Can back pain be “Iatrogenic” – i.e. healthcare induced?

The healthcare world has created a new problem: highly sensitive imaging techniques like MRI’s can pick up degeneration that is normally occurring in healthy individuals.  The very sight of these images can lead a patient down a cascade of negative behaviors associated with an increase in pain, and hence, an iatrogenic phenomenon has occurred.  I first read about this phenomenon in Dr. John Sarno’s books, and although perhaps overstated in some instances, the phenomena that he describes absolutely ring true with certain clients that I’ve seen over the years.

This a tremendous short video which illustrates the powerful affect of nocebo, and the iatrogenic affect that MRI’s and poor communication between healthcare professionals and clients can have on back pain.

Also, a review of Sarno’s work, by Ingraham of PainScience:

TENS (Transcutaneous Electrical Nerve Stimulation)

There are some instances in which I like to make use of the “gate-control theory” (Melzack and Wall, 1965) – especially in cases where clients are looking for immediate pain relief.  A device like the TENS unit has a practical application in moments like this.

The infamous gate theory proposes that pain is caused by activity in small-diameter nerve fibers.  By stimulating the larger-diameter sensory nerve fibers, we can reduce the client’s perception of pain.  Melzack and Wall hypothesized that within the dorsal horn of the spinal cord, a “gating mechanism” exists, which can be manipulated (i.e. opened or closed) to allow or inhibit the transmission of painful information through it, essentially preventing the brain from processing these painful signals.  TENS works, in theory, by selectively exciting A-beta nerve fibres in the skin, which reduces the amount of painful stimulation being transmitted by A-delta and C-fibers (which are smaller).  Optimal frequency for this to occur is ~90-130Hz.  There is also potential for TENS to affect extra-segmental, descending pain pathways by decreasing the release of excitatory neurotransmitters (aspartate + glutamate), and increasing the release of inhibitory neurotransmitters (GABA + serotonin).  Also, potential for modulation of endogenous opiods i.e. endorphins.

UCLA Neuroscience Researcher Alex Korb

Alex Korb Ph.D. writes in his book entitled “The Upward Spiral”: “The results are fairly clear that massage boosts your serotonin by as much as 30 percent. Massage also decreases stress hormones and raises dopamine levels, which helps you create new good habits… Massage reduces pain because the oxytocin system activates painkilling endorphins. Massage also improves sleep and reduces fatigue by increasing serotonin and dopamine and decreasing the stress hormone cortisol.”

In the same vein, this is taken from the abstract of a meta-analysis of Massage Therapy (MT) research: “Single applications of MT reduced state anxiety, blood pressure, and heart rate but not negative mood, immediate assessment of pain, and cortisol level. Multiple applications reduced delayed assessment of pain. Reductions of trait anxiety and depression were MT’s largest effects, with a course of treatment providing benefits similar in magnitude to those of psychotherapy.”

If you’re ever interested in finding out more about the effectiveness of any treatment/modality/drug/supplement, PubMed is always a good place to start.  Meta-analyses are like summaries of many studies put together, and therefore create the “average” results amongst all the studies being examined as well as decreasing bias.

EBM (Evidence-Based Medicine) vs. Clinical Experience

Essentially, this could read as “proven effects” vs. “placebo”.  Ingraham of PainScience alluding in his microblog to the difference between thinking that a particular treatment/modality/technique is working, and actually knowing through science that it does.  As a healthcare practitioner, I think this is exceptionally important.  In order to provide ethically responsible care, you should know that a treatment is working in an objective manner, without convincing yourself that it does.

How did humans evolve “athletically” ?

I’ve read an interview conducted with Dan Lieberman, Professor of Human Evolutionary Biology and put some of his thoughts in bullet format.  The link to the full interview can be found at the bottom of this blogpost.

  • most popular sports at Olympics: power sports: 100m dash for ex.
  • however, IF you think about humans as being POWER athletes, then really we are “wimps”, compared to other animals
  • Usain Bolt can run 10.4 m/s.  Any goat (yes, any goat or sheep) can run twice as fast, with no training!
  • typical chimpanzee is ~2 to 5 times more powerful than a human (and they weigh less).
  • long distances, however, is where humans shine.  In some cases (high temp.), humans can outrun a horse, and with comparatively little orthopedic/musculoskeletal repercussions (he emphasizes that even non-athletes can run a marathon with a bit of training), i.e. it’s not something extraordinary for humans, unlike Bolt’s sprint time, which is for humans
  • “We’re actually remarkable endurance athletes, and that endurance athleticism is deeply woven into our bodies, literally from our heads to our toes. We have adaptations in our feet and our legs and our hips and pelvises and our heads and our brains and our respiratory systems. We even have neurobiological adaptations that give us a runner’s high, all of which help make us extraordinary endurance athletes. We’ve lost sight at just how good we are at endurance athleticism, and that’s led to a perverse idea that humans really aren’t very good athletes.”
  • argument is, that we have evolved to be endurance “athletes”.  Hunter-gatherers and subsistence farmers performed huge volumes of work

Evidence mounting for massage therapy’s ability to improve athletic recovery rate

An interesting study pertaining to the the efficacy of massage with regards to recovery and muscle soreness, as well as improved physiological restoration and physical performance in male bodybuilders. (Link below will bring you to a PubMed abstract – this particular study was published in the Journal of Sport Science in 2015)

Espom Salts – Something to rethink…

Paul Ingraham of PainScience is a science-journalist and has an SBM or science-based medicine approach to all-things massage therapy related.  This is one of his most popular articles – it has been a rather controversial one.  The article suggests that it isn’t the epsom salt that is helping your sore muscles, but rather the warm water you’re sitting in!

Lebron James is hiring a full-time personal massage therapist

Possibly the most impressive athletic specimen the world has ever seen – and he’s hiring himself a personal RMT.  The science isn’t quite there yet in terms of supporting massage therapy as being able to reduce recovery time with absolute certainty, however, a story like this goes a long way in terms of suggesting that it does!