Nociplastic Pain, Small Fiber Neuropathy & Chronic Low Back Pain

Nociplastic pain is “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain” (Kosek et al 2016). Central sensitization is a central process to this experience. Central sensitization encompasses impaired functioning of inhibitory, descending anti-nociceptive mechanisms (Meeus et al., 2008), and over activation of descending and ascending pain facilitatory pathways (Staud et al., 2007, Meeus...

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The Iliolumbar Ligament and Chronic Low Back Pain: Anatomy, Causation, Assessment & Treatment

Iliolumbar ligament Anatomy Figure 1. The Sacroiliac Ligaments from Grays Anatomy The location of the iliolumbar ligaments is between the iliac crest to transverse process of L4 and L5. The nerves from the L4 and L5 ventral rami pass around the Iliolumbar ligaments as shown in figure 2. Kim (2017) examined 14 fixed cadavers and found huge variation in the routes of the L4 and L5 lumbosacral trunks relative to the inferior and superior bands of the iliolumbar ligaments. With both passing anteriorly or posteriorly variously in multiple combinations amongst different cadavers. IB=...

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The Therapeutic Alliance and Low Back Pain

The therapeutic relationship has been defined as; “A helping relationship that’s based on mutual trust and respect, the nurturing of faith and hope, being sensitive to self and others, and assisting with the gratification of your patient’s physical, emotional, and spiritual needs through your knowledge and skill” (Pullen and Mathias 2010). All practitioners of the “healing arts” have experienced the importance of this relationship in helping to get the patient to comply with assessment, explain what they feel and want and helping them turn up for follow ups! In recent years more...

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The Low Back Pain Diet

Nutrition   Sleep Track with sleep cycle, try to average 8hrs Less sleep increase sensitivity to painful stimuli and is associated with the onset of chronic pain problems Most people start to move towards a more “pro-inflammatory” state at less than 7hrs sleep Aim for a 1g of protein a day for each kg of healthy body weight. 100g of meat, fish or nuts will give you approx 20g of protein as a rough guide. Look to get this from animal sources where possible. Nuts are an acceptable substitute for 1 portion a day. 3 eggs will provide approx 21grams Ideally you would split this...

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Gratitude and Low Back Pain

Gratitude is frequently stated to be useful to improving health within alternative health circles. However is there any evidence that improving our focus on gratitude can be useful to improving low back pain? There have not been any studies examining the benefits of gratitude interventions on pain. However, gratitude interventions have improved positive affect, inflammatory markers and specifically depression and anxiety. Emmons and McCullough (2003) were the first to examine the effects of focusing on gratitude or hassles on psychological markers. They assigned patients to focus on either gratitude,...

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