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Nau mai, haere mai! This website is a learning resource that is primarily designed for Musculoskeletal Medicine training in New Zealand. It also aims to be useful for GPs, other doctors, and medical students. It is not written for patients but they are welcome to read the articles. Click on a body region on the skeleton or a portal below to get started.
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Featured Wiki Article for 1 May 2025
Causes and Sources of Chronic Thoracic Pain
Chronic thoracic spine pain is an often perplexing clinical problem. While less common than neck or low back pain, mid-back pain is still significant – about 15% of people report thoracic spine pain at any given time.[1] Importantly, thoracic pain is sometimes associated with serious underlying pathology more often than neck or low back pain.[2] Understanding the sources versus the causes of thoracic pain is critical for an anatomical diagnosis (a “reductionist” approach advocated by Bogduk.[1] In this context, “source” refers to the specific anatomical structure generating nociceptive signals, whereas “cause” refers to the pathophysiological process affecting that structure (e.g. degeneration, inflammation, fracture). For example, a thoracic zygapophysial (facet) joint may be the pain source, while osteoarthritic degeneration of that joint is the cause. - Read More
New and Updated Articles
- Rib Level Identification
- Vertebral Level Identification
- Rotator Cuff Tendinopathy
- Shoulder Biomechanics
- Chronic Post-Traumatic Neck Pain
- Knee Osteoarthritis
- Post-Radiofrequency Ablation Neuritis of the Spine
- Third Occipital Nerve
- Scapular Winging
- Foot Drop
- Weakness
- Sensory Polyneuropathies
- Leg Length Discrepancy
- Lumbar Radicular Pain and Radiculopathy
- Migraine
- Neck-Tongue Syndrome
- Cervicogenic Headache
- Indomethacin Responsive Headaches
- Trigeminal Neuralgia
- Pain Oriented Sensory Testing
Featured Open Access Journal Article for 1 June 2025
Education about pain and experience with cognitive-based interventions do not reduce healthcare professionals’ chronic pain
Asaf Weisman et al. PeerJ. May 2025
ABSTRACT - This cross-sectional study investigated whether healthcare professionals (HCPs) with chronic pain (HCPs+CP) who are familiar with pain neuroscience education (PNE) and cognitive-based interventions (such as CBT, ACT, and mindfulness) experience less pain and improved quality of life. An anonymous online questionnaire was distributed to 550 HCPs (319 healthy, 231 with chronic pain) internationally. The results showed that pain intensity did not significantly differ between HCPs+CP with primary versus secondary chronic pain, nor did it negatively correlate with their knowledge or experience with cognitive-based interventions. While HCPs+CP initially showed slightly lower quality of life scores than healthy HCPs, these differences became non-significant when only those familiar with the interventions were compared. Notably, among healthy HCPs who had recovered from chronic pain, only 11% attributed their recovery to cognitive-based interventions, with most citing physical therapy or spontaneous recovery. The study concludes that, for HCPs with chronic pain, education about pain and experience with cognitive-based interventions do not correlate with reduced pain intensity, though quality of life may be comparable to healthy colleagues, challenging current theoretical models for these interventions.
EDITOR'S COMMENT - This is a very unique angle to explore the efficacy of therapeutic pain neuroscience education. The results fit with what I see clinically - it can improve function but has no effect on pain intensity. Patients seek an understanding of why they are sore, but this is usually because there is the implication (often misguided) that if they know the reason then it can be "fixed." Pain neuroscience education gives an explanation but it doesn't provide a way forward for meaningfully reducing pain.
“I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.”
— The Hippocratic Oath: Modern Version, Lasagna 1964
