Kieran is passionate about understanding all the factors that cause low back pain; the genetic, environmental, physical, psychological and the lifestyle components. This helps you get out of pain and then develop a lifestyle that helps prevent recurrence of pain.



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Kieran is a chartered physiotherapist, registered nutritional therapist and corrective exercise specialist who specialises in helping people in chronic pain get back to what they do best.

Kieran is fascinated to understand the causes of someone's pain. From here he puts together a plan using physiotherapy, exercise, nutritional therapy and education to help you get back to what you do best.

Kieran is based at the Bowskill Clinic, 4 Duke Street, W1U 3EL near Bond Street tube station. Where patients are unable to attend the clinic he can do home appointments.

To find out more about Kieran see his bio here

To ask Kieran a question or book an appointment; call 07830160323 email kieran@kieranmacphail.com

The effects of the microbiome on pain mechanisms are incredibly broad, of particular note is the ability for it to regulate the maturation and function of microglia (brains immune cells which can alter firing patterns of all neurons). Through this mechanisms its tricky to think of a pain the gut microbiome couldn't influence. ...

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Very interesting CRPS patient last week. No pain on active movements or palpation. Pain 10/10 after 10 minutes plus walking or standing. Now needs to be stood on to get pain relief, previously clicking his back relieved it.

I suspect a decrease in descending inhibition. He used get relief with clicking his back (stimulates descending inhibition), now needs much larger forces to stimulate it (people standing on him). His pain comes on with low level nociceptive stimulus- prolonged holds but quickly escalates, suggesting an exaggerated temporal summation potentially due to a lack of descending inhibition.

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2.9.1 Spinal Epidural Lipomatosis
Malone et al (2018) reviewed the charts of 831 patients with the diagnosis of spinal stenosis over a 30 month period. All patients had spinal MRIs. Grading of Spinal Epidural Lipomatosis (SEL) was performed using the Borré method. 52 patients (21 female and 31 male) had symptomatic moderate and severe SEL. We found a prevalence of 6.26% and an annual incidence of 2.5%. SEL was most commonly seen at L5-S1 level. 27% had received corticosteroids. All SEL patients were overweight and 79% were obese.
Furthermore in a retrospective study of cauda equina cases obesity was a risk factor for cauda equina syndrome from disc herniation (Cushnie et al 2018). The cauda equina syndrome cases also had a greater amount of herniated material, focally narrower canal, and larger epidural fat deposits. The authors suggest the increased epidural fat may be the mechanism linking obesity with CES.

Cushnie, D., Urquhart, J.C., Gurr, K.R., Siddiqi, F. and Bailey, C.S., 2018. Obesity and spinal epidural lipomatosis in cauda equina syndrome. The Spine Journal, 18(3), pp.407-413.
Malone, J.B., Bevan, P.J., Lewis, T.J., Nelson, A.D., Blaty, D.E. and Kahan, M.E., 2018. Incidence of spinal epidural lipomatosis in patients with spinal stenosis. Journal of orthopaedics, 15(1), pp.36-39.

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Psychological stress= LPA= demyelination of small nerves = fibromyalgia like pain? Maybe

McDougall et al (2017) showed that injection of Lysophosphatidic acid (LPA) in to a joint caused demyelination and neuropathic pain. Intermittent psychological stress induced fibromyalgia like pain in mice (Ueda and Neyamar 2017), however this pain was not produced in mice deficient of lysophosphatidic acid receptor 1 (LPA1) gene. Furthermore it could be completely cured by the repeated intrathecal treatments with LPA1 antagonist, AM966, which did not show acute action. This suggests that intermittent psychological stress increases the production of LPA which cause demyelination of small nerve fibers leading to the widespread pain seen in the chronic overlapping pain conditions.

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