International Spine and Pain Institute

ABSTRACT Objective: To investigate the effect of the examination process (history taking and physical examination) on pain and function. Methods: An observational cohort trial of patients presenting to outpatient physical therapy clinics for the first time with low back pain (n = 34, 57.7 ± 18.7 years, 53% female). A blinded investigator measured participants prior to the beginning of the initial evaluation and after each component of evaluation (history taking and physical examination). Another physical therapist provided normal history taking and physical examination as the patient case presented itself. Primary outcome measure was numeric pain rating scale (NPRS) for the low back and leg. Secondary outcomes and time during examination process and connection between PT and patient were also measured as potential confounders. Results: Participants showed a significant reduction in pain through just the history taking and physical exam for both the back with an NPRS reduction of 1.23 and the leg showing a 0.95 NPRS reduction. The most significant reduction occurs after history taking. Discussion: The evaluation process produced small, but significant, therapeutic effects related to pain, fear-avoidance, pain catastrophization, and functional measures of mobility and sensitivity. The therapist's report of connection with the patient did not alter the patient outcome.

В статье рассматривается вопрос о целесообразности изменения содержания 13-й статьи Конституции РФ, запрещающей государственную идеологию как таковую. Обосновывается необходимость законодательного закрепления исторически сложившейся системы ценностей, приоритетов и целей, составляющих основу государственной идеологии. Подвергаются критике взгляды неолибералов, отрицающих актуальность повышения регулирующей роли государства в различных сферах общественной жизни. Раскрывается современное содержание понятия национальная идея . The article considers the feasibility of changing the content of article 13 of the Constitution of the Russian Federation, which prohibits state ideology as such. The need to legislate on the historical system of values, priorities and goals that form the basis of state ideology is justified. The views of neoliberals who deny the relevance of increasing the regulatory role of the State in various spheres of public life have been criticized. The modern content of the concept of national idea is revealed.

в условиях сложившейся экономической системы в России вопросы действенного хозяйствования и грамотного проработанного расходования государственных средств по прежнему особо актуальны. Теневые схемы оборота наличных денежных средств создают благоприятную почву для распространения негативных политических и социально-экономических процессов, влияют на эффективность функционирования экономических институтов, выступают фактором их криминализации и дестабилизации. В рамках статьи рассмотрены схемы незаконного обналичивания денежных средств, дана уголовно-правовая характеристика такого рода преступлений, изучены методы противодействия данному явлению, предложены пути усиления контроля над незаконным обналичиванием денежных средств. in the current economic system in Russia, issues of efficient management and well-designed and well-spent spending of public funds are still particularly relevant. Shadow cash flow schemes create favorable conditions for the spread of negative political and socio-economic processes, affect the functioning of economic institutions, and act as a factor in their criminalization and destabilization. Within the framework of the article, schemes of illegal cash withdrawal were considered, a criminal law characterization of such crimes was given, methods of counteracting this phenomenon were studied, ways of strengthening control over illegal cash withdrawals were proposed.

BackgroundThe use of pain neuroscience education (PNE) has been shown to be effective in reducing pain, improving function and lowering fear and catastrophisation. Pain neuroscience education utilises various stories and metaphors to help patients reconceptualise their pain experience. To date no individualised study has looked at which stories and metaphors may be the most effective in achieving the positive outcomes found with the use of PNE.ObjectivesThis study examined patient responses to the usefulness of the various stories and metaphors used during PNE for patients who underwent surgery for lumbar radiculopathy.MethodTwenty-seven participants who received preoperative PNE from a previous randomised control trial (RCT) were surveyed 1-year post-education utilising a 5-point Likert scale (0 – ‘do not remember’, 4 – ‘very helpful’) on the usefulness of the various stories and metaphors used during the PNE session. Participant demographics and outcomes data (pain intensity, function and pain knowledge) were utilised from the previous RCT for analysis and correlations.ResultsNineteen surveys were returned for a response rate of 70%. No story or metaphor mean was below 2 – ‘neutral’, lowest mean at 2.53; 6 of the 11 stories or metaphors scored a mean above 3 – ‘helpful’.ConclusionNo individual story or metaphor stood out as being predominately important in being helpful in the recovery process through the use of PNE.Clinical implicationsThe overall messages of reconceptualising pain during PNE may be more important than any individual story or metaphor.

To evaluate the evidence for the effectiveness of sham surgery in orthopedics by conducting a systematic review of literature. Systematic searches were conducted on Biomed Central, BMJ.com, CINAHL, the Cochrane Library, NLM Central Gateway, OVID, ProQuest (Digital Dissertations), PsycInfo, PubMed/Medline, ScienceDirect and Web of Science. Secondary searching (PEARLing) was undertaken, whereby reference lists of the selected articles were reviewed for additional references not identified in the primary search. All randomized controlled trials comparing surgery versus sham surgery in orthopedics were included. Data were extracted and methodological quality was assessed by two reviewers using the Critical Review Form-Quantitative Studies. Levels of scientific evidence, based on the direction of outcomes of the trials, were established following the Australian National Health and Medical Research Council (NHMRC) Hierarchy of Evidence (Australian National Health and Medical Research Council, 1999). This review includes six randomized controlled trials (RCTs) involving 277 subjects. All six studies were rated as very good on methodological quality. Heterogeneity across the studies, with respect to participants, interventions evaluated, and outcome measures used, prevented meta-analyses. Narrative synthesis of results, based on effect size, demonstrated that sham surgery in orthopedics was as effective as actual surgery in reducing pain and improving disability. This review suggests that sham surgery has shown to be just as effective as actual surgery in reducing pain and disability; however, care should be taken to generalize findings because of the limited number of studies.

ABSTRACTThe interview of a patient attending physical therapy is the cornerstone of the physical examination, diagnosis, plan of care, prognosis, and overall efficacy of the therapeutic experience. A thorough, skilled interview drives the objective tests and measures chosen, as well as provides context for the interpretation of those tests and measures, during the physical examination. Information from the interview powerfully influences the treatment modalities chosen by the physical therapist (PT) and thus also impacts the overall outcome and prognosis of the therapy sessions. Traditional physical therapy focuses heavily on biomedical information to educate people about their pain, and this predominant model focusing on anatomy, biomechanics, and pathoanatomy permeates the interview and physical examination. Although this model may have a significant effect on people with acute, sub-acute or postoperative pain, this type of examination may not only gather insufficient information regarding the pain experience and suffering, but negatively impact a patient’s pain experience. In recent years, physical therapy treatment for pain has increasingly focused on pain science education, with increasing evidence of pain science education positively affecting pain, disability, pain catastrophization, movement limitations, and overall healthcare cost. In line with the ever-increasing focus of pain science in physical therapy, it is time for the examination, both subjective and objective, to embrace a biopsychosocial approach beyond the realm of only a biomedical approach. A patient interview is far more than “just” collecting information. It also is a critical component to establishing an alliance with a patient and a fundamental first step in therapeutic neuroscience education (TNE) for patients in pain. This article highlights the interview process focusing on a pain science perspective as it relates to screening patients, establishing psychosocial barriers to improvement, and pain mechanism assessment.

Patients with low back pain (LBP) often display faulty beliefs and cognitions regarding their pain experience. Pain neuroscience education (PNE) aims to alter the pain experience by targeting these faulty beliefs and cognitions. One PNE strategy aims specifically to reframe commonly held beliefs about tissues by patients with LBP as the single source of pain. In line with this reasoning, it is hypothesized that physical therapists (PT) treating patients with LBP may indeed experience similar, if not worse, pain experiences while treating a patient with LBP. To date, this assumption has never been studied. A PT LBP questionnaire was developed, validated and distributed to a convenience sample of attendees of an international PT conference. One-hundred and ten PTs completed the questionnaire for a 71% response rate. Ninety percent of the PTs reported having experienced LBP, with 27% at the conference experiencing LBP at the time. Of the PTs that have experienced LBP 75% reported not having received any imaging; 81% no formal diagnoses, 58% no treatment and 86% not having missed work due to LBP. Eighty-six percent of therapists reported having experienced LBP while treating a patient with LBP, with 50% convinced their LBP was higher than the LBP experienced by the patient they were treating. The results from this study indicate PTs often treat patients with LBP while suffering LBP. It is suggested that this knowledge may potentially help patients with LBP reconceptualize their LBP experience leading to expedited recovery.

In recent years there has been an increased interest in pain neuroscience in physical therapy. Emerging pain neuroscience research has challenged prevailing models used to understand and treat pain, including the Cartesian model of pain and the pain gate. Focus has shifted to the brain's processing of a pain experience, the pain neuromatrix and more recently, cortical reorganisation of body maps. In turn, these emerging theories have catapulted new treatments, such as therapeutic neuroscience education (TNE) and graded motor imagery (GMI), to the forefront of treating people suffering from persistent spinal pain. In line with their increased use, both of these approaches have exponentially gathered increasing evidence to support their use. For example, various randomised controlled trials and systematic reviews have shown that teaching patients more about the biology and physiology of their pain experience leads to positive changes in pain, pain catastrophization, function, physical movement and healthcare utilisation. Graded motor imagery, in turn, has shown increasing evidence to help pain and disability in complex pain states such as complex regional pain syndrome (CRPS). Most research using TNE and GMI has focussed on chronic low back pain (CLBP) and CRPS and none of these advanced pain treatments have been trialled on the thoracic spine. This lack of research and writings in regards to the thoracic spine is not unique to pain science, but also in manual therapy. There are, however, very unique pain neuroscience issues that skilled manual therapists may find clinically meaningful when treating a patient struggling with persistent thoracic pain. Utilising the latest understanding of pain neuroscience, three key clinical chronic thoracic issues will be discussed – hypersensitisation of intercostal nerves, posterior primary rami nerves mimicking Cloward areas and mechanical and sensitisation issues of the spinal dura in the thoracic spine.

Recently a preoperative pain neuroscience education (NE) program was developed for lumbar surgery (LS) for radiculopathy as a means to decrease postoperative pain and disability. This study attempts to determine the short term effects, if any, of providing NE before surgery on patient outcomes. A case series of 10 patients (female = 7) received preoperative one-on-one educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet, prior to LS for radiculopathy. Post-intervention data was gathered immediately after NE, as well as 1, 3 and 6 months following LS. Primary outcome measures were Pain Catastrophization Scale (PCS), forward flexion, straight leg raise (SLR) and beliefs regarding LS. Immediately following NE for LS for radiculopathy, all patients had lower PCS scores, with 5 patients exceeding the MDC score of 9.1 and 8 of the patients had PCS change scores exceeding the MDC by the 1, 3 and 6 month follow ups. Physical changes showed that fingertip-to-floor test in 6 patients had changes in beyond the MDC of 4.5 cm and 6 patients had changes in SLR beyond the MDC of 5.7°. The main finding, however, indicated a positive and more realistic shift in expectations regarding pain after the impending LS by all patients. The results of the case series suggest that immediately after NE, patients scheduled for LS for radiculopathy had meaningful detectable changes in pain catastrophizing, fingertip-to-floor test, passive SLR and positive shifts in their beliefs about LS.