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 31 articles & books in 192 days, breaking down into 27 major updates, 18 medium, 14 minor. That’s every 3.2 days in recent history; there have been 1655 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

LDec 4The Complete Guide to Patellofemoral Pain Syndrome — Evidence update — Updated several references throughout the introductory sections, along with many related edits and improvements.
MDec 2The Medical Blind Spot for Aches, Pains & Injuries — Fairly extensive modernization of the article, reflecting substantial evolution in my views over the last decade.
LNov 22The Complete Guide to Chronic Tension Headaches — New section.
MNov 22The Complete Guide to Chronic Tension Headaches — Minor update, cervicogenic headache chapter — Discussed the special case of suboccipital neuralgia.
SNov 10Cramps, Spasms, Tremors & Twitches — Added hemifacial spasm to the list of examples of pathological contractions.
SOct 30Vulnerability to Chronic Pain — Added a little evidence and evidence-informed speculation about the possibility of more short-term anti-inflammatory benefits of a healthier diet.
LOct 30Chronic, Subtle, Systemic Inflammation — New section.
SOct 28Marijuana for Pain — Science update about the efficacy and safety of CBD — all bad news, I’m afraid. But it’s not surprising.
MOct 19The Complete Guide to Low Back Pain — Revision, MDT review chapter — Just a bunch of miscellaneous revision as I prepared the chapter for publication as an excerpt.
MOct 7Neuropathies Are Overdiagnosed — Science update with some substance, a bit more than just a citation: Peet et al really adds to the case that the fraudulent marketing of anticonvulsants was a pain care catastrophe, resulting in extreme over-prescription.
LOct 5The Complete Guide to Low Back Pain — New section.
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.

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 1114 posts dating back to 2010.

  1. Inflamed, but not psychosocially » Dec 1, 23
  2. Case study of good natural recovery from cauda equina syndrome » Nov 27, 23
  3. Q&A: Can “compensation” for an old injury cause a new pain? » Nov 25, 23
  4. No obvious neck abnormalities in headache patients 🔈 » Nov 22, 23
  5. This heartburn news is giving me heartburn! 🔈 » Nov 18, 23
  6. Wim Hof Method vs. The Null Hypothesis 🔈 » Nov 11, 23
  7. Heart stopping information: exactly how we faint » Nov 4, 23
  8. A point for PEMF? Pending confirmation of effect size » Nov 1, 23
  9. Do you feel lucky, punk? CBD product efficacy and toxicity » Oct 28, 23
  10. Pass the bag of pain! Junk food as an inflammation driver 🔈 » Oct 24, 23
  11. An overdue review of the venerable McKenzie Method (Member Post) 🔈 » Oct 20, 23
  12. Criticize the science that supports you » Oct 17, 23
  13. Cell phone horns 😈 + salamander on NPR about tech and bodies 🔈 » Oct 14, 23
  14. The surreal appeal of pain “hacks” » Oct 13, 23
  15. Paxlovid rebound is not a thing + Covid hurts 🔈 » Oct 10, 23
  16. Preventing arthritis and tendinitis is easier than you think (with patience) 🔈 » Oct 6, 23
  17. Weekend warriorism maybe not so bad 🔈 » Oct 2, 23
  18. ACT feels nicer than CBT » Sep 30, 23
  19. Today’s weird therapy I’ve never even heard of: eurythmy! » Sep 30, 23
  20. Fainting follow-up: vasovagal syncope versus the vagal manoeuvre (plus a vagus-hype glossary) 🔈 » Sep 29, 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, ~750 of them more substantively annotated.

  1. Patients and clinicians managing patellofemoral pain should not rely on general web-based information. Silva et al., 2020, Phys Ther Sport. » added Nov 2023
  2. Cannabidiol (CBD) products for pain: ineffective, expensive, and with potential harms. Moore et al., 2023, J Pain. » added Oct 2023
  3. Proinflammatory Dietary Intake Relates to Pain Sensitivity in Chronic Nonspecific Low Back Pain: A Case-Control Study. Elma et al., 2023, J Pain. » added Oct 2023
  4. Improved outcome after lumbar microdiscectomy in patients shown their excised disc fragments: a prospective, double blind, randomised, controlled trial. Tait et al., 2009, J Neurol Neurosurg Psychiatry. » added Oct 2023
  5. Prevalence and Risk Factors of de Novo Widespread Post-COVID Pain in Non-Hospitalized COVID-19 Survivors: A Nation-Wide Exploratory Population-Based Survey. Ebbesen et al., 2023, J Pain. » added Oct 2023
  6. C-reactive protein (CRP) is associated with chronic pain independently of biopsychosocial factors. Farrell et al., 2023, J Pain. » added Oct 2023
  7. Attitudinal responses to current concepts and opinions from pain neuroscience education on social media. Weisman et al., 2022, Musculoskelet Sci Pract. » added Jun 2023
  8. Centralization and directional preference: An updated systematic review with synthesis of previous evidence. May et al., 2018, Musculoskelet Sci Pract. » added Mar 2023
  9. Surgical interventions for lumbar disc prolapse. Gibson et al., 2007, Cochrane Database Syst Rev. » added Mar 2023
  10. Can Exercise Positively Influence the Intervertebral Disc? Belavý et al., 2016, Sports Med. » added Mar 2023
  11. Inciting events associated with lumbar disc herniation. Suri et al., 2010, Spine J. » added Mar 2023
  12. Diagnosing Discogenic Low Back Pain Associated with Degenerative Disc Disease Using a Medical Interview. Tonosu et al., 2016, PLoS One. » added Mar 2023
  13. Nerves are more abundant than blood vessels in the degenerate human intervertebral disc. Binch et al., 2015, Arthritis Res Ther. » added Mar 2023
  14. Relationship between herniated intervertebral disc fragment weight and pain in lumbar microdiscectomy patients. Mariajoseph et al., 2022, J Clin Neurosci. » added Mar 2023
  15. 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
  16. 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
  17. Prediction of an extruded fragment in lumbar disc patients from clinical presentations. Pople et al., 1994, Spine (Phila Pa 1976). » added Feb 2023
  18. 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
  19. 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
  20. Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study. Gugliotta et al., 2016, BMJ Open. » added Feb 2023

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.