In April, Jorge Fuentes published this paper, Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Some subjects with chronic low back pain were given real interferential current therapy and others sham interferential current, but what was really being tested was the therapeutic alliance. It turned out that therapeutic alliance had the biggest effect on pain scores.
One of the co-authors was Maxi Miciak. See her blog posts on the importance of finding a theory base for physiotherapy in to place therapeutic context within, here, here and here.
Lately Bronnie Thompson, an OT in New Zealand who writes, studies and teaches about pain, offered a brilliant suggestion: let's not discuss back pain in terms of injury at all. Let's talk about it like one would a headache:
"Given that most people will have a bout of back pain in their lifetime (up to 90% of people in some studies), I keep wondering if perhaps we could think of back pain as a lot like having a headache. A headache of the back. We don’t think of head pain as “head injury”, we think of it as a headache – we usually take a bit of pain relief, go for a walk, de-stress, and it’ll settle down. Occasionally a headache is a sign of something more serious – but most of the time it’s a nuisance and a wakeup call to take more care of our wellbeing."I couldn't agree more.
So much institutionalized inertia.
1. Sifferlin A, This Is the No. 1 Cause of Disability Worldwide, Time, March 25/2014
2. Fuentes J, Armijo-Olivo S, Funabashi M, Miciak M, Dick B, Warren S, Rashiq S, Magee DJ, Gross DP; Enhanced therapeutic alliance modulates pain intensity and muscle pain sensitivity in patients with chronic low back pain: an experimental controlled study. Phys Ther. 2014 Apr;94(4):477-89.
3. Miciak M; Finding Freud in Physiotherapy Parts I, II, III. Ignite Physio blog, May 2014
4. Thompson B; Sticky Back Beliefs, HealthSkills blog, May 26/2014.
5. Zusman M; Belief reinforcement: one reason why costs for low back pain have not decreased. J Multidiscip Healthc. 2013; 6: 197–204. May 16/2013