Pain neurophysiology education for the management of individuals with chronic low back pain: systematic review and metaanalysis
Clarke, C.L. et al. (2011), Man Ther 16: 544-549.
Okay, I’m running out of steam. Let me summarise:
Two studies made it into this “systematic review”. Two. 122 patients. The study text states:
There was very low quality evidence that PNE is beneficial for pain, physical-function, psychological-function, and social-function.
Meta-analysis found PNE produced statistically significant but clinically small improvements in short-term pain.
“Clinically significant” was 5 points on a hundred-point scale. So, it reduced it by 1/2 a point out of ten. Sure, that’s not nothing, but it’s nothing to write home about, either. I doubt any person living with moderate chronic pain would be happy to pay $100 for a 20-minute treatment that delivered 1/2 a point of pain reduction. I think they’d take a Panadol instead and get much better pain relief. And for severe pain? Just no.
Anyway, the study concludes:
There is a need for more studies investigating PNE by different research groups to support early promising findings. Until then firm clinical recommendations cannot be made
There is a need for more studies…no firm clinical recommendations can be made.
Ahhh but clinical recommendations HAVE been made. And entire treatment plans have been designed and implemented under the misguided, falacious idea that “Explain Pain” reduced pain and disability.
That this study is cited as evidence that “Explain Pain” reduces pain, when the study specifically says the exact opposite is evidence of extreme arrogance and brazen confidence that no one actually bothers to read the ‘evidence’!
“Don’t worry my dudes, they’ll never read the fine print! Let’s get out and promote it, we’ll make a killing!” (Lorimer Moseley, probably)
And so millions of physiotherapists bought “Explain Pain” and bought into the philosophies it expouses and even more so the cult of Dr Lorimer Moseley, all round good guy Aussie Larrikin and funster. And they used it to torture their patients, with a whole bunch of bullshi…er…education that has been shown to be completely INEFFECTIVE for reducing pain and disability. Oh, and they charged their patients at an average rate of $300 an hour for the privilege.
“Evidence based” must mean something different in physio-land.
Also, isn’t the publisher responsible for fact-checking? They have published this crap and make a mint out the proceeds. Shouldn’t they have checked that what was in this book is actually true?
I guess not.
I think I need a break. I’m pretty sure I know how the next few studies are going to pan out. But right now, I’m zero for ten. Two more studies to go. Even if they are both huge population based studies that show unequivocally that every person who reads “Explains Pain” (and really understands and ‘gets it’ as Dr Lorimer Moseley so often says) experiences reduced pain and disability, the evidence would still be wanting.