., 2022, Musculoskelet Sci Pract. » added Jun 2023
  2. Centralization and directional preference: An updated systematic review with synthesis of previous evidence. May et al., 2018, Musculoskelet Sci Pract. » added Mar 2023
  3. Surgical interventions for lumbar disc prolapse. Gibson et al., 2007, Cochrane Database Syst Rev. » added Mar 2023
  4. Can Exercise Positively Influence the Intervertebral Disc? Belavý et al., 2016, Sports Med. » added Mar 2023
  5. Inciting events associated with lumbar disc herniation. Suri et al., 2010, Spine J. » added Mar 2023
  6. Nerves are more abundant than blood vessels in the degenerate human intervertebral disc. Binch et al., 2015, Arthritis Res Ther. » added Mar 2023
  7. Diagnosing Discogenic Low Back Pain Associated with Degenerative Disc Disease Using a Medical Interview. Tonosu et al., 2016, PLoS One. » added Mar 2023
  8. Clinical aspects of sciatica and their relation to the type of lumbar disc herniation. Reihani-Kermani et al., 2005, Archives of Iranian Medicine. » added Mar 2023
  9. Severity of symptoms and signs in relation to magnetic resonance imaging findings among sciatic patients. Karppinen et al., 2001, Spine (Phila Pa 1976). » added Mar 2023
  10. Relationship between herniated intervertebral disc fragment weight and pain in lumbar microdiscectomy patients. Mariajoseph et al., 2022, J Clin Neurosci. » added Mar 2023
  11. Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople et al., 1994, Spine (Phila Pa 1976). » added Feb 2023
  12. Symptomatic and asymptomatic abnormalities in patients with lumbosacral radicular syndrome: Clinical examination compared with MRI. van Rijn et al., 2006, Clin Neurol Neurosurg. » added Feb 2023
  13. Characteristics of patients with low back and leg pain seeking treatment in primary care: baseline results from the ATLAS cohort study. Konstantinou et al., 2015, BMC Musculoskelet Disord. » added Feb 2023
  14. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. Gugliotta et al., 2016, BMJ Open. » added Feb 2023
  15. Two-year outcome after lumbar microdiscectomy versus microscopic sequestrectomy: part 2: radiographic evaluation and correlation with clinical outcome. Barth et al., 2008, Spine (Phila Pa 1976). » added Feb 2023
  16. Magnetic resonance imaging findings 10 years after treatment for lumbar disc herniation. Fraser et al., 1995, Spine (Phila Pa 1976). » added Feb 2023
  17. Efficacy, safety, and tolerability of antidepressants for pain in adults: overview of systematic reviews. Ferreira et al., 2023, BMJ. » added Feb 2023
  18. Trends in the Concurrent Prescription of Opioids and Gabapentin in the US, 2006 to 2018. Peet et al., 2022, JAMA Intern Med. » added Jan 2023
  19. Comparative efficacy of exercise therapy and oral non-steroidal anti-inflammatory drugs and paracetamol for knee or hip osteoarthritis: a network meta-analysis of randomised controlled trials. Weng et al., 2023, Br J Sports Med. » added Jan 2023
  20. Effectiveness and cost-effectiveness of universal school-based mindfulness training compared with normal school provision in reducing risk of mental health problems and promoting well-being in adolescence: the MYRIAD cluster randomised controlled trial. Kuyken et al., 2022, Evid Based Ment Health. » added Dec 2022

What’s new on this page about new stuff?

Ironically, I’ve actually updated this page quite a few times without logging the change. 😜

May 24, 2023 — An update to the updates page?! It’s so meta! It’s not going to happen often, but I just finished improving the whole update-logging system in several ways. Most of the upgrades are "under the hood," but there is now much better filtering for the update list, and the foundations have been laid for more improvements in the future.

2016 — Publication.